Prostate cancer

INTRODUCTION

• Prostate is a small walnut-shaped gland in males situated below the bladder in front of the rectum.
• Prostate cancer is the most common cancer among men (after skin cancer).
• Prostate cancer is the cancer in prostate gland.
• Many prostate cancer grow slowly and remain confined to prostate gland, however, few prostate cancer grows rapidly and present in advanced state. Treatment depends upon the stage of prostate cancer.

SYMPTOMS

• Weak urinary stream

• Difficulty in passing urine

• Frequent urination
• Blood in urine
• Blood in semen
• Bony pains
• Loss of weight and appetite
• Erectile dysfunction

Risk factors

•Older age- Prostate cancer is more common after 50 years of age.

•Familial factors – more common in a person whose relative such as father or brother has prostate cancer.

•Race – black race has more incidence of prostate cancer compared to white race.

•Genetic factors – rarely, few genetic FACTORS lead to development of prostate cancer.

•Obesity- obese people are more prone to development of prostate cancer.

Screening

•Most urologist encourage men after 50 years to undergo screening for prostate cancer which include DRE (digital rectal examination) and serum PSA (prostate specific antigen) measurement.

diagnosis

•DRE – prostate gland is felt through rectum and checked for any nodule or hardness of gland which is suspicious for cancer.

•Serum PSA – normal value in average sized prostate vary from 0-3 ng/ml. Increased PSA level suggests possibility of prostate cancer.

•MRI prostate – in suspicious cases with PSA 4-10 ng/ml, multiparametric MRI prostate is advisable. it tell the doctor about the estimated risk of prostate cancer in that patient.

•TRUS biopsy – final diagnosis of prostate cancer is made on prostate biopsy. systematic 12 core prostate biopsy is taken by ultrasound guidance. Severity of disease is also assessed by Gleason scoring on biopsy.

CANCER STAGING

•Staging of prostate cancer is done after checking the level of serum PSA, findings on DRE and biopsy report.

•Staging of prostate cancer is done by PSMA PET scan or CT scan/MRI scan abdomen with bone scan. •After staging tests, patients are segregated into localised, locally advanced or metastatic prostate cancer.

TREATMENT

Treatment of prostate cancer depends upon various factors such as stage of disease, level of serum PSA, overall health of patient, life expectancy of patient.

•Deferred treatment – very low risk cancers with minimal risk of spread may be kept on surveillance. Similarly, treatment may be avoided in patients with low life expectancy.

•Surgery – surgical removal of prostate (robotic surgery- RARP/lap surgery) is done in patients with localised disease. Sometimes it is done in locally advanced prostate cancer in combination with other treatments. •Radiation therapy – radiation therapy involves use of high energy to kill the prostate cancer cells. It is achieved by radiations from external source (ebrt) or from internal source after placing radioactive source in the prostate gland (brachytherapy). 

•Hormone deprivation therapy – this therapy is useful in advanced and metastatic stage to decrease the testosterone level in blood. Testosterone hormone helps in growth of prostate cancer. Many injections such as lhrh antagonist and agonist are available which helps in reduction of testosterone hormone level. This can also be achieved by bilateral orchiectomy (testes removal).

• Chemotherapy – chemotherapy such as docetaxel/cabazitaxel is used in patients with metastatic prostate cancer.

•Bone health – bisphosphonate injections are used to prevent osteoporosis associated with the metastatic prostate cancer.