Even to this day, there is a lot of hush-hush around the topic of prostate cancer, not a lot of people like to talk about it or anything that it entails. However, it is incredibly important to raise awareness around the same considering the fact that it is one of the most concerning diagnoses that one can be going through.
To begin with, prostate cancer is a type of cancer that starts in the prostate gland, a small walnut-shaped gland in men. The prostate gland is located below the bladder and in front of the rectum. The prostate gland produces some of the fluid that makes up semen.
Dr Sajjan Rajpurohit, Senior Director-Medical Oncology, Max Super Speciality Hospital, Shalimar Bagh, says, “Prostate cancer is the most common cancer in men after skin cancer. It is estimated that about 1 in 9 men will be diagnosed with prostate cancer during their lifetime. The risk of prostate cancer increases with age. Most prostate cancers are slow-growing and do not cause any symptoms. However, some prostate cancers can grow quickly and spread to other parts of the body.”
Dr. Ganesh Bakshi, Consultant, Uro-Oncology, P.D. Hinduja Hospital & Medical Research Centre, Khar & Mahim noted, “Prostate cancer incidence is on the rise and currently, it is the second most commonly diagnosed cancer in men, with an estimated 1.4 million new diagnoses worldwide in 2020. As the years go by and factors like lifestyle, diet, sedentary activity, environmental pollution, pollution in food products and stress grow, this incidence may rise in the future. There is a familial element to this cancer as well, requiring the nearby or closest relatives to be vigilant. This makes it necessary to have good information about prostate cancer.”
“Prostate cancer in various stages can be treated with a multitude of treatment options based on certain risk categories. The patient needs to be evaluated accordingly. The common diagnostic tests are PSA, Prostate biopsy, multi-parametric MRI, and PSMA PET CT scan. The results from these help us group patients in various risk strata and grossly into 3 categories – localized [confined to prostate], locally advanced [spread around prostate], and metastatic [ spread to different or distant parts of the body] prostate cancer,” he further added.
“The treatment of prostate cancer depends on the stage of the cancer, the patient’s age and overall health, and the patient’s preferences,” says Dr. Rajpurohit.
It must be noted that treatments are offered as per these groups and also taking into account family history, age, life expectancy, overall health status, and the presence of other debilitating diseases such as significant heart disease or other prior cancers.
Dr. Bakshi points out “Usually, a patient should be offered a joint clinic or a tumour board advice; in other words – a multidisciplinary team decision.”
- Active surveillance:
“This is an option for men with low-risk prostate cancer who are not experiencing any symptoms. Active surveillance involves regular monitoring of the cancer to see if it grows or spreads,” says Dr. Rajpurohit.
Dr. Bakshi added, “Active surveillance involves following up with the patient with an examination of the prostate, PSA, and as required MRI of the prostate. In case of any suspicion of disease increase, a shift to active treatment is warranted.”
- Radical Prostatectomy
“Radical prostatectomy involves surgical removal of the prostate, seminal vesicles, and lymph nodes in the pelvis. The surgery is moreover done minimally invasive using the robot with good results. Post-surgery a urinary catheter is kept for a week and later for a few days patient needs to wear a diaper. The urine control comes back in a few days with good perineal exercise which tones up the urinary sphincter or valve,” informs Dr. Bakshi.
In younger and indicated patients, a nerve-sparing surgery can be done which decreases the post-surgery erectile dysfunction. The histopathology report after surgery would help guide further treatment decisions.
- Hormone therapy:
“This treatment lowers the levels of testosterone, which can help to slow the growth of prostate cancer. Hormone therapy can be given alone or in combination with other treatments,” says Dr. Rajpurohit.
- Radiation therapy:
Radiation therapy kills the cancer by focusing strong X-rays in a particular calculated dose. The radiation can be external – External beam radiation therapy or internal – Brachytherapy [inserted seeds or needles with radioactive source]. Hormone therapy injections are used many times in combination with radiation treatments.
- This treatment removes the prostate gland and sometimes other nearby tissues. Surgery is usually recommended for men with high-risk prostate cancer or for men who are not candidates for other treatments.
This treatment uses extreme cold to kill cancer cells. Cryotherapy is not as common as other prostate cancer treatments.
This treatment uses the body’s own immune system to fight cancer. Immunotherapy is still being studied for prostate cancer, but it is showing promise in some cases.
Dr. Bakshi mentions, “In metastatic prostate cancer, treatment goals include keeping the disease in control and having a good quality of life. The various treatments are hormone therapy [ reduction of testosterone hormone] combined with tablets[Androgen receptor inhibitors – abiraterone acetate / Enzalutamide / Apalutamide / Darolutamide] or chemotherapy with docetaxel.”
He further went on to add, “Options for giving hormone therapy include injectables combined with anti-androgen tablets in the initial period. These need to be given continuously and are available in monthly, 3, or 6 monthly depot doses. Another way is surgery – Bilateral orchiectomy, removal of both testes, also is the easiest and cheapest way to reduce the levels of testosterone which is achieved within 12 to 24 hours of surgery.”