Prostate cancer, one of the common cancers in men, develops in prostate, a small gland in male reproductive system that produces the seminal fluid. The seminal fluid nourishes and transports sperm.
Prostate cancer can grow either slowly or rapidly. Slow growing prostate cancer is usually limited to prostate gland and may not cause serious harm. Whereas, rapidly growing prostate cancer can spread to other parts of the body and cause harm.
The treatment of prostate cancer is likely to be successful if detected early when it's limited to prostate only.
Making a diagnosis of prostate cancer is done by performing several tests.
If prostate cancer is suspected, you may be referred to an urologist (specialist of urinary tract and male reproductive system), an oncologist (specialist who treats cancer) or a radiation oncologist (an oncologist whose area of expertise is radiation therapy).
How to prepare yourself for the visit?
Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. Here is what you can do:
List out all the symptoms.
Write down your key medical information.
Ask a friend or a family member to accompany you during the visit
Write down the names of all your medications, vitamins or supplements.
Make a list of the questions to ask your doctor. Some typical questions can be:
- Do my symptoms indicate prostate cancer?
- What’s the size of my prostate cancer?
- Has my prostate cancer spread to other parts?
- What is my Gleason score?
- What is my prostate-specific antigen (PSA) level?
- Do I need more tests?
- What are my treatment options and side effects of each option?
- Do I need to start cancer treatment now or shall I wait to see if the cancer grows?
- How do you predict my prognosis?
What your doctor wants to know?
Be well prepared to answer the questions your doctor is likely to ask:
- When did you start noticing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Does anything improve or aggravate your symptoms?
Screening for prostate cancer
Prostate cancer screening for men in their 50s or those who carry risk factors is a topic of debate among medical organizations. Tests for screening of prostate cancer include:
- Digital rectal exam (DRE): In this test, your doctor puts a gloved, lubricated finger into your rectum to look for any abnormalities in your prostate.
- Prostate-specific antigen (PSA) test: Blood level of PSA is raised in people with prostate cancer or infection or inflammation.
Combination of DRE and PSA test can detect prostate cancers at early stage.
Diagnosing prostate cancer
If DRE or PSA test shows unusual results, your doctor proceeds with:
Ultrasound: It uses sound waves to produce images of your prostate. Transrectal ultrasound involves inserting a special probe into your rectum. Prostate biopsy: A sample of tissues from your prostate is removed from the affected area and sent to lab for further analysis.
Staging Prostate Cancer
Once the diagnosis is confirmed, the next step is staging the disease. Most commonly, Gleason score is used to determine your disease stage. It ranges from 2 (nonaggressive cancer) to 10 (aggressive cancer). Cancer with higher Gleason score tends to spread more quickly. In some cases, your doctor may recommend imaging tests like bone scan, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan to detect if the cancer has spread to other body parts. Stage of your cancer is a major factor that determines your treatment and its outcome.
Stage I: Cancer is limited to small area of prostate and the cancer cells are nonaggressive
Stage II: Cancer is aggressive and may be small or large
Stage III: The cancer has spread to nearby tissues
Stage IV: The cancer has spread to other body parts, such as bladder, lymph nodes, bones or other organs
Treatment for prostate cancer depends on the speed of cancer progression, cancer stage, and overall health.
An active surveillance may be enough for early stage prostate cancer. It involves frequent blood tests, rectal exams and possible biopsy for monitoring the development of cancer. Treatment is necessary if cancer is progressing.
Active surveillance is an option for the cancers that produce no signs, have slow growth and are confined to prostate only. One of the major disadvantages of active surveillance is, “missed” disease progression as symptoms may not be noticed between the checkups.
- Radiation therapy: It uses ionizing radiation to destroy cancer cell. Radiation may be given from a source your body (external beam radiation) or the source may be placed in your prostate (brachytherapy). It may cause painful urination, urinary urgency, loose stool, erectile dysfunction.
- Hormone therapy: Hormone therapy works by blocking the production of testosterone in your body. As prostate cancer cells depend on testosterone for their growth, blocking its production kills the cancer cells. It includes:
- Medications that block testosterone production: Medications such as luteinizing hormone-releasing hormone (LH-RH) agonists inhibit testosterone production by preventing the stimulation of testicle to synthesize testosterone. Examples include leuprolide, goserelin, triptorelin and abiraterone.
- Medications that deprive cancer cells of testosterone: Anti-androgens like bicalutamide, flutamide, and nilutamide block the effect of testosterone on cancer cells.
- Orchiectomy: It is a surgery to remove the testicles which results in decreased testosterone production.
Hormone therapy may cause side effects like erectile dysfunction, hot flashes, brittle bones, reduced sex drive or weight gain.
- Surgery to remove the prostate: Radical prostatectomy involves surgical removal of cancer cells along with neighboring tissue and lymph nodes. Radical prostatectomy can be conducted by:
- Robot assisted surgery: The surgery is conducted by your surgeon using a robot that’s inserted into your abdomen through incisions on your body.
- Retropubic surgery: The prostate gland is removed through a small cut in your lower abdomen.
- Perineal surgery: The prostate is removed through incision between your anus and scrotum.
- Laparoscopic prostatectomy: The prostate is removed through small incisions in the abdomen with the help of laparoscope (a tiny camera). Problems with erection or urinary control are common after a radical prostatectomy.
- Cryosurgery or cryoablation: It uses liquid nitrogen to freeze cancer cells. The cancer cells are exposed to liquid nitrogen via a needle followed by heating. Cryosurgery is beneficial for men who don’t respond to radiation therapy.
- Chemotherapy: It uses oral or injectable drugs to kill cancer cells. It is used for a cancer that has spread to other body parts or is resistant to hormone therapy.
- Biological therapy: It involves injecting genetically modified immune cells into your body. Sipuleucel-T is a FDA approved therapy for advanced, recurrent prostate cancer.