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Prostate Cancer Treatment

 

Prostate is a gland which secretes fluid that protects and nourishes sperm.  It is located between the penis and the bladder. Prostate cancer develops when cells grow abnormally in the prostate and is one of the most common cancers among men, but it can usually be treated successfully.

What are the symptoms of prostate cancer?

Prostate cancer does not give symptoms in the early stages, which makes it difficult to diagnose in early-stage. Symptoms experienced by the patient are:

  • Frequent urination
  • Interrupted or weak urine flow or the urge to empty the bladder
  • The urge to urinate at night frequently
  • Blood in the urine
  • New onset of erectile dysfunction
  • Pain or burning sensation during urination, which is much less common
  • Pain or discomfort when sitting, due to an enlarged prostate
  • Pain in the back, hips, or pelvis that doesn’t go away
  • Painful ejaculation

 

 

What causes prostate cancer and who is at risk?

The exact cause of prostate cancer is not known. However, certain risk factors will increase the chances of cancer.

 

  • Inherited gene mutations: Certain gene mutations can be carried from one generation to other, and they seem to play a role in about 10% of prostate cancers. Cancer caused due to inherited genes is known as hereditary cancer. Certain inherited mutated genes have been linked to hereditary prostate cancer like BRCA1, BRCA2, RAD51D, etc.
  • Acquired gene mutations: Many gene mutations related to prostate cancer seem to develop during a man's lifetime rather than having been inherited and these mutations are not passed on to children. This is called acquired gene mutation.

Age: Chances of prostate cancer rises rapidly after the age of 50. About 6 in 10 cases of prostate cancer are found in men older than 65.

Family history: If you have a family member with history of prostate cancer, then there is an increased risk associated with it.

Race/ethnicity: Prostate cancer commonly develops in African-American men and in Caribbean men of African ancestry than in men of other races.

Geography: Prostate cancer is less common in Asia, Africa, Central America, and South America than in North America, Australia, etc.

 

Factors with less clear effects on prostate cancer risk

Diet: Some studies have linked that men who have a high calcium intake (through food like dairy products or supplements) may have a higher risk of developing prostate cancer.

Obesity: Some studies say being obese might be linked to the risk of getting prostate cancer.

Smoking: Some research has been linked smoking to a possible increased risk of dying from prostate cancer; however, this finding needs to be confirmed by other studies.

 

How is prostate cancer diagnosed?

Prostate cancers are challenging to diagnose in the early stages as they do not give any symptoms. When you visit the doctor with symptoms, he will examine you to identify the problem.

  • Physical examination: The doctor will take your health history, including eating habits, past illness, etc. He will do a physical check-up and look for signs of the disease, such as any urinary or sexual problems and how long you have had them. He might do a digital rectal exam (DRE), where he inserts the gloved and lubricated finger into the rectum.

During this exam, the doctor may sometimes feel a tumor.

 

 

Based on the observations from the physical examination, he will suggest some tests that will help confirm the diagnosis.

  • Prostate-specific antigen (PSA) blood test: PSA is a protein made by cells in the prostate gland (both normal cells and cancer cells). If the patient has prostate cancer, these values are likely to be more than the normal range.
  • Biopsy: It is the diagnostic procedure that helps to confirm the diagnosis of prostate cancer. Needle biopsy is a procedure done to take out a small sample of cells from the site with the help of a small needle. Sometimes, an ultrasound or computerized tomography (CT) scan is used to perform the biopsy.

Transrectal ultrasound (TRUS): A small probe is lubricated and inserted via rectum. The probe gives off sound waves which enter the prostate and create echoes; a computer turns these echoes into an image. This test helps in looking for cancer and is sometimes used during prostate biopsy.

 

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the tumor spread to the lymph nodes or other areas of your body. These tests also help in determining the grade of cancer. These tests may include:

 

  • CT scan: This test uses a special dye medium that helps with a clear image of the body parts from different angles. It can help in seeing detailed images of soft tissue and blood vessels. CT scan is used to measure the tumor size and helps look for the spread of the tumor to different body organs.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed body images. It helps in measuring the size of the tumor and also to look for the spread of cancer.
  • Chest X-ray: X-ray uses a small amount of radiation to create a picture of the structures inside of the body. It helps the doctors to find out if cancer has spread to the lungs.
  • Positron emission tomography (PET) or PET-CT scan: A PET scan uses a small amount of radioactive sugar substance, which is injected into the patient's body. This sugar substance is then used by cells, and a scanner then detects this substance to makes images of the organs inside of the body.

 

What are the stages of cancer?

 

 

  • Stage I: Cancer is slow-growing and involves one-half of 1 side of the prostate or even less than that.
  • Stage II: The tumor is present only in the prostate. The tumor may be small but may have a high risk of expanding.
  • Stage IIA: The tumor at this stage cannot be felt and includes half of 1 side of the prostate or even less than this. Cancer cells are well differentiated. There may be larger tumors present but can be differentiated well.
  • Stage IIB: The tumor is present only inside the prostate, and it may be felt during DRE. The cancer cells are moderately differentiated.
  • Stage IIC: The tumor is present only inside the prostate, and it may be large enough to be felt during DRE. The cancer cells may be poorly or moderately differentiated.
  • Stage III: The cancer is growing or maybe of high grade. This indicates locally advanced cancer that is likely to grow and spread. PSA levels are high.
  • Stage IIIA: Cancer has grown outside the outer layer of the prostate into nearby tissues. It may also have invaded the seminal vesicles.
  • Stage IIIB: Cancer has spread beyond the prostate gland and may have invaded nearby structures, such as the rectum or bladder.
  • Stage IIIC: The cancer cells are poorly differentiated, which means they look extremely different from the healthy cells.
  • Stage IV: Cancer cells at this stage has spread beyond the prostate gland.
  • Stage IVA: Cancer has invaded the regional lymph nodes.
  • Stage IVB: Cancer has invaded the distant lymph nodes, other parts of the body.

 

How is prostate cancer treated?

Management of cancer depends on various factors like the stage of the disease, the patient's age, and his overall health. A combination of treatment such as surgery, radiation therapy, and chemotherapy are planned for patients which are best suited for them.

  • Watchful waiting or Active surveillance: As most prostate cancer grows slowly, your doctor may closely track how the disease makes you feel and get you regular tests to keep the check on cancer status.
  • Surgery: Surgery for cancer depends upon the size and the location of the tumor. There are various surgical procedures done depending upon the stage of cancer. Your doctor may only remove your prostate gland, or they might take the tissue around it. Surgery is suitable for healthy patients or in a case where cancer has not grown.
  • Hormone therapy: As prostate cancer growth is driven by male sex hormones called androgens, lowering these hormone levels can help slow the growth of cancer. The most common androgen is testosterone, and hormonal therapy is used to lower the levels of testosterone in the body, either by surgically removing the testicles or by taking drugs that turn off the function of the testicles.
  • Vaccine therapy: Sipuleucel-T (Provenge) is a vaccine for cancer. This vaccine boosts the immune system that attacks cancer cells in the prostate. The vaccine is used to treat advanced prostate cancer, which is no longer responding to hormone therapy but is causing some or no symptoms.
  • Radiation therapy: Radiation therapy is the leading treatment given to a patient whose cancer has not spread. Radiation therapy utilizes high-energy x-rays or other types of radiation to kill cancer cells. Radiation therapy can be used in a targeted area or whole body; the doctor carefully directs the energy to the affected area that focuses on killing the cancer cells.
  • Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills. Abiraterone is a chemotherapy drug that stops tissues from making testosterone. Apalutamide and enzalutamide drugs prevent cancer cells from getting the signal to grow and divide.
  • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy. Olaparib and Rucaparib are some drugs approved for the treatment of patients with prostate cancer.

 

What to expect after surgery?

 

After surgery, patients may have to stay in the hospital on an average of 1-3 days. This is the time where your body is in the recovery phase. You may experience some complications like pain and discomfort around the incision that will be managed by pain medications, and it will gradually heal.

Once discharged from the hospital, the pain will be managed by the oral medications prescribed by your doctor. After your surgery site heals, your catheter will be removed, and

this is usually done 7-10 days after surgery. It is recommended to avoid any strenuous activity or heavy lifting for at least one month after surgery.

 

What is the survival rate of cancer?

The survival rate of the patient depends on the factors like type and stage of cancer.

  • 5-year survival rate for patients with localized (cancer is limited to the area where it has started) cancer is nearly 100%.

 

 

Prevention tips

Prevention of prostate cancer is not possible. However, by making some lifestyle modifications, you can lower the risk.

1. Eat fewer calories and exercise more to maintain a healthy weight.

2. Limit the use of dairy products and red meat.

3. Avoid taking excessive calcium intake.

4. Eat more fish –several studies suggest that fish can help protect against prostate cancer as they have “good fat,” like omega-3 fatty acids.

5. Incorporate cooked tomatoes (cooked with olive oil), which may be beneficial, and cruciferous vegetables (like cauliflower and broccoli) into many of your weekly meals. Green tea and soy-based foods are also helpful dietary components.

6. Avoid smoking and drinking alcohol as this may increase the risk of cancer.

7. Men older than 45 years or with a family history of prostate cancer, it is recommended to discuss the risks and benefits of screening with a PSA test with your doctor.

 

 

 

Symptoms

As discussed earlier, prostate cancer progresses very slowly and as such, the patient does not experience any major symptoms during the initial stages. However, as the problem advances, the patient is likely to experience the following symptoms:

  • Trouble or discomfort while urinating
  • Reduced pressure in the stream of urine
  • Traces of blood in the semen and urine
  • Pelvic pain and discomfort
  • Musculoskeletal pain
  • Erectile dysfunction

Diagnosis

A number of tests and screenings are performed to detect whether a person has prostate cancer. These include:

  • Digital rectal exam (DRE) – It involves the physical examination of the prostate by inserting a gloved and lubricated finger in the rectum. If any abnormality is detected, you may require some more tests
  • Prostate-specific antigen (OSA) test –The doctor will collect a blood sample and analyse it for PSA levels. If the levels are higher than normal, it might be an indication of prostate cancer.

If the results of your PSA and DRE screenings are not normal, your doctor may recommend further tests:

  • Ultrasound – Transrectal ultrasound is performed to thoroughly evaluate the prostate. It involves the use of a small probe which is inserted via the rectum to generate a precise image of the gland.
  • Biopsy – A small sample of the prostate tissue is collected and examined for the traces of any malignancy.

Stages

Prostate cancer is classified into 4 stages. These are as under:

Stage I – The earliest stage of cancer in which it progresses very slowly. The tumour is so small that it cannot be felt and involves one-half side of the gland or even less than that. PSA levels are very low and malignant cells are well differentiated.

Stage II – The tumour is still confined to the prostate. PSA levels range from low to medium. Although the tumour is small, it has slightly elevated risks of metastasizing.

Stage III – The cancer is high-grade and has advanced locally. The tumour continues to grow at a considerably fast pace and PSA levels are also elevated.

Stage IV – The cancer has metastasized to the regional & distant lymph nodes and other parts of the body.

Treatment

Some cancers are slow-growing and do not require any treatment at all whereas others require immediate treatment which is based on the following factors:

  • Stage and grade of the cancer
  • Age and overall health
  • Risk category
  • Preference of the patient

The various treatment options available include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Cryotherapy

Prevention

Although you cannot completely negate the risks of prostate cancer, you can surely alleviate these by following a healthy lifestyle:

  • Add more fruits and veggies to your diet and cut down on the intake of high-fat foods. The nutrients present in fruits and vegetables significantly contribute to your health
  • Prefer natural nutrients over supplements
  • Stay active and avoid a stagnant lifestyle. Start slow and increase the pace gradually
  • Keep your weight under check and lose those extra pounds

Go for regular health check-ups, especially if you have a family history of the problem

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