Prostate Cancer: What are the Symptoms and Treatment?

Prostate cancer is characterized by the presence of cancerous cells in the prostate (part of the male reproductive system). Prostate adenocarcinomas are one of the most common types of cancer in males. Prostatic intraepithelial neoplasia can increase the chance of prostate cancer.

Stages of prostate cancer –

Stage I, II -Cancer is confined to the prostate only
Stage III – Cancer has extended beyond the prostate to nearby lymph nodes.
Stage IV – Cancer has spread to other parts of the body.

What Causes Prostate cancer?

Studies have found that prostate cancer can be caused by different DNA mutations like a mutation in:

BRCA1 and BRCA2 genes, DNA mismatch repair genes, HOXB13, RNASEL. ¹

What are the Risk Factors?

Age
Race/ethnicity
Geography
Family history
Lynch syndrome
Obesity

Signs and symptoms

It shows no symptoms at an early stage.

Trouble urinating
Blood in the urine or semen
Bone pain
Weight loss
Erectile dysfunction
Slow or weak urinary stream

What are the Complications?

Secondary cancers, Incontinence (lack of voluntary control over urination), and Erectile dysfunction.

Diagnosis: How to diagnose Prostate cancer?

Medical history – Check for symptoms and other risk factors.
Physical examination – Digital rectal exam (DRE), Prostate-specific antigen (PSA) test.
Diagnostic tests – The tests performed are:
- Computerized tomography(CT) scan : Series of x-ray images taken at different angles
- Positron emission tomography (PET) scan : A procedure that uses radioactive glucose to find malignant tumor cells in the body.
- Magnetic resonance imaging (MRI) : A procedure that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the body.
- Prostate biopsy
  - Core needle biopsy (larger needle used to collect lung tissue)
- Transrectal ultrasound (TRUS)– A procedure in which high-energy sound waves (ultrasound) are used to form a picture of lungs called a sonogram.
- Other lab tests may include blood tests, urine tests, Prostate Health Index (PHI), 4Kscore test, and PCA3 tests (such as Progensa).

Treatment: How is Prostate cancer treated?

Surgery is the main treatment for most prostate cancers.

Surgery :
Radical prostatectomy – Main type of surgery
Entire prostate gland is removed with some surrounding tissue and few lymph nodes.
Radiotherapy
- 1. External radiation therapy uses a machine outside the body to send radiation toward cancer.
- 2. Internal radiation therapy uses a radioactive substance that is placed directly into or near cancer.
Cryotherapy
- Use of very cold temperatures to kill cancer cells
Hormone therapy
1. Treatment to lower testicular androgen levels
  1. Orchiectomy–
    - It is a type of surgery but acts as a form of hormone therapy
    - Surgery to remove testicles
  2. LHRH agonists – Leuprolide (Lupron, Eligard), Goserelin (Zoladex),Triptorelin (Trelstar)
  3. LHRH antagonists – Degarelix, Relugolix (Orgovyx)
2. Treatment to lower androgen levels from the adrenal glands – Abiraterone (Zytiga), Ketoconazole.
3. Anti-androgens – Flutamide (Eulexin), Bicalutamide, Enzalutamide.
Chemotherapy uses anti-cancer drugs to kill and stop the growth of cancer cells
Medications-
- Docetaxel (Taxotere)
- Cabazitaxel (Jevtana)
- Mitoxantrone (Novantrone)
- Estramustine (Emcyt)
Immunotherapy
- Cancer vaccine– Sipuleucel-T (Provenge) – specific for each man
- Immune checkpoint inhibitor–
  - The immunotherapy drug pembrolizumab (Keytruda) ( PD-1 protein inhibitor) is approved to treat tumors that have either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.

Targeted therapy: Identify and attack specific cancer cells without harming normal cells
- PARP inhibitor– Rucaparib, Olaparib.

Prevention: Can we prevent it?

Prevention of Prostate cancer –

Prostate cancer can not be prevented but some factors may reduce the risk of prostate cancer such as –

Healthy weight
Physical activities
Some drugs may reduce the risk of cancer – e.g., 5-alpha reductase inhibitors.

Living with Prostate cancer–

Follow-up care ( doctor visits and tests)
Staying at a healthy weight
Regular physical activities

When to see a doctor? :

It is wise to consult with a urologist immediately if observed any symptoms. The typical consultation fee for a urologist ranges from Rs. 500 to Rs. 1500 in India.