Prostate cancer is a disease in men in which cancer develops in the prostate, a gland in the male reproductive system. Cancers in the urinary tract are part of uro-oncology and usually prostate cancer develops most frequently in men over 50 years.
SYMPTOMS

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. However, symptoms include frequent urination, increased urination at night, difficulty in starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty in achieving erection or painful ejaculation.

Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs, from cancer which has spread to these bones. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and faecal incontinence.

It is the commonest amongst urological cancers, usually occurring with an aging population but recent studies have revealed it being detected increasingly amongst men in their 40’s and 50’s. It is increasingly being seen in Indian men as well perhaps related to progressive Westernisation.
SCREENING & DIAGNOSIS

Cancer in the prostate is completely treatable, when diagnosed early, with excellent functional outcomes and hence early detection is the key. However, even when detected at a later stage good treatment options are available for controlling the disease. PSA, a simple blood test is used as a screening tool for patients with prostate cancer aiding both in diagnosis and follow up. Adding value to PSA is a digital rectal examination by a urologist.

If the PSA result is abnormal, patients are advised to undergo prostatic biopsy followed by a comprehensive review by a urological surgeon. This is essential for further diagnosis and treatment options.

Two common causes of high PSA levels besides prostate cancer are enlargement of the prostate (benign prostatic hypertrophy (BPH)) and infection in the prostate (prostatitis).

The only test which can fully confirm the diagnosis of prostate cancer is a biopsy, the removal of small pieces of the prostate for microscopic examination. The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features of any cancer found. Tissue samples can be stained for the presence of PSA and other tumour markers in order to determine the origin of malignant cells that have metastasised. However, prior to a biopsy, several other tools may be used to check the prostate and the urinary tract.

Cystoscopy shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the urethra.

Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum.
TREATMENT

Radiation therapy – Ionizing radiations are used to kill prostate cancer cells. It can be external beam radiation therapy or brachytherapy. It may be used instead of surgery for early cancers, and in advanced stages of prostate cancer to treat painful bony metastases.

Surgery – Treatment options like Radical Prostatectomy where the whole prostate along with the structures attached to it are removed maybe used. This operation can be done as Robotic Prostatectomy or by laparoscopy or by open method. The urological surgeon will guide the best method depending on various factors. Post operatively majority of the patients are fit for discharge by the next day. A urinary catheter, which is fitted at the end of the operation is ready for removal with a few weeks.

Hormonal therapy – It is used when cancer has spread from the prostate. It may also be given to certain men undergoing radiation therapy or surgery to help prevent the return of their cancer.
Article By
Apollo Hospitals