Signs, stages, and treatment options

Prostrate cancer is cell growth starting in the prostate, a small gland located just below the bladder that helps make semen. It is a part of the male reproductive system. Prostate cancer is one of the most prevalent cancers, usually detected early and growing slowly. Most patients can achieve a full recovery when detected with the disease early.

Signs and symptoms of prostate cancer

While early-stage prostate cancer rarely causes symptoms, signs appear as the disease progresses and one begins to notice changes. Here are some symptoms:

# Frequent urge to urinate, particularly at night

# Weak or a start-stop urine flow

# Pain or burning during urination

# Urinary incontinence or loss of bladder control

# Loss of bowel control

# Painful ejaculation and erectile dysfunction

# Blood in semen or urine

# Pain in low back, hip or chest

Stages of prostate cancer

Doctors use the Gleason score and cancer staging to determine the seriousness of the disease and accordingly prescribe treatment protocols. The Gleason score tells your doctor how abnormal your cancer cells are. A higher Gleason score indicates a greater number of abnormal cells.

Staging of the disease helps find out how much the cancer has spread. If the cancer is in your prostate gland only, it is ‘local’. If it has proliferated adjacent structures, it is ‘regional’ and if the cancer has spread to other organs, it is ‘metastasis’. The most common instance is of prostate cancer spreading to the bones and lymph nodes. It can also affect the liver, brain, lungs and other organs.

Treatment options for prostate cancer

The choice of treatment will depend on the overall condition, extent and rate of spread of the cancer. The medical team would usually comprise urologists, radiation oncologists and medical oncologists. When diagnosed early, most prostate cancers can usually be cured.

# Surveillance: Active surveillance involving regular screenings, scans and biopsies, is used in early, low-risk cancer with no symptoms. For older patients with co-morbidities, a wait-and-watch policy is often adopted, with the focus more on alleviating the symptoms rather than removing the cancer.

# Surgery: A radical prostatectomy is used to remove a diseased prostate gland. It’s often an effective technique in eliminating prostrate cancers that haven’t metastasized. Your doctor can advise on the best removal method once he/she is convinced that you need surgery. It can be open radical prostatectomy involving a single incision in the abdomen, or robotic radical prostatectomy performed through several tiny incisions operated by a robot system through a console.

# Radiation therapy: It can be administered as a standalone treatment or in combination with other methods. Brachytherapy involves placing radioactive seeds inside the prostate to kill cancer cells while preserving surrounding healthy tissue. EBRT or external beam radiation therapy delivers strong X-rays at the tumour. Advanced types like the IMRT can target the cancer while sparing healthy tissue.

# Systemic therapies: These therapies travel through the body to kill cancer cells or impede their growth. This group includes:

Hormone therapy: In this therapy, medication is used to block or lower testosterone, which helps prostate cancer grow. Some patients might need to have their testicles removed.

Chemotherapy: This therapy uses drugs to destroy cancer cells and can be used separately or along with hormone therapy for advanced cancer.

Immunotherapy: This method is targeted at boosting the immune system so that it can better locate and combat cancer cells. It’s often used on advanced or recurring cancers.

Targeted therapy: This concentrates on genetic mutations causing cancer and works best for tumours with BRCA mutations.

# Focal therapy: It’s a newer and experimental form of treatment that is aimed at destroying the tumours inside the prostate. It is usually recommended if the cancer is low-risk and hasn’t spread.