Prostate Cancer

About The Prostate

The prostate is a gland that is only found in men. It lies just below the bladder and in front of the rectum. It makes fluid that forms part of the semen. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body).

What Is Prostate Cancer?

Prostate cancer is when abnormal cancer cells grow in the prostate and may spread from the prostate to other parts of the body, especially lymph nodes and bones.

Grades Of Prostate Cancer

Most prostate cancers are slow growing. However they are divided into low, intermediate and high risk categories. High risk prostate cancer can grow and spread rapidly compared to the low and intermediate grade prostate cancers and as such need to be treated appropriately at earlier stages of the disease.

Symptoms Of Prostate Cancer

In the early stages of prostate cancer does not exhibit any symptoms. However, in the more advanced stages it can cause

  • Difficulty in passing urine
  • Blood in the urine

A non-cancerous condition of the prostate called Benign Prostatic Hyperplasia (BPH) can also cause similar symptoms.

If the prostate cancer remains undetected and has spread to other parts of the body it is termed metastatic prostate cancer and causes pain in the pelvis and back bones. It can also block the tubes that drain urine from the kidney, leading to failure of the kidneys.

Risk Factors For Prostate Cancer

Age

The older a man gets the greater the chance of getting prostate cancer

Family History

Having a first degree relative with prostate cancer increases the risk 2 to 3 fold.

Diet

Some evidence does suggest that a diet high in processed meat, red meat or milk products can increase risk of prostate cancer.

Diagnosis

A variety of tests are required to confirm the diagnosis of prostate cancer. They include:

  • Examination (DRE)
  • Blood tests (PSA)
  • Imaging (MRI)
  • Prostate biopsy

DRE

This is where the urologist examines the prostate with his/her finger to assess size, abnormal texture or any modularity of the prostate.

While an abnormal examination may indicate prostate cancer a normal DRE does not exclude prostate cancer.

PSA

The prostate produces a protein called Prostate Specific Antigen (PSA). PSA prevents the semen from becoming too thick. While most of the PSA is in the semen, a very small amount gets into the blood. To determine the level of PSA in the blood a blood test is done. PSA blood test has a role in diagnosis and treatment of prostate cancer. In men with prostate cancer, PSA can leak from the prostate into the blood causing the PSA level to be higher than normal. However, a high PSA level does not automatically mean that prostate cancer is present. PSA levels in blood can also be elevated in other situations such as:

  • Prostate infection
  • Urinary tract infection
  • Enlargement of prostate
  • Trauma
  • After sexual activity

MRI

Due to the recent advent of the more powerful MRI machines (3T), scanning the prostate with an MRI machine can detect abnormal areas in the prostate more accurately. This allows more precise targeting of these areas during a biopsy.

Prostate Biopsy

To confirm a diagnosis of prostate cancer one requires a small piece of prostate tissue from the abnormal area to be assessed under a microscope. This is what a biopsy aims to do. Prostate biopsy can be done via the rectum or via the perineum using ultrasound or MRI guidance.

To find out more about Trans Rectal Ultra Sound (TRUS) biopsy Click Here.

To find out more about Transperineal Prostate Biopsy (TPB) Click Here.

Treatment

Treatment of prostate cancer depends on stage of cancer at the time of diagnosis. If detected early enough it is termed Localised prostate cancer (ie: cancer contained within the prostate).

Localised Prostate Cancer

This can be treated with:

If the cancer is of low volume and low grade. This requires regular surveillance of the cancer using PSA, prostate biopsy and MRI. If the cancer shows signs of progression then definitive treatment is advised.

This is when the whole prostate is removed. This operation can be done either via:

  • An Open approach. To find out more about open radical prostatectomy. Click Here.
  • Key Hole (laparoscopic) approach
  • Robotic approach. Click Here.
This is where radiation is used to eradicate the cancer cells in the prostate. Patients who opt for this treatment will be referred to a radiation oncologist.

Locally Advanced Prostate Cancer

This is where the cancer has left the confines of the prostate and started to spread to nearby structures. In such situations treatment options are:

  • Combined radical prostatectomy and radiotherapy. This is also called multimodal therapy and provides the best chance of cure.
  • Radiotherapy alone. In such cases higher doses of radiotherapy are used. Also called high dose rate (HDR) brachytherapy.

Metastatic Prostate Cancer

This is where the prostate cancer has spread to other organs such as lymph nodes and bone. In such cases cure as yet is not possible and attention turns to slowing the growth of prostate cancer and controlling symptoms.

Treatment is mainly by manipulation of testosterone levels. This can be done by:

Prostate cancer depends on testosterone for growth and by lowering the testosterone levels via injections it can shrink the tumour cells and slow their growth. However, ultimately after a few years the cancer will be able to grow without testosterone.
This is given when the cancer is no longer responsive to the hormone therapy. In such situations the patient will be referred to a medical oncologist.
When all treatment options are exhausted palliative care via palliative care physicians is offered.
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