Prostate Cancer

Prostate Cancer

Prostate Gland Overview

The prostate is a gland in men located below the bladder and in front of the rectum. Its primary function is to produce fluid that nourishes and transports sperm, which is vital for fertility. As men age, the size of the prostate tends to increase.

What is Prostate Cancer?

Prostate cancer occurs when healthy cells in the prostate grow uncontrollably, forming a tumor. These tumors may be benign or malignant.

• Prostate cancer grows slowly compared to other cancers, often showing no symptoms in the early stages.

• Even if it spreads, with appropriate treatment, patients can maintain a good quality of life.

• PSA (Prostate-Specific Antigen) testing is critical for early detection of prostate cancer.

Prostate-Specific Antigen (PSA)

PSA is a protein produced by cells in the prostate gland. A blood test can measure PSA levels, helping to detect prostate cancer early.

• Elevated PSA levels may indicate prostate cancer but can also result from benign prostate enlargement.

• High-risk individuals should undergo PSA testing annually. However, not all individuals with prostate cancer will have high PSA levels.

Statistics

• Prostate cancer is one of the top 10 most common cancers in India.

• Globocan 2018 reported around 25,696 new cases annually in India.

Risk Factors

1. Age:

• The risk increases with age, and 60% of cases occur in men over 65 years.

2. Family History:

• If multiple family members are affected, the condition is called Familial Prostate Cancer (20% of cases).

• Genetic mutations such as BRCA1 or BRCA2 genes increase the likelihood.

3. Hereditary Risk Indicators:

• Three or more relatives with prostate cancer.

• Cancer present across three consecutive generations.

• Multiple family members diagnosed before the age of 55.

• Hereditary Breast and Ovarian Cancer (HBOC) Syndrome in the family.

Screening for Prostate Cancer

1. Digital Rectal Examination (DRE):

• A doctor checks the prostate by inserting a finger into the rectum to feel for abnormalities.

2. PSA Test:

• Used for early detection, though routine screening is controversial and not always recommended in asymptomatic men.

Symptoms

• Frequent urination

• Difficulty starting urination

• Night-time urination

• Blood in urine

• Recent erectile dysfunction

• Pain or burning sensation during urination

• Pain in the lower back, hips, or thighs (if cancer has spread)

• Swelling in legs

• Fatigue

Diagnosis

1. PSA Test and Free PSA Test

2. Digital Rectal Exam (DRE)

3. Biopsy: Tissue sample analyzed under a microscope.

4. MRI Fusion Biopsy

5. Transrectal Ultrasound (TRUS)

6. Imaging Tests:

• CT Scan

• MRI

• PET-CT

• Whole-body Bone Scan

Staging and Gleason Score

• Gleason Score measures how abnormal the cancer cells appear under a microscope.

• Score 6: Low-grade, slow-growing cancer.

• Score 7: Intermediate risk.

• Scores 8-10: High-grade, aggressive cancer.

Stages of Prostate Cancer:

1. Stage I: Localized cancer, undetectable by DRE, with low PSA levels.

2. Stage II: PSA levels increase, and cancer is detectable but remains confined to the prostate.

3. Stage III: Cancer spreads beyond the prostate.

4. Stage IV: Cancer spreads to lymph nodes or distant organs, such as the bones.

Treatment Options

1. Active Surveillance and Watchful Waiting

• Active Surveillance: Monitoring the cancer without immediate treatment, suitable for low-risk cases.

• Watchful Waiting: For elderly patients or those with other severe health issues, where only symptoms are managed.

2. Surgery

• Radical Prostatectomy: Removes the prostate gland and nearby tissues.

• Robotic or Laparoscopic Prostatectomy: Minimally invasive surgery with fewer side effects.

• Bilateral Orchidectomy: Removal of both testicles to reduce hormone levels.

• TURP: Transurethral resection to relieve urinary obstruction.

3. Radiation Therapy

• External Beam Radiation Therapy (EBRT): Uses a machine to target radiation at the prostate.

• Brachytherapy: Places radioactive sources directly in the prostate.

• Proton Therapy: Uses protons instead of X-rays for more targeted treatment.

4. Hormone Therapy (Androgen Deprivation Therapy - ADT)

• Reduces levels of testosterone to slow cancer growth.

• GnRH Agonists: Medications like Leuprolide to suppress hormone production.

• Orchidectomy: Surgical removal of the testicles to decrease testosterone.

5. Chemotherapy

• Common drugs:

• Docetaxel with Prednisone

• Cabazitaxel

6. Targeted Therapy

• Drugs like Olaparib and Rucaparib target specific genetic mutations.

7. Immunotherapy

• Boosts the immune system to fight cancer cells.

8. Radiation Infusion Therapy

• Lutetium Lu 177 targets prostate-specific membrane antigen (PSMA) to deliver radiation to cancer cells.

9. Bone-Modifying Drugs

• Prevent bone complications in advanced cancer.

• Common drugs: Zoledronic Acid and Denosumab.

Follow-up Care

After treatment, regular follow-ups are essential to:

• Monitor for recurrence.

• Manage side effects.

• Conduct physical exams, blood tests, and imaging studies as needed.

Prostate cancer is manageable, especially when detected early. With advances in surgery, radiation, and targeted therapies, many patients can maintain a good quality of life. Regular screening and follow-ups are key to ensuring long-term health.

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