Introduction to prostate cancer
Prostate gland lies at the neck of the bladder deep down in the lower part of abdomen (pelvis) and is normally involved in sexual reproduction process. Prostate size normally increases with age and causes symptoms. The most common reason for the urinary symptoms is benign (non cancerous) age related enlargement of prostate. Generally, these symptoms can be well controlled with medication or by a small operation (TURP).
Prostate cancer in India: There is increasing incidence of prostate cancer noted in Indian population. In major cities like Delhi and Kolkata, prostate cancer is the second most common cancer in men. Compared to Caucasian (white) patients, there is early evidence to suggest that prostate cancer is more lethal in Asian men.
It is advisable for patients with difficulty passing urine to seek specialist help to discuss investigation for prostate cancer. This advice is more important in patients who have early onset of symptoms in their fifties and patients who have a first degree relative (father, paternal or paternal uncle) who has suffered with prostate cancer.
The symptoms of prostate cancer include
• Difficulty passing urine
• Blood in the urine
• Needing to strain to pass urine
• Pain deep in the pelvis (in front of back passage)
• Bony pain
The various investigations in the process of diagnosis and management of prostate cancer are
Digital rectal examination: This examination involves your doctor inserting a lubricated gloved finger into the rectum (back passage) to feel the condition of the prostate that lies close to the rectal wall.
Prostate specific antigen: A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate.
As men get older the prostate gland grows and there an associated rise in the PSA. A high PSA may indicate some type of prostate disease including prostate cancer.
PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is the cause of raise in PSA level.
TRUS biopsy: Ultrasound scans use sound waves to build up a picture of the inside of the body. To scan the prostate gland a small probe is passed into the back passage and the image of the prostate appears on a screen. This type of scan is used to measure the size and density of the prostate. A biopsy is taken at the same time for examination under the microscope by a pathologist. The scan may be uncomfortable but it only takes a few minutes.
MRI scan: This test is undertaken to stage prostate cancer. The test involves the patient being introduced into a tunnel with detailed magnetic images taken of the target organ. The tests helps in localising cancer as well as giving an accurate stage of the cancer.
Bone scan: Bone scan is an isotopic scan that gives detailed information about the extent of spread of prostate cancer. The test involved an injection of a dye (isotope) and pictures of the whole body taken after few hrs.
PSMA PET: Prostate specific membrane antigen PET CT is the latest investigation helping the specialists in studying the extent of cancer. It is a very sensitive as well as a specific scan. The investigation is similar to Bone scan however the test takes 3-4 hrs for it to be done. There are only few specialist centres offering this investigation.
Radical surgery: Radical prostatectomy especially if carried out using the da Vinci robot gives excellent outcomes with respect to curing prostate cancer. In localised prostate cancer more than 90% of the patients are cured. Surgery is the preferred treatment especially in young patients. Surgery can be performed for stage I,II and early Stage III
Radiotherapy:Radiotherapy either in the form of Brachytherapy, external beam radiotherapy or the latest technique using Tomotherapy gives very good outcomes similar to radical surgery in curing prostate cancer. Surgery can be performed for stage I,II and Stage III
Hormone manipulation: Hormone manipulation can be used in combination with radiotherapy to improve the chances of cure with radiotherapy. It is also used in a setting of advanced cancer where the objective is to control the cancer.
Chemotherapy: There is very good evidence that chemotherapy when given along with hormone manipulation for advanced prostate cancer improves the survival.