Prostate cancer tends to be asymptomatic in the initial stages, where the cure is mostly feasible.
The serum PSA helps identify patients at risk if the levels are elevated
Cancer of the prostate is the most common cancer among males worldwide, as per Globocon 2012. It mostly affects individuals after the age of 45. The prostate is an organ of the male genitalia that is associated above with the urinary bladder and inferiorly with the proximal urethra, for which it acts as an intermittent conduit. It is responsible for forming approximately 80% of the secretions of the semen.
Prostate cancer tends to be asymptomatic in the initial stages, where the cure is mostly feasible. It tends to cause very few disturbances, or if the symptoms of urination do appear, they appear very late in the course of the disease.
The cancer spreads to the lymph nodes (glands present throughout the body for fighting infection and other diseases), bones, and rarely to the other organs of the body.
Therefore, the disease needs to be optimally diagnosed in a time frame where we can treat it adequately. For the same reason, there are screening methods to detect individuals at high risk for the disease:
• Physical examinations along with digital rectal examinations and serum PSA determination, which is a blood examination.
• The screening of individuals is recommended after the age of 50 but should be done earlier if the index person has a family history of the disease.
• A digital rectal exam detects any nodules or hardness in the prostate, which is suggestive of further action and diagnosis.
• The serum PSA helps identify patients at risk if the levels are elevated.
• The next step in the diagnosis flowchart is the prostate biopsy, which is a procedure to obtain prostatic tissue from the suspicious areas to diagnose the cancer. The procedure was conventionally done blindly guided by the hardness of the tissues.
• Nowadays, the standard technique is guided by ultrasound, or better yet, an MRI TRUS fusion biopsy if needed in case the MRI suggests suspicious areas.
• The biopsy confirms or refutes the presence of the cancer and also helps stratify the disease into grades. The grading, known as the Gleasons Grading, helps classify the disease into milder and more aggressive forms.
Staging and treatment
Staging literally means estimating the spread of the disease across the body. A locally confined disease suggests that the disease is limited to the prostate without direct invasion into any of the surrounding organs. A disease that spreads across the body is known as metastasis.
A locally confined disease fares best with treatment.
Treatment options
Treatment options include surgery and radiation therapy. The surgery is a robot-assisted radical prostatectomy available at a few centers across the country.
The surgical robot is used to assist in the precise surgery. It is an advanced form of laparoscopic surgery where a robot is docked and helps in crucial tissue handling, greater degree of freedom in surgery, lesser loss of blood, and faster recovery from the surgery.
The patient is admitted a day prior to the operation. The surgery lasts for about 4 to 5 hours, and the hospital stay for the patient is about 4 to 5 days. The patient goes home on a catheter, which can be taken out after 10 to 14 days.
Radiation therapy is delivered by radiation oncologists and has evolved over the past decades to reduce the falloff doses to the surrounding organs like the bladder, rectum, and gut.
The side effects of the radiation therapy include bleeding in the urine, stools, and late-stage side effects like radiation cystitis or proctitis.
It is beneficial to personalize the treatment for all patients, including hormonal therapy or radiation therapy, as the patient merits.
(Dr. Vikram Batra, Consultant Urology, HCMCT Manipal Hospital, Dwarka)
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