Prostate Cancer

The prostate gland is part of the male reproductive system situated in front of the rectum and below the urinary bladder encircling the first part of the urethra. The nerves that control erections surround the prostate. The prostate makes a fluid that helps in reproduction. Male hormones (androgens, testosterone) secreted by testes make the prostate grow.

Worldwide, Prostate Cancer is the second leading cause of cancer death. The probability estimates indicated that one out of every 59 men will contract a Prostate Cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. Average annual carcinoma prostate incidence rates in India are about 5.0 to 9.1 per lakh/yr according to the available reports. About 85% of Prostate Cancers were detected at late (III and IV) stage in India; in contrast to the US where 15% of either cancer is diagnosed at late stage.

The incidence of Prostate Cancer increases with age most often in men over the age of 50. Men with a family history of Prostate Cancer are at higher risk too. Men who are obese and eat a diet high in fat (Western-style foods) are also at a higher risk for prostate cancer.

There are advantages and disadvantages to screening for Prostate Cancer. You should talk to your doctor about whether or not you should be screened. Your doctor will help assess the balance of risks and benefits to screening based on factors like your age, family history and current health.

Prostate Cancer screening and early detection is extremely important for a number of reasons, including the facts that: If caught early, survival rates for Prostate Cancer are nearly 100%. Early detection and treatment are the best protections against advanced Prostate Cancer.

For patients in whom Prostate Cancer is detected early, a variety of potentially curative treatment options are available. These include surgical removal of the prostate (radical prostatectomy), radiation therapy, radioactive seed implantation, and cryosurgery. More advanced forms of Prostate Cancer require different types of treatment and cure may not be possible

HUnfortunately, Prostate Cancer gives rise to symptoms only in late stages (Even BPH can have these symptoms).Following are the symptoms of Prostate Cancer:

• Difficulty to start urination
• Less force to the stream to the stream of urine
• Dribbling after you finish urinating
• Frequent urination especially at night
• Blood in the urine and semen
• Pain while urinating and ejaculation
• Hip and lower back pain
• Unexplained weight loss and/or loss of appetite

Doctor examines prostate gland by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. This is called a digital rectal exam (DRE) or per rectal examination (PR).

Another way to check for Prostate Cancer is measuring blood levels of PSA which is a short form for Prostate-Specific Antigen. Men who have Prostate Cancer may have a higher level of PSA in their blood (It can also raise in non-cancerous diseases of prostate like prostatitis).

This involves a small ultrasound probe being put into your back passage to get a clearer picture of the prostate. This more often than not is rather uncomfortable, but it shouldn't hurt, and won't take long

Biopsy is required to confirm the diagnosis if PSA and DRE are normal. In biopsy, a small amount of tissue is removed from the prostate with a needle which is then examined under a microscope for cancer cells. If the biopsy is taken and Prostate Cancer is found,the tumour is graded (Gleason grade) in the laboratory. Some men may need additional tests to know the extent of the disease:

• Bone scan: By injecting a radioactive substance into the body, bony images are taken by scanner. The pictures may show cancer that has spread to the bones.
• CT scan: Doctors use CT scans to look for prostate cancer that has spread to lymph nodes and other areas.
• MRI Scan: An MRI can show whether cancer has spread outside prostate and also lymph nodes or other areas.

Following are the stages of Prostate Cancer:

• Stage 1: The cancer is small and contained within the prostate.(T1)
• Stage 2: The cancer is larger and may be in both lobes of the prostate, but is still confined to the organ. (T2)
• Stage 3: The cancer has spread beyond the prostate and may have invaded the adjacent lymph glands or seminal vesicles. (T3, N1)
• Stage 4: The cancer has spread to other organs, or to bone. (T4, M1)

The major treatment options for Prostate Cancer include active surveillance, surgery, radiation, medical therapy and their combination. A patient's treatment options will depend upon his age, the stage of the disease, and the advice of a physician.

Disease confined within the prostate: Options include surgery, radiotherapy, active surveillance, cryosurgery, HIFU

• Surgery: Surgical removal of the entire prostate gland is called radical prostatectomy which is widely practiced and safe. Radical prostatectomy can be achieved by either open surgery, key hole surgery also called laparoscopic surgery and robotic surgery. Each type has benefits and risks.
• Open surgery: The surgeon makes a large incision (cut) into your body to remove the prostate and is called radical retropubic prostatectomy.
• Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen.
• Robotic laparoscopic surgery: A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.The common complications include impotence, incontinence of urine and ends on the type of surgery. Hospital admission is usually for three to six days.

Radiation therapy is an option for men with early and locally advanced stage of Prostate Cancer. It can also be used after surgery to destroy any cancer cells that remain in the area and to alleviate pain in Metastatic disease.

There are two types of radiation therapy. External radiation: The radiation comes from a large machine outside the body. Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds.

Side effects depend mainly on the dose and type of radiation. If you have external radiation, you may have diarrhoea or frequent and uncomfortable urination. Both internal and external radiation can cause incontinence and impotence.

Watchful Waiting is another option involving careful observation without immediate treatment for Prostate Cancer. This may be an appropriate therapeutic course for men who: are found to have less aggressive tumours, which often tend to grow slowly and  are older than 70 years of age, have significant coexisting illnesses.

• Locally advanced disease: Disease coming out of the prostate but not spread to other organs. Treatment of this group of patients is predominantly radiotherapy. Surgery is used only in selected patients. Administering hormonal treatment before radiation therapy and continuing it for up to 2 years is known to cause improvement in disease control. Hormonal treatment is usually in the form of injections (LHRH analogues).
• Metastatic disease: Disease spread to lymph nodes, bones and other organs constitute metastatic diseases.

Cure is rarely possible in this group. The main mode of treating this group of patients is hormonal treatment. Male hormones (androgens) can cause Prostate Cancer to grow. The testicles (95%) and adrenal (5%)are the body's main source of the male hormone testosterone.

Drugs used in Hormone Therapy:

• Luteinizing hormone-releasing hormone (LH-RH) agonists: leuprolide, goserelin, and triptorelin.
• Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
• Other drugs: Ketoconazole

Surgery to remove the both testicles is called orchiectomy. Hormone therapy causes side effects such as impotence, hot flashes, and loss of sexual desire. Also, any treatment that lowers hormone levels can weaken bones.Biphosphanates (Zolendronic acid) are used to reduce the fractures of bones.

With time, most prostate cancers can grow and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy (Docetaxel, Estramustine and Prednisolone) or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.

Men with advanced prostate cancer may experience pain. Radiation,chemotherapy and bone-building drugs that shrink tumours can all be effective in controlling pain. Non steroidal analgesics: Important group of drugs like Ibuprofen, Paracetamol and Nimusalide are useful. Narcotics are powerful drugs mimic the body's own pain-killing chemicals. Narcotics may be given as a pill, a patch, or as an intravenous (IV) drip by health-care professionals, for severe pain.

Acupuncture has been proven in clinical studies to help relieve pain.Meditation, prayer, and yoga also help some people

There are recent reports that as prevention drugs like Finesteride and Dutesteride are useful, but these drugs are not yet FDA approved.

If you have been diagnosed with Prostate Cancer, you and your family probably have a lot of questions about the disease and its treatment. Printing out this list and taking it with you to your doctor's office may help you get the answers you need. Be sure to write out the answers, so that you can review the information as often as you like.

Information is designed for educational purposes only.Any decisions should be made in conjunction with your physician or therapist. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon, any information in this brochure.

• National Men's Resource Centre
• The Prostate Cancer Foundation of Australia
• National Cancer Institute: Prostate cancer: what do you need to know about?
• www.mens-hormonal-health.com