Prostate Cancer

Facts about prostate cancer 

Q 1 what is prostate cancer?

Prostate cancer starts in the cells of the prostate. The prostate is a small gland in the pelvis, found only in men. It’s located between the penis and the bladder, and surrounds the urethra.

The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.

Q 2 what are the causes of prostate cancer?

  • Age –Most cases are diagnosed in men over 50 years of age
  • Family history – Having a brother or father who developed prostate cancer before age 60 seems to increase your risk of developing prostate cancer
  • Obesity – recent research suggests there may be a link between obesity and prostate cancer, and a balanced diet and regular exercise may lower your risk of developing prostate cancer
  • High levels of androgens

Q 3 what is prostate cancer screening? 

Screening is done in a normal person and is used to look for cancer before you have any symptoms or signs

The American Cancer Society (ACS) recommends screening should be done after discussion with the patient. The discussion about screening should take place at:

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test. 

Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.

Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

Q 5 what are the symptoms of prostate cancer?

  • Needing to pee (urinate) more frequently, often during the night
  • Needing to rush to the toilet
  • Difficulty in starting to pee (hesitancy)
  • Straining or taking a long time while peeing
  • Feeling that your bladder has not emptied fully
  • blood in urine or blood in semen

Symptoms that cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles, and unexplained weight loss.

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 6 How is prostate cancer diagnosed? 

  • The doctor will perform a general physical examination and digital rectal examination (DRE) in which the surgeon will insert a lubricated, gloved finger in anus to check the size and shape of the prostate and feel for any lumps or abnormal areas.
  • Prostate-specific antigen (PSA) blood test
  • Transrectal ultrasound (TRUS)

A transrectal ultrasound (TRUS) uses an ultrasound probe placed in the rectum to make images of the prostate. It is used to:

  • guide a needle used to take a biopsy from the prostate 
  • measure the size of the prostate
  • look for abnormal areas of the prostate

If the results of the biopsy confirm prostate cancer, then the doctor may advise having additional tests to assess how widespread the cancer is. These tests may include:

  • Blood tests – To assess the state of liver, kidneys and bone marrow
  • Multiparametric MRI – To find out the local spread of disease 
  • Chest X-ray – To check if cancer has spread to the lungs or not 
  • Bone scan – To check if cancer has spread to bone or not
  • Sometimes a PSMA-PET scan – To know the distant spread of disease 

A word of caution 

There is a common myth that taking biopsy leads to the spread of cancer cells in the body. This is not true. Taking a biopsy does not lead to the spread of cancer cells in the body.

Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.  

Q 7 What is prostate cancer staging? 

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread.

  • Stage I: the cancer is small and only in the prostate
  • Stage II: the cancer is larger and maybe in both lobes of the prostate but is still confined to the prostate
  • Stage III: Cancer has spread beyond the prostate to nearby lymph glands or seminal vesicles
  • Stage IV: cancer has spread to other organs such as the bone and is referred to as metastatic cancer.

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q 8 How prostate cancer is treated?  

Prostate cancer is curable if diagnosed at an early stage. Surgery and sometimes radiation therapy are the only curative options. 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

  • Localized prostate cancer (stage 1& 2) 

Surgery +/- radiation therapy 

  • Locally advanced prostate cancer (stage3) 

Combination of hormonal therapy plus radiation therapy

  • Advanced prostate cancer (stage4) 

Options include hormonal therapy, chemotherapy, and/or radiation therapy.  The decision depends upon extension of disease and the general condition of the patient. 

  • Surgery 

The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

It can be done via the open, laparoscopic or robotic method 

  • Hormone therapy is also called androgen suppression therapy. 

Prostate cancer cells require testosterone for growth. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone 

Hormone therapy alone does not cure prostate cancer. It can be used to slow the progression of advanced prostate cancer and relieve symptoms.

Types of hormone therapy

  • Orchidectomy (surgical castration)

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the testosterone is made. This causes most prostate cancers to stop growing or shrink for a time.

  • Medical castration (Given in form of injection)
  • LHRH agonists example Leuprolide Goserelin Triptorelin 
  • LHRH antagonist  example Degarelix 
  • Anti-androgens 

These are testosterone receptor blocker. They are taken daily as pills example Flutamide and Bicalutamide.

CRPC 

Cancer that has not spread but is no longer responding to other forms of hormone therapy (known as non-metastatic castrate-resistant prostate cancer (CRPC)

Drugs used are: 

  1. Newer anti-androgens Enzalutamide & Abiraterone
  2. Cancer vaccine: Sipuleucel-T