Prostate Cancer

Screening & Diagnosis Of Prostate Cancer

Clinical examination: The clinician will ask for symptoms of prostate cancer such as passing urine more frequently or difficulty passing urine, leaking of urine, blood in the urine or erection-related problems. A digital rectal examination is also carried out with a gloved finger in the rectum to feel the prostate gland for any lumps or abnormalities.

Prostate-specific Antigen (PSA) test: This is a blood test used to screen patients for prostate cancer. It measures the amount of a specific protein in the blood called prostate-specific antigen. This protein can be produced by both cancerous and noncancerous tissue in the prostate. High levels of PSA may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels.

Biopsy: If the digital rectal examination and PSA tests are suspicious, a sample of tissue will be taken from the prostate gland to look for cancer cells. The procedure is called transrectal ultrasound scan guided (TRUS) biopsy, in which an ultrasound scanner is inserted into the rectum and a fine needle is then used to take samples of tissue from the prostate gland. These are then sent to the laboratory where the pathologist will examine the samples under the microscope to confirm the diagnosis and provide details on the characteristics of the cancer cells.

Radiological Tests: CT scan- It is a type of x-ray that lets doctors visualise internal organs in cross-section to help in staging. MRI scan - It uses magnetic fields and radio waves to produce detailed images and help with staging and to search for spread to distant organs in the body. PET scan - It involves injecting a radioactive substance into a vein and can help find areas of cancer that an MRI or CT scan may miss, especially when it spreads to other parts of the body. Bone scan - This is a scan to look for spread of cancer to the bones.

Treatment Of Prostate Cancer

The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
Active surveillance and watchful waiting: This involves only the close monitoring of the cancer and is an option for low- or intermediate-risk localised prostate cancer. The blood PSA levels and prostate biopsies or MRI scans are carried out often. The aim is to manage, rather than cure, the cancer.

• Surgery: The removal of the prostate gland is radical prostatectomy, which aims to completely remove the prostate gland, surrounding tissues and lymph nodes. A variant is nerve-sparing prostatectomy in which the prostate tissue is removed without removing the nerves that control erection but can only be done when the cancer is not growing close to the nerves. Radical prostatectomy is major surgery, and may not be suitable for men with slowly growing prostate or those with contraindications to surgery. Other types of surgery include transurethral resection of the prostate (removal of the inner part of the prostate) or removal of the testicles both of which can help relieve the symptoms or control the spread of cancer. Side effects: Problems controlling the flow of urine, leakage of urine, erection issues, swelling in the genital region or in the legs etc.

• Radiotherapy: Radiotherapy uses ionising radiation to destroy the DNA of cancer cells. It may be external beam radiotherapy (from a machine outside the body) or brachytherapy (radioactive source placed inside the prostate gland). This form of therapy is recommended for localised or locally advanced prostate cancer. Side effects: fatigue, skin irritation, bladder inflammation, diarrhoea, blood in urine or semen, loss of pubic hair, etc.

• Hormone therapy: Prostate cancer requires testosterone to grow. Hormone therapies block the actions of testosterone. This reduces the risk of prostate cancer recurring after treatment with surgery or radiotherapy as well as slows the growth of advanced cancer. There are three types of therapy: Androgen deprivation therapy (stops the testicles from producing testosterone and are given by injection or implanted), Anti-androgens (oral medications that prevent testosterone from reaching the cancer cells) Abiraterone (new type of therapy that blocks the formation of testosterone). Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss and bisphosphonate drugs are prescribed to lessen the risk of fractures. Side effects: fractures, loss of sex drive, erection problems, hot flushes, decreased body hair, loss of muscle bulk, hypertension, urinary tract infections, anaemia, blood in urine, fatigue, joint pain, acne etc. Side effects depend on the agent used.
• Chemotherapy: It is indicated in some patients who are fit enough to receive it. When taken by mouth or injected, the drugs enter the bloodstream and can reach cancer cells throughout the body and is known as systemic chemotherapy. When chemotherapy is placed into an organ, or a body cavity it affects cancer cells in those areas (regional chemotherapy). The type of therapy depends on the type and stage of the cancer. Side effects: Depend on the agent used but commonly include hair loss, anaemia, anorexia, diarrhoea, nail disorders, nerve damage, mouth ulcers, risk of bleeding etc.

• Cryosurgery: This is also known as cryoablation and involves freezing and heating tissue to kill the cancer cells. Small needles are inserted in the prostate with the help of ultrasound guidance and the cold gas is placed in the needles causes the surrounding tissue to freeze. A second gas is then introduced to reheat the tissue. These cycles of freezing and thawing kill the cancer cells.
  Palliative care: It is to describe care interventions to manage the symptoms of cancer and side effects of treatment of prostate cancer. Specialists also offer support in coping with the prognosis and preparation for end-of-life care. Palliative care in prostate cancer may include management of pain, diarrhoea, urinary incontinence, nutritional problems, leg swelling and bedsores etc.
  

Sources: European Society for Medical Oncology (ESMO); Mayo Clinic; National Cancer Institute;