Prostate Cancer

The prostate is a small walnut-structured gland in the pelvis of men. It is located next to the bladder and can be checked by getting a digital rectal exam. Prostate cancer is a form of cancer that develops in the prostate gland. Prostate cancer is due to an uncontrolled (malignant) growth of cells in the prostate gland.Growths in the prostate can be benign (not cancer) or malignant (cancer).It is the second-leading cause of cancer deaths for men. It is the most common cancer in men; some cases of prostate cancers grow very slowly, while others are very aggressive and spread quickly to other organs.

The cause of prostate cancer is still not fully understood, but there are several factors which predispose to the development of the disease that include age, ethnicity, genetic factors, diet and physical activity.

Types of prostate cancer:

The type of prostate cancer is based on the type of cell the cancer started in.There are different types of prostate cancer. The most common type is called acinar adenocarcinoma.

Acinar adenocarcinoma : Adenocarcinomas are cancers that develop in the gland cells that line the prostate gland. Nearly everyone with prostate cancer has this type.
Ductal adenocarcinoma : Ductal adenocarcinoma starts in the cells that line the ducts (tubes) of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma.
Urothelial carcinoma : Urothelial carcinoma starts in the cells that line the tube carrying urine outside of the body (the urethtra). This type of cancer usually starts in the bladder and spreads into the prostate.
Squamous cell cancer : These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than adenocarcinoma of the prostate.
Small cell prostate cancer : Small cell prostate cancer is made up of small round cells. It's a type of neuroendocrine cancer.

Signs & Symptoms

Early prostate cancer usually causes little to no symptoms. As the disease advances, symptoms can be changed as minor daily annoyances.

symptoms include:

Difficult, painful, and frequent urination
Blood in urine orsemen
Pain and stiffness in back, hips, or upper thighs
Weakness/numbness in legs and feet
incontinence
erectile dysfunction
Burning sensation while urinating
Painful ejaculation

Diagnosis

Prostate cancer diagnosis is based on DRE (digital rectal examination) and prostate-specific antigen (PSA) concentration in the blood serum.

Digital rectal examination : A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

Prostate-specific antigen (PSA) concentration: PSA is a serine protease from the kallikrein-related peptidase family mainly produced in prostate glandular epithelial cells.PSA levels above 10 ng/mL are characteristic for patients with a high risk of cancer (biopsy isrecommended). Moreover, it is helpful in decision making which patient should undergo biopsy.
Biopsy : Two approaches are used to perform biopsy,
- a) Transrectal (TR) biopsy : Transrectal ultrasound-guided (TRUS) biopsy is the most common way to collect samples. During TRUS biopsy, the needle goes through the rectal wall, then 10 to 12 samples from different areas of the prostate gland are taken.
- b) Transperineal (TP) biopsy : The needle goes through the skin between the testicles and perineum. Transperineal approach results in lower risk of sepsis and usually requires general anaesthesia.
Imaging test : MRI gives a better resolution in soft tissues than ultrasound and is used to determine the place where a biopsy of a gland will be performed.

Management

There are several options available for the management and treatment of prostate cancer. Specific treatment options available for prostate cancer, depending on the stage of the disease are- active surveillance, radiation therapy, surgery, and radiopharmaceutical therapy, chemotherapy, immunotherapy, hormone therapy, and bisphosphonate therapy. According to the development of the disease, such therapy options are considered. For example, in the case of localized cancer-active surveillance, surgery or radiation therapy can be advised. For locally advanced stage- Androgen deprivation therapy and radiotherapy may be advised in combination or surgery may be seen as an option, although it is not commonly preferred. When the disease reaches the metastatic stage- Androgen deprivation therapy is general advice.

If cancer has spread beyond the prostate, treatment options change accordingly, so most experts who treat prostate cancer use a different type of nomogram to predict the probability of spread. Treatment by watchful waiting/active surveillance, HIFU, external-beam radiation therapy, brachytherapy, cryosurgery, and surgery are, in general, advised to men whose cancer remains within the prostate.

Follow-Up

Follow-up after prostate cancer treatment depends on the risk group and the type of treatment you had. If you had surgery, radiation therapy, hormone therapy, or a combination of these treatments, follow-up visits are usually scheduled: every 3 to 6 months for the first 5 years and once a year after 5 years.

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