Prostate cancer is the term for cancer that develops in the prostate. This section contains information on what prostate cancer is, its diagnosis, treatment, and side effects of treatment.
What do you mean by prostate cancer？
As a part of the male reproductive system, the prostate’s main job is to create fluid for semen. Its weight is around 20-40 grams and its size is comparable to that of a walnut. It is located just before the rectum and below the bladder.
When cells in the prostate gland begin to grow out of control, it leads to prostate cancer.
How common is prostate cancer in India？
According to government statistics, India had 37416 documented instances of prostate cancer in 2016, and in 2020, that number will rise to 41532. By 2025, it is anticipated that there will be about 47,000 new instances of prostate cancer.
About 3% of all cancer cases in the nation are cases of prostate cancer.
What are the risk factors for prostate cancer？
The risk factors mainly include:
- Age: The risk of prostate cancer increases with age. Rarely, it affects men under the age of 40 years.
- Ethnicity: The disease affects African American men more frequently than any other race, while Asian and Hispanic men are less likely to develop prostate cancer.
- Family history: Prostate cancer is more likely to affect those who have a family history of the disease.
- Genes: A tiny percentage of prostate cancers are caused by inherited gene mutations including mutations in BRCA1 and BRCA2.
- Smoking: According to studies, the risk of getting prostate cancer may be double for heavy smokers compared to non-smokers. Furthermore, smoking increases the risk of prostate cancer mortality.
- Diet: Your risk of getting the disease increases if you consume more calories, animal fats, refined sugar, and fewer fruits and vegetables. Poor outcomes are also associated with inactivity. It is well-recognized that obesity (or being extremely overweight) raises a man’s risk of dying from prostate cancer.
What are the types of prostate cancer?
Almost all cases of prostate cancer are adenocarcinomas. It is a type of cancer that originates from the glandular tissues which are responsible for producing secretions for the seminal fluid.
Rarely, some other cancer can spread to the prostate which includes:
- Small cell carcinomas
- Transitional cell carcinomas
- Neuroendocrine tumours
- Sarcomas
What are the symptoms of prostate cancer?
Prostate cancer symptoms vary from person to person, with some people not having any symptoms at all while others experience the following:
- Difficulty to begin the urine flow
- Weak or irregular urine flow
- Frequent urination, particularly at night
- Difficulty in fully emptying the bladder
- Burning or discomfort during urinating
- Urine or sperm with blood
- Persistent pain in the pelvic region or hips and back pain
- Painful ejaculation
How is prostate cancer diagnosed?
The best method for detecting prostate cancer early is through screening from the age of 50 onward. If there is a history of the disease in your family, your healthcare professional might begin testing sooner.
Prostate cancer screening exams include:
Digital rectal exam
- During this exam, a finger is inserted into the rectum while wearing gloves and lubricant to feel the prostate gland, which is located in front of the rectum
- Unusual growths or hard spots can indicate cancer
Blood test for prostate-specific antigen (PSA)
- The prostate gland produces a protein called a protein-specific antigen (PSA)
- Increased PSA levels could be indicative of cancer
- PSA levels can also increase if you have benign prostatic hyperplasia (BPH) or prostatitis
Biopsy
- The most accurate approach to diagnose prostate cancer is by a needle biopsy where samples of tissue are taken and examined for cancer
Magnetic resonance imaging (MRI)
- This produces fine-grained images of the prostate during an MRI-guided prostate biopsy
Who should undergo screening for prostate cancer?
Screening is advised if you are a man who is:
- Above 50 years of age
- Having a positive history of prostate cancer in your family
How is prostate cancer classified in terms of stages and grades?
The Gleason grading system is the most often used system of grading. This technique assigns each tissue fragment a grade between 3 and 5.
- The tissue is considered to be nearly normal if the grade is less than 3
- A tumour with a grade of 3 is likely to grow slowly
- Prostate cancer with a high grade of 5 is extremely aggressive and high-risk
This algorithm then combines the two most frequent grades identified in biopsy samples to get a score.
The staging of prostate cancer indicates its location, size, and whether it has spread to other regions of the body.
- The TNM (tumour, nodes, and metastasis) system is used for staging
- Digital rectal examination, as well as other imaging tests such as an ultrasound, CT scan, MRI, or bone scan, are used to detect the “T” stage
- Imaging scans reveal whether and where cancer has progressed, for instance, to lymph nodes or bone.
Men with a Gleason grade of 7 or above and those with advanced prostate cancer typically undergo these staging imaging tests.
What are the treatment approaches for prostate cancer?
Treatment approaches for prostate cancer include:
Surveillance
Active Surveillance
- Prostate cancer is not actively treated when under active surveillance
- Regular PSA testing, DREs, and occasional biopsies are used to track cancer’s progression
- If cancer spreads while you’re under active surveillance, your doctor will recommend the next steps for you
Watchful Waiting
- This is a simpler method of monitoring cancer without treatment
- Regular biopsies or other forms of active surveillance are not used
- Treatment is only started when the patient experiences any symptoms or in the case of the spread of cancer
- For prostate cancer patients who cannot or do not want to receive therapy, it is best
- It is particularly beneficial for men with additional medical issues that would prevent them from receiving more harsh forms of treatment
Localised Therapy
Surgery
- Laparoscopic radical prostatectomy
In this, small cuts are made in the abdomen camera and small tools are used to remove the prostate
- Laparoscopic radical prostatectomy with robotic assistance (RALP)
- A robotic system holds and controls the laparoscopic surgical equipment, and a camera assists the surgeon
- This enables the removal of the prostate through tiny ports inserted in your abdomen
- RALP produces comparable results, in less blood loss and infections and is minimally invasive
- Retropubic Open Radical Prostatectomy
- Your lower belly is opened and the prostate is removed
- Simultaneously, the surrounding tissue is examined and removed if needed
- This is more invasive compared to the previous two
Radiation therapy
- High-energy radiation is used in radiation therapy to either kill or stop the growth of cancer cells
- Prostate cancer can be treated mostly with radiation (in place of surgery)
- If the cancer is not completely eliminated after surgery or if it comes back, it can also be used afterward
- Usually, photon or proton beams are used in radiation therapy.
- Radiation therapy for prostate cancer comes in two different forms:
- External radiation treatment
- Brachytherapy (internal radiation)
Cryotherapy
- The cancer cells are destroyed by freezing
- Men who are poor candidates for surgery or radiotherapy due to other health concerns can receive this treatment
- Special needles called “cryoprobes” are inserted into the prostate gland
- To control the freezing process, ultrasonography is used to guide the needles
- A patient is followed up after cryotherapy with routine PSA tests.
Systemic Therapy
Hormonal Therapy (Androgen Deprivation Therapy)
- Similar to how we need food for growth, prostate cancer cells also depend on the hormone testosterone
- It makes use of medications to reduce or block the hormones testosterone and other male sex hormones that support cancer
- After the first local aggressive therapy, malignancies that have progressed or returned are treated with ADT to inhibit their growth
- Additionally, it is applied briefly before, during, and after radiation therapy
Chemotherapy
- Advanced-stage prostate cancer is treated with chemotherapy
- Additionally, it is employed when cancer has metastasized, or spread, to additional organs or tissues
- The bloodstream is where the medications travel
- Both malignant and non-cancerous cells are attacked since they kill any quickly proliferating cell
- To lessen any potential negative effects, dosage and frequency are strictly regulated
- Chemotherapy is frequently used with other therapies
Immunotherapy
- Through immunotherapy, cancer cells are found and destroyed by your body’s immune system
- The majority of these methods are currently undergoing clinical studies
How many people survive prostate cancer?
90% of men with prostate cancer survive for at least five years after their diagnosis. The majority of tumours grow slowly and advance over many years. Patients usually pass away from other causes rather than the disease itself.
How can I prevent prostate cancer?
Prevention mainly includes:
- A healthy diet comprising chiefly fruits and vegetables
- Exercising regularly
- Maintaining a healthy weight
