Prostate Cancer

• The prostate gland is found only in males and is a part of male reproductive system.
• The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made up of two lobes or regions enclosed by an outer layer of tissue. It is located in front of the rectum and just below the urinary bladder which is the storage organ for urine. The prostate gland surrounds the urethra, the canal through which urine passes out of the body.
• The size of the gland varies with the age. In adult men, a typical prostate is about 3 cm thick and 4 cm wide and weighs about 20 grams, as the age advances, the prostate gland increases in size and can be anything between 40 grams to 100 grams or more.

Functions

• Prostate gland squeezes the fluid into the urethra as sperm move through during the sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.
• It also plays a part in controlling the flow of urine.

Prostate Cancer

Prostate cancer can be more virulent or aggressive if found in younger individual.. Older the age of a man slower is the growth of prostate hence, it is important to screen further prostate regularly after the age of 50.

Symptoms Of Prostate Cancer

• Difficulty urinating
• Hesitancy
• Frequent urination
• Sense of incomplete voiding
• Taking a long time to pass urine
• Blood in the urine.

These symptoms may or may not be present in early stage of prostate cancer. Hence, the regular screening is required. If the Prostate Cancer is detected and treated early the survival chances are greatly increase.

Investigations for Prostate Cancer

1. The PSA test:More African-American men develop prostate cancer than Caucasian-American men. Asian men living in Asia have the lowest incidence.
2. MRI: MRI test will not only detect the irregularity of prostate but also give ….local extension of the prostate cancer if present. MRI will also give us a clue of the prostate spreading outside ccapsule of the prostate or into the lymph nodes.
3. Transrectal Ultrasonography (TRUS) of the prostate : The prostate needle biopsy is done under local anaesthesia in a radiology suite. TRUS rectal ultrasound of prostate is used to take 12 – 16 cores of prostatic tissue through a needle inserted under the guidance of ultrasound professional. The tissue taken is sent for histopathology examination.
4. Transrectal Ultrasonography (TRUS) of the prostate:  The prostate needle biopsy is done under local anaesthesia in a radiology suite. TRUS rectal ultrasound of prostate is used to take 12 – 16 cores of prostatic tissue through a needle inserted under the guidance of ultrasound professional. The tissue taken is sent for histopathology examination.
5. Grading of prostate cancer:The histopathology examination not only gives the diagnosis of prostate cane but it also grades the severity of prostate disease. This grading is called Gleason’s score.
6. Gleason’s score : The Gleason’s score not only keeps plant the disease but also can predict the prognosis of prostate cancer.
• The score upto 0 - 6: The cancer could be slow growing tumour and many a times a conservative approach may be taken and if the cancer is small and localised, patient can be kept under wait and watch policy and the prostate cancer my not be virulent.
• The score upto 7: This kind of prostate cancer grows and spreads and it is important to treat rather than wait and watch.
• The score upto 8 – 10: The cancer is likely to grow and spread fast and may have already spread to other organs. The disease can be quite aggressive and further evaluation may be necessary to check on the spread of the cancer called metastasis.

Staging Of Prostate Cancer

• The staging of prostate cane is determined by the knowledge of spread of the cancer. The following diagram will aptly describe the staging of the prostate cancer.
• Further, PET CT scan or PSMA PET Scan can also be done to evaluate extent of the disease from head to toe.

Treatment Of Prostate Cancer

• Radical Prostatectomy: This is a surgical removal of prostate gland primary to remove entire growth of prostate cancer. This can be achieved by open Laparoscopic and Robotic surgery.
• Active Surveillance: Active surveillance is recommended if the prostate cancer is small and of low grade. During the surveillance the patient is asked to do repeat PSA test at variable intervals along with DRE examinations sometimes repeat biopsy may require.
• Radiation therapy-External beam: This therapy gives the radiation to the localised area to kill the prostate cancer cells. This is generally undertaken if the surgery is too risky because of their medical conditions like stroke, bypass, poor general health of patient or any other contra indications. Generally, radiation therapy takes more than 30 – 35 sessions and treatment spread over period of 03 months.
• Radiation therapy-Brachytherapy:This therapy involves insertion of low dose seed implant brachy therapy or high dose rate brachy therapy (HRD).
• Low-dose seed implant brachytherapy - The seeds are inserted through the skin in the perineum (the area between the anus and scrotum). Procedure is performed under either general or spinal anaesthesia and lasts approximately 1 hour.
• HDR - Under anaesthesia, approximately 15 needles are inserted through the perineum. These needles are wired to the radiation source that delivers a high radiation dose to the prostate. The needles are then removed. The treatment takes 10–20 minutes.

Treatment Of Advanced Prostate Cancer

• Hormone Therapy: This therapy is generally used if prostate cancer has spread outside or recurrence of prostate cancer after any other mode of therapy used in the past.
• Bilateral Subcapsular Orchidectomy: Bilateral subcapsular orchidectomy is performed to remove the substance of the testicles which in turn stimulates growth of the prostate cancer cells. This is called surgical orchidectomy. Once again if the surgery is contradictory, medical orchidectomy can be done.
• Chemotherapy

Further, the specific anti-cancer drugs are used in advanced, metastatic or recurrent cancer where even hormone therapy also failed. The urologist doctor will decide on the drugs to be used with combination or any other treatment.

After Successful Treatment – What Happens After Treatment?

Treatment for prostate cancer is often successful in removing cancer cells and tumors. This is both exciting and relieving, but can also be scary and stressful. Many men worry about the cancer returning and how to get back into their daily routines.

• Follow up care
• Fatigue
• Good Nutrition
• Physical Activity