Prostate Cancer

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Overview

Prostate cancer is a type of cancer that develops in the prostate, which is a walnut-shaped small gland located near the bladder in men. The prostate gland produces prostatic fluid, which nourishes the sperms. This prostatic fluid combines with the fluid from seminal vesicles to form semen that transports sperms.

Prostate cancer is one of the top 10 common cancers among Indian men. However, with regular screening tests, prostate cancers can be diagnosed in early stages and effectively managed.

HCG has the best prostate cancer specialists in India who are trained to treat prostate cancers with customised and result-oriented treatment plans that lead to positive clinical outcomes.

Symptoms

Prostate cancer is slow-growing, and the symptoms are not apparent in the earlier stages. Prostate cancer is associated with the following symptoms:

Frequent urination, especially at night
Interrupted urine flow
Blood in the urine or semen
New onset of erectile dysfunction
Painful ejaculation
Pain or burning during urination
Discomfort or pain when sitting, caused by an enlarged prostate

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The exact cause of prostate cancer is not known. However, several factors increase the risk of developing prostate cancer. The key risk factors include:

Age: The risk of developing prostate cancer increases with age. Incidences of prostate cancer are higher in males older than 50 years old.
Family History: Those with a positive family history of prostate cancer are at higher risk. This type of cancer develops due to the combination of shared genes and lifestyle factor
Diet: A high-fat diet is found to increase the risk of prostate cancer.

Other risk factors include obesity, smoking, alcohol consumption, and ethnicity. Prostate cancer is observed to be more prevalent among African-American and Caribbean men than other races.

Diagnosis

Screening for prostate cancer may help in reducing the risk of prostate cancer or detecting it in its early stages. It is recommended that individuals with a positive family history of prostate cancer and those who are above 50 years old opt for prostate cancer screening annually. Screening may involve one or more of the following tests:

a. Prostate-specific antigen (PSA) test: This test analyses the blood sample for levels of PSA, a protein produced by the prostate gland. Higher PSA levels could indicate cancer growth.

b. Digital Rectal Exam (DRE): During DRE, the doctor uses his lubricated, gloved finger to examine the lower rectum and the prostate gland to check for abnormalities in terms of size, shape or texture of the prostate gland.

If cancer growth is detected, additional tests like a prostate biopsy, MRI scan, CT scan and bone scan will follow. Treatment will be planned based on the results of these tests.

At HCG, our prostate cancer specialists strive to deliver the best prostate cancer treatment in India via superior quality diagnostic support and innovative treatment approaches.

Treatment

The treatment of prostate cancer depends on various factors like the rate at which the cancer is growing, the cancer stage, the overall health of the patient and the patient’s preference. Being a slow-growing cancer, prostate cancer may not need immediate treatment in a few cases. In these cases, prostate cancer is managed through active surveillance and observation.

a. Active Surveillance: Through active surveillance, cancer growth is closely monitored with tests like PSA tests, rectal examinations and biopsies at regular intervals. If the test results change, the doctor may suggest opting for treatment options to remove the tumour or contain the tumour growth. Active surveillance is ideal for men with low-risk tumours without symptoms.

b. Observation (Watchful Waiting): Watchful waiting is a form of less-intensive follow-up with a goal to monitor cancer until it has metastasised or has started exhibiting symptoms, and then address it with a suitable treatment modality. Watchful waiting is ideal for older men and those with other life-threatening health conditions.

The treatment modalities for prostate cancer are classified into two types: localised therapy and systemic therapy.

c. Localised therapy:

Localised therapy is meant to treat the cancer cells in a specific site. Localised therapy is useful in treating early-stage prostate cancer that is confined to the prostate gland only.

Surgery: Surgery involves the removal of the prostate and some lymph nodes surrounding the gland through a procedure called radical prostatectomy. Radical prostatectomy is generally performed through one of the following:

1. Robotic-Assisted Laparoscopic Radical Prostatectomy (RALP): A minimally-invasive procedure wherein the prostate gland is removed through tiny incisions using a robotic system that is equipped with a camera. Faster recovery and reduced blood loss are key advantages of this procedure.
2. Retropubic / Perineal Open Radical Prostatectomy: In this procedure, the prostate gland and the lymph nodes in the pelvic area are removed through an incision made in the lower belly or in between the anus and the scrotum.
3. Laparoscopic Radical Prostatectomy: In this procedure, small incisions are made in the abdomen to remove the prostate using small tools and a camera.

Radiation therapy: Radiation therapy delivers high-energy radiation beams to the prostate gland to kill the cancer cells. Radiation is delivered through:

1. External Beam Radiation Therapy (EBRT): EBRT involves the delivery of high-energy X-rays or proton beams from outside the body to the location of the tumour, where it destroys the cancer cells.
2. Brachytherapy or Internal Radiation Therapy: In this type of radiation therapy, the source of radiation, known as an implant or seed, is placed inside the prostate gland or next to it. It allows the delivery of radiation doses (high or low) specifically to the cancer tissue without affecting the adjacent healthy tissues.

d. Cryoablation/ Cryotherapy: Cryoablation is a less-invasive and image-guided process of killing cancer cells through controlled freezing of the prostate tissues. Special needles, known as ‘cryoprobes’, are inserted into the prostate through the skin between the scrotum and anus. Then, a very low-temperature gas is delivered through these needles to freeze the prostate tissues. Later, a second gas is delivered through the needle to reheat the tissue. The cycles of freezing and thawing kill the cancer cells.

e. Systemic therapy:

Systemic therapy aids in the management of metastatic prostate cancer, wherein cancer has spread outside the prostate gland. Systemic therapies act on the entire body and help in treating the cancerous growths wherever they are located, including the ones that are too small to detect.

1. Hormone therapy (Androgen-Deprivation Therapy): Hormone therapy works by reducing the levels of male hormones, which act as the fuel for the growth of prostate cancer cells. This helps in either halting or delaying the progression of prostate cancer. The hormone therapy options include:

Medications that prevent the body from producing testosterone
Medications that block testosterone from reaching cancer cells
Surgery for the removal of testicles (orchiectomy) as part of prostate cancer treatment

2. Chemotherap Chemotherapy involves medication that is given intravenously or by mouth to kill the cancer cells. It has been shown to prolong survival and reduce pain in men with advanced-stage prostate cancer.

3. Immunotherapy (Biologic Therapy): Immunotherapy involves extracting some of the patient’s own immune cells, genetically engineering them to fight prostate cancer, and then injecting the cells back into the patient’s body intravenously. This treatment is observed to prolong survival in men with advanced prostate cancer.

Frequently Asked Questions

1. Is prostate cancer common in India?

Prostate cancer is one of the top 10 cancers among Indian men. The risk of developing prostate cancer among men increases with age. However, awareness and regular screening could help in reducing its incidence.

2. How can I know if my prostate cancer is fast-growing or slow-growing?

The nature of your prostate cancer can be found through comprehensive diagnostics. If your doctor thinks immediate treatment is not necessary, then you may be put under observation or active surveillance throughout which you will be asked to undergo regular tests and constantly monitored for symptoms of metastasis or any other complications.

If the test results are alarming, the doctor may suggest immediate intervention for efficient management of the disease.

3. How often should I undergo prostate cancer screening?

As age increases, the risk of prostate cancer increases. Therefore, it is recommended for men aged 50 and above to undergo prostate cancer screening annually.

Depending on the results of your first screening test, your doctor may alter the frequency of the screening test.

4. Do high PSA levels always point towards prostate cancer?

No, high PSA levels do not always point towards prostate cancer. A less severe condition, benign prostatic hyperplasia (BPH) also leads to high PSA levels. Therefore, if high PSA levels are reported, additional tests are required to confirm a prostate cancer diagnosis.

5. Is prostate cancer treatment painful?

A few treatments may cause pain, which is temporary and wears off over time.

The degree of pain may also depend on the stage of cancer that is being treated. For example, radiation therapy for prostate cancer that has spread to bones may cause pain; however, this may not be the case with all patients.

It is always better to talk to the doctor before the treatment, who will let you know what to expect from the treatments administered and how to prepare for them.