Prostate Cancer

Prostate cancer is one of the common causes of mortality from cancer in men. Therefore screening for prostate cancer at earlystages is always beneficial so that effective treatment can be provided. Treatment for prostate cancer mainly depends on the type and stage of cancer and therefore appropriate screening is essential. Screening of prostate cancer can be done by:

Digital rectal exam: In this method, your physician inspects your prostate gland for any lumps by inserting a lubricated,gloved finger into your rectum.

Prostate-specific antigen test: Prostate-specific antigen (PSA) is a protein produced by the prostate gland and the blood concentration of this protein is measured in this test. Elevated levels of PSA imply the possibility of prostate cancer. However other tests should also be performed in order to confirm the diagnosis because PSA concentration may be elevated in other conditions too.

Prostate biopsy: Prostate biopsy is a more dependable screening method for prostate cancer. Tissue from the prostate is excised and viewed under a microscope for any abnormalities. If cancer is observed, the cancer will be graded into stages to determine the best treatment approach.

Treatment

Several treatment options are available for treating prostate cancer. The standard approaches among them are watchful waiting (active surveillance), radiation therapy, hormone therapy, surgical therapy (radical prostatectomy), chemotherapy and biological therapy. Your physician decides an appropriate treatment option based on the stage of prostate cancer.

Watchful waiting (active surveillance)
Watchful waiting or active surveillance involves monitoring the patient’s condition until the symptoms or laboratory results alter. The purpose of this surveillance is to observe the prostate cancer over a long period of time to check the growth and symptoms. In patients with no symptoms and minor growth of the cancer, treatment can be delayed or avoided as it affects the patient’s quality of life adversely.

Radiation therapy (radiotherapy)
Radiation therapy involves application of high energy X-rays to kill or arrest the growth of cancer cells. Radiation therapy is of two types.

• External beam radiation therapy: The radiation is directed to the cancer site from a radioactive source placed outside the body.
• Internal beam radiation therapy (Brachytherapy) in which radioactive substances sealed as seeds, pellets, or catheters are placed along the prostate gland near the cancer site.

Hormone therapy (androgen deprivation therapy)
Testosterone is a male sex hormone which helps the prostate cancer cells to grow larger. Hormone therapy involves stopping the production of testosterone or blocking testosterone from reaching the prostate cancer cells. Thiscan be achievedby using drugs, surgery, or other hormones that reduce testosterone.

• Drugs that stop production of testosterone: Luteinizing hormone-releasing hormone (LH-RH) agonists such as leuprolide, goserelin, triptorelin and hisrelin.
• Drugs that blocks testosterone from reaching cancer cells: Anti androgens such as bicalutamide, flutamide and nilutamide.
• Surgery (orchiectomy): This procedure involves removal of the testicles to reduce the testosterone levels quickly.

Surgical therapy (radical prostatectomy)
If the patient has good health, surgery can be recommended to treat prostate cancer. Radical prostatectomy refers to the removal of the prostate gland and the cancer cells contained within it. The prostate gland is removed either through an incision in the abdominal wall (retropubic prostatectomy) or perineum (perineal prostatectomy).

Chemotherapy
Chemotherapy involves using anti-cancer (cytotoxic) drugs tostop the growth of cancer cells either by killing or by stopping cell division. Chemotherapy can be given throughout the body (systemic chemotherapy) by oral/intravenous route, or to a particular region of the body (regional chemotherapy).

Biological therapy
Biological therapy involves using biological agents to cure prostate cancer by acting against the patient’s immune system. Unlike chemotherapy, biological agents act directly on the cancer cells.

Cryosurgery, high-intensity focused ultrasound (HIFU), and proton beam radiation therapy are some other possible newer treatment options that are being studied in clinical trials.

• Cryosurgery kills theprostate cancer cells by employing freezing and thawing techniques using a special probe.
• High-intensity focused ultrasound (HIFU)therapy kills or destroys the cancer cells by the application of high-frequency ultrasound waves.
• Proton beam radiation therapy involves using a stream of high-energy protons to kill cancer cells.