Prostate cancer and it's management

Prostate is a small walnut-shaped gland, which is found only among men. It produces seminal fluid that nourishes and transports sperm and is the main component of male ejaculate. Prostate cancer is the most common malignancy of human male population. It usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. However, all prostate cancers are not docile, especially when they are diagnosed at younger age. Such cancers are more aggressive, can spread quickly and can be fatal if they are not treated appropriately. In past, prostate cancer was considered to be a disease confined to American Blacks, however its prevalence is increasing rapidly among other races and Indians as well.

Symptoms

Prostate cancer has no specific clinical symptoms in its early stage. Prostate cancer that's more advanced may cause symptoms such as: difficulty in urination, decreased force of urine, blood in the urine, blood in the semen, bone pain, weight loss etc.

Diagnosis

Screening: Screening for prostate cancer is an important way to diagnose it at early stage. It means testing for a disease even if there is no suspicion of its occurrence or there is no symptom related to it. The prostate specific antigen [PSA], a blood test and digital rectal examination are the two components of screening.

Biopsy: It is a type of very minor surgery wherein tiny pieces of prostate tissue are removed and are looked at under a microscope. This is the only way to confirm the presence of prostate cancer.

Imaging studies and staging of disease: Once a cancer of prostate is suspected or proven, a special form of MRI and PET-CT scan are important to know its extent and stage.

Prostate Cancer Management

Treatment of prostate cancer is mainly stage dependent apart from other factors. It is individualized based upon the age of person at the time of diagnosis, expected life expectancy and overall health status. Broadly, based on its clinical stage or extent, it is categorized into localized prostate cancer, locally advanced prostate cancer and metastatic prostate cancer.

1. Treatment options for clinically localized prostate cancer include the following:

• Watchful waiting
• Active surveillance
• Radical prostatectomy
• Radical Radiation therapy

Standard options for fit and healthy people are primarily radical surgery or radiotherapy. These are the only two options that scientifically proven to offer possible cure of disease. The advancements in surgical techniques and advent of robotic surgery has revolutionised the prostate cancer treatment maintaining results of cancer control with significant improvement in outcome and reduction in complication rate. Watchful waiting, active surveillance and other emerging treatments like targeted therapy and whole-gland ablation have limited role in the management localized prostate cancer.

2.    Non localized or recurrent prostate cancer:

Prostate cancer may recur in up to a third of men after definitive local therapy. Patients with recurrent cancer or those with advanced prostate cancer at the time of initial diagnosis require multimodality treatment involving different therapies. They require radiotherapy, surgery, hormone treatment or chemotherapy in different combinations depending upon disease status. Based on response to hormone treatment, prostate cancer is subdivided into hormone-sensitive or hormone-refractory status. Metastatic or recurrent disease states are rarely curable, but recent advances in the understanding of salvage radiation therapy, chemohormonal therapy, different methods of androgen blockade, and recent targeted therapies has greatly prolonged survival for these men.

Radiation therapy: it is the use of high-energy rays to destroy cancer cells inside the prostate. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. It can be delivered in two ways: External Beam Radiation Therapy (EBRT) where radiation is delivered into prostate from a machine kept outside or Brachytherapy, where radiation is delivered by implanting the radiation source inside the prostate gland. EBRT is the more common and better way to deliver radiation.

Hormonal therapy: The prostate cancer is dependent on testosterone or androgens for its growth that is the basis of hormone or androgen ablation treatment. It basically cuts off the androgens production using different ways. Hormone therapy is used to treat prostate cancer in many different situations, including localized, locally advanced, and metastatic prostate cancer, as well as rising PSA level after surgery and/or radiation therapy for localized prostate cancer.

Chemotherapy: Chemotherapy may be a treatment option for treating prostate cancer that has spread to other areas of the body. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Immunotherapy: Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

To sum up, prostate cancer is a common cancer among men of all races and ethnicities and is on the rise. Localized cancer can be cured with surgery or radiotherapy. Advanced or metastatic cancers are managed using multimodality treatment and can be given acceptable outcomes with god survival.

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