Prostate cancer is a cancer of the small walnut-shaped gland near the urinary bladder in men that produces seminal fluid.
Seminal fluid nourishes and transports the sperm. The prostate is located in front of the rectum and just below the bladder, where the urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. Older men, usually in the sixth decade of their life, are at a higher risk of this disease.
Symptoms
At the early stages of this cancer, most men will not experience any symptoms. Some men, however, will experience the following symptoms that might indicate the presence of prostate cancer:
- Frequent urination, especially at night
- Difficulty in starting urination or holding back urine
- Weak or interrupted flow of urine
- Painful or burning urination
- Difficulty in having an erection
- Painful ejaculation
- Blood in urine or semen
- Frequent pain or stiffness in the lower back, hip or upper thigh
Causes
The exact cause of prostate cancer is under investigation. However, increasing age and high testosterone are known risk factors.
Diagnosis
Since the above mentioned symptoms can potentially indicate the presence of other diseases or disorders, men who experience any of these symptoms should undergo a thorough check-up to determine the underlying cause of the symptoms.
- A blood test for a protein known as Prostate Specific Antigen (PSA)
- An ultrasound examination through the rectum is suggested, usually after the doctor has examined the prostate through the rectum (Digital Rectal Examination – DRE)
Management
Depending on the stage of the disease, hormonal therapy, surgery and/or radiation therapy are initiated. Some patients may require chemotherapy at a later stage.
Treatment
The prostate cancer treatment options depend on several factors, such as:
- How fast the cancer is growing
- How much it has spread
- The overall health
- The benefits and the potential side effects of the treatment
Immediate treatment may not be necessary
For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance.
In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show that cancer is progressing, then the doctor recommends surgery or radiation.
Active surveillance carries a risk that the cancer may grow and spread between checkups, making it less likely to be cured.
Radiation therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:
External beam radiation: During external beam radiation therapy, the patient lies on a table while a machine moves around the body, directing high-powered energy beams to the cancer. The patient undergoes external beam radiation treatments five days a week for several weeks. External beam radiation uses x-rays or protons to deliver the radiation.
Brachytherapy: Brachytherapy involves placing many rice-sized radioactive seeds in the prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. The doctor implants the radioactive seeds in the prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed.
Hormone therapy
Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:
- Medications that stop the body from producing testosterone
- Medications that block testosterone from reaching cancer cells
- Surgery to remove the testicles (orchiectomy)
Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumours. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumours before radiation therapy. This can make it more likely that radiation therapy will be successful.
Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.
Surgery to remove the prostate
Surgery for prostate cancer involves removing the prostate gland, some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:
- Using a robot to assist with surgery
- Making an incision in your abdomen
- Making an incision between your anus and scrotum
- Laparoscopic prostatectomy
Freezing prostate tissue
Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.
Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.
Multiple new chemotherapy drugs have recently been approved for treatment of progressive, metastatic prostate cancer.
Immunotherapy
A form of immunotherapy has been developed to treat advanced, recurrent prostate cancer. This treatment takes some of the patient’s own immune cells, genetically engineers them to fight prostate cancer, and then injects the cells back into the patient’s body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple visits.