Prostate Cancer

Prostate cancer is caused when cells in the prostate multiply and grow out of control to form a mass or tumour. Being a very variable disease, some tumours remain small and grow so slowly that they cause no problems for the rest of a man’s life; others are aggressive (which may eventually spread to bone), grow quickly and become life- threatening.

If prostate cancer is diagnosed early (before it has spread outside the prostate gland) it can be treated very successfully. Treatment provides long term cure for at least 9/10 cases. However, when the cancer is advanced, it becomes very difficult to cure. If the cancer has spread outside the gland, the prospects are worse. Even a small amount of spread reduces the chance of a cure. More distant spread makes a cure very unlikely. Treatment can give these patients extra years of life and stop the pain of the disease, but is only able to cure a minority of them. Overall, only about one in three of patients with cancer spread outside the prostate survive for five or more years after the diagnosis. All men over 50 should be aware of the warning signs and check with their doctor at regular intervals.

5% to10% of cases runs in families, where the patient inherits a high risk of this type of cancer. Men with a single first-degree relative–father, brother or son–with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is highest in men whose family members were diagnosed before age 65.

As men increase in age, their risk of developing prostate cancer increases exponentially.  Race also has an effect: Men of Afro-Caribbean descent are about twice as likely to get it whereas men of Asian descent have a lower risk of prostate cancer. There is no known way of preventing prostate cancer, and research has not found any reliable evidence that any particular diet or change in lifestyle can reduce the risk of getting it.

• Prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races.
• Having a father or brother with prostate cancer more than doubles a mans risk of developing this disease.
• Men with Lynch syndrome, have an increased risk for a number of cancers, including prostate cancer. Inherited mutations of the BRCA1 or BRCA2 genes increases risk of prostate cancer.

Early stage prostate cancer does not cause any symptoms. So men who are above 50 years of age are advised to undergo voluntarily testing for prostate cancer.

Warning signs

• Frequent urination, more often at night
• Difficulty in urinating
• Blood in the urine / painful urination
• Ejaculation may be painful (less common)
• Achieving or maintaining an erection may be difficult (less common).
• Inability to urinate
• Passing urine often (particularly at night)
• Weak or interrupted urine flow
• Pain when urinating
• Pain in the lower back, hips and upper thighs

However, all of these symptoms can also be caused by other conditions, such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.

The three main things that can go wrong are:

• Benign Prostatic Hyperplasia (BPH) - a simple enlargement of the prostate
• Prostatitis - an inflammation or infection of the prostate
• Prostate Cancer

If prostate cancer is diagnosed early, it can be treated very successfully. However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and consult their doctors at regular intervals. At the moment, routine screening for prostate cancer is not carried out in any country, because there is no firm evidence that it would save lives. But early detection in a well educated and informed patient can detect early cancer.

Progression

Prostate cancer cells can spread anywhere in the body. In practice, though, most cases of prostate cancer metastasis occur in the lymph nodes and the bones. Prostate cancer metastasis occurs when cells break away from the tumour in the prostate.

Diagnosis

• Primary diagnosis: Prostate-specific antigen (PSA) blood test, Digital rectal exam (DRE)
• Advanced diagnosis: Prostate biopsy

Sometimes prostate cancer is so slow growing that no treatment is needed. ‘Watchful waiting’ is used in these cases, with regular monitoring of the patient, by regular PSA tests, to find out if the cancer changes. Commonly practiced options include surgery and radiation therapy for early cancers and hormonal treatment for advanced cancers.

Surgery called prostatectomy, where the whole prostate gland is removed, may be advices in some cases. The options for patients with early diagnosed organ-confined prostate cancer are

• Robotic Radical Prostatectomy (most commonly used)
• Laparoscopic Radical Prostatectomy
• Traditional Open Radical Prostatectomy

This procedure is also called da Vinci Robotic pProstatectomy. It is a minimally invasive surgical removal of the prostate involving the latest advancements in robotics and computer technology.

Radiotherapy/Brachytherapy

In radiation treatment, high energy rays kill the cancer cells. This can be used in early prostate cancer, to destroy the tumour, and in advanced tumours, to reduce the pain caused by tumour cells which have spread to the bones.

Hormone Therapy

Since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour, but do not kill it, so they have to be taken for a long time. However, after a while (anything between 3 and 20 years), most prostate cancers develop the ability to grow without androgens, and the hormone therapy stops working.

Progression

• Stage I : Most bladder cancers start in the innermost lining of the bladder.
• Stage II/III : Cancer grows into or through the other layers in the bladder wall
• Stage IV : Cancer grows outside the bladder and into nearby structures (lymph nodes, bones, lungs, liver)

Diagnosis

• Primary diagnosis : Cystoscopy, Biopsy, Urine Cytology.
• Advanced diagnosis : Imaging like Computed Tomography (CT or CAT) scan, Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) scan

The outlook for people with bladder cancer varies dramatically depending on the stage of the cancer at the time of diagnosis.

• Nearly 90% of people treated for superficial bladder cancer (Ta, T1, CIS) survive for at least five-ten years after treatment.
• 50-70% of invasive bladder cancer patients survive for up to 5 years.
• Only about 5% of people with metastatic bladder cancer survive for at least two years after the diagnosis.

Treatment in a nutshell

Treatment options depend on the stage of bladder cancer. Three types of standard treatment are used, as follows:

• Surgery: Different types of surgeries such as Transurethral Resection (TUR) with fulguration, Radical Cystectomy, Partial Cystectomy or Urinary Diversion can be performed based on requirement. It is done by Endoscopy, Robotic or open approach.
• Radiation therapy: In radiation therapy, high-energy x-rays or other types of radiation is used to kill cancer cells or keep them from growing.
• Chemotherapy: In chemotherapy, drugs are used to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Top tips

• Eat tomatoes, watermelon, and other red food. They owe their bright colour to a powerful antioxidant called lycopene which destroys free radicals so they cant attach to your cells and wreak havoc on your hard-working immune system.
• Green vegetables contain compounds that help your body break down cancer-causing substances called carcinogens. A nutrient-rich diet may also help slow the spread of cancer.
• Fatty acid, known as omega-3, may help reduce your risk of developing prostate cancer.
• Men who drink green tea, or take green tea extract supplements, have a lower risk of prostate cancer than those who dont.
• Be careful not to overcook meat, as it produces carcinogens
• Stop Smoking
• Too much fat, especially in the middle of your body, is linked to an increased risk of prostate cancer. Exercise regularly.

Milestones

• Our specialists have managed more than 250 kidney cancers in last four years, and most recently, da Vinci Robotic surgeries have been done with internationally acceptable outcomes.
• Our outcomes are in accordance with international guidelines of prostate cancer management. We, in India, are the first ones to perform the fastest 100 robotic surgeries after installing the da Vinci robot with excellent outcomes.

Reported outcomes

Survival Rate	85-90 per cent
Morbidity	6-12 per cent

Top tips

• Choose a low-fat, low-cholesterol diet.
• Stop smoking.
• Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.
• Choose a diet rich in a variety of colourful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.
• Keep a check on the risk factors.

At Uro-Oncology service of Kokilaben Hospital, we have managed more than 500 prostate cancer patients in four years and have state-of-the-art da Vinci Robotic Surgery and Radiation Techniques to treat such patients. Our outcomes are in accordance with international guidelines of prostate cancer management. We have multidisciplinary team approach and tumour board which consists of uro-oncologist, medical oncologist, radiation oncologist and onco pathologist and radiologist where decision making is done according to the global standards. We, in India, are the first one to perform the fasted 100 robotic surgeries after installing Da Vinci robot with excellent outcomes.