Prostate Cancer

How to diagnose prostate cancer?

Digital rectal examination- The rectum is located close to the prostate gland. The doctor will examine the through the rectum. If your prostate gland is cancerous, it may feel very hard and nodular. However, very often, the prostate may feel quite normal, even though cancer cells are present. This is major disadvantage of DRE

PSA test- A sample of blood is taken for prostate-specific antigen (PSA). A small amount of PSA is generally found in blood. Men who have Prostate cancer tend to have more amount of PSA in their blood. However, the PSA test cannot be always relied upon and sometimes, men who have prostate cancer will have normal PSA. The increase in the PSA level could be also due to several other factors such as urine infections, recent prostate biopsies, having a urinary catheter, prostate or bladder surgery or a prostatic massage etc. PSA levels higher than normal may be due to prostate cancer or other causes. A biopsy often recommended by doctor if PSA is persistently elevated.

TRUS guided Prostate Biopsy- Biopsy is recommended if PSA is persistently elevated or DRE shows abnormal features. Numerous samples of tissue (usually 12 from all the sites of prostate) are taken  by biopsy from the prostate for pathological examination. The biopsy is generally performed under Transrectal ultrasound scan.

If the biopsy shows the presence of prostate cancer, several other tests performed to determine the stages of diseases

  • Radio-Isotope bone scan
  • MRI scan
  • PSMA PET Scan
  • Abdomino Pelvic CT Scan

What are the staging of prostate cancer?

Grossly there are three stages of diseases, localised or early prostate cancer , locally advanced, advanced or metastatic prostate cancer

What are the treatment options for localised or early prostate cancer

The major treatment options for early prostate cancer include:

  • Watchful waiting
  • Active surveillance
  • Surgery or removal of the prostate gland
  • Radiotherapy

Low grade disease, elderly patient often advised for watchful waiting. Treatment started once the symptoms develops. Young people who have low-grade early prostate cancer may be recommended active surveillance. If the cancer starts to progress, they will be asked to undergo surgery or radiotherapy. People who have moderate- to high-grade cancer are often recommended Radical Prostatectomy or surgery to completely remove the prostate gland or radiotherapy of the prostate. These treatments help to eliminate all the cancer cells and thus cure the cancer. The radiotherapy can be given to the patient using an external machine or even directly into the prostate gland.

What are the treatment options for locally advanced prostate cancer?

The treatment options for locally-advanced prostate cancer mainly include Radiotherapy, Hormonal therapy, Watchful waiting and Surgery. Sometimes in combination of treatment. There are certain factors which are taken into account prior to deciding the best treatment options. This includes physical health, grade and stage of diseases, PSA level, potential risk of treatment etc.

What are the treatment option of advanced Cancer prostate?

The treatment options for advanced prostate cancer mainly include Hormonal therapy (Medical or surgical castration)  Chemotherapy, Radiotherapy and controlling symptoms. Radical surgery is not recommended. However TURP may be performed to alleviate the symptoms. Treatment is mailnly directed to improve the quality of life