Dr. Bhoopat Singh Bhati - Prostate Cancer: Symptoms, Diagnostics And Treatment

Prostate Gland: Overview

• The prostate is a walnut-sized gland located below the bladder in males.

• It surrounds the urethra and produces seminal fluid, which is essential for sperm nourishment and transport.

• The gland enlarges with age, particularly after the age of 50, increasing the risk of cancer.

Epidemiology

• In India, prostate cancer is:

  • The second most common cancer among men in Delhi and Karnataka.

  • The third most common in Mumbai.

• Globally, it is the sixth leading cause of cancer-related death in men.

Risk Factors

• Advancing age: The risk increases significantly after the age of 50.

• Family history: There is a higher risk if a father, brother, or grandfather has prostate cancer.

• Genetics: BRCA1 and BRCA2 gene mutations increase risk.

• Ethnicity: African-American men are more prone globally.

• Lifestyle: Obesity, smoking, sedentary habits, and high-fat diets may contribute.

Symptoms

• Asymptomatic in early stages; often detected during routine health checks.

• Urinary symptoms:

  • Difficulty in urination.

  • Increased frequency, especially at night.

  • Weak or interrupted stream.

  • Post-micturition dribbling.

• Advanced symptoms:

  • Blood in urine or semen.

  • Bone pain, especially in the back.

  • Limb swelling (from lymphatic spread).

Diagnostic Tools

1. Clinical Examination: Digital Rectal Examination (DRE): Assesses prostate size, texture, and abnormalities.

2. Blood Tests: PSA (Prostate-Specific Antigen): A screening marker for prostate cancer.

3. Imaging Studies: Trans rectal Ultrasound (TRUS) and Multipara metric MRI.

4. Biopsy: Typically, 12 cores are taken under local anesthesia and help confirm the diagnosis through histopathology.

5. Staging Investigations: A PET scan or bone scan is used to assess the spread, especially to the bones.

Treatment Options

1. Active Surveillance:

   • For low-grade, localized tumours in older patients.

   • Regular PSA tests and monitoring every 6 months.

2. Surgical Interventions:

   • Robotic-assisted Radical Prostatectomy:

     • Minimally invasive, faster recovery, and better precision.

   • Laparoscopic/Open Surgery:

     • Alternatives where robotic surgery is unavailable.

   • Goal: Complete removal of the prostate and reconnection of the urinary tract.

3. Radiation Therapy:

   • External Beam Radiation Therapy (EBRT) or Brachytherapy.

   • Effective in localized disease or for patients unfit for surgery.

4. Hormonal Therapy (Androgen Deprivation Therapy - ADT):

   • Reduces testosterone to control tumour growth.

   • Includes medical (injections/tablets) and surgical methods (orchiectomy).

   • Drugs include Enzalutamide, Abiraterone.

5. Chemotherapy:

   • Used in advanced, metastatic, or hormone-resistant cases.

   • Targets rapidly dividing cancer cells.

6. Immunotherapy and Targeted Therapy:

   • Emerging options targeting specific cancer cell markers.

   • Improve outcomes in selected advanced-stage patients.

Preventive Measures

1. Healthy Lifestyle:

   • Regular exercise (45 minutes/day).

   • Maintain a healthy body weight.

   • Avoid tobacco and alcohol.

2. Balanced Diet:

   • Rich in vegetables, fruits, and whole grains.

   • Lycopene (tomatoes), broccoli, cauliflower, and green tea may offer protective benefits.

3. Hydration:

   • Adequate water intake is essential for supporting urinary health.

4. Supplements:

   • No FDA-approved supplements for prevention.

   • Long-term benefits have been noted with Omega-3, Vitamin D3, Zinc, and Selenium (consult your physician).

5. Routine Screening:

   • PSA testing and DRE after age 50, or earlier if there is a family history.

   • Helps in early detection and the initiation of curative treatment.

Conclusion

• Prostate cancer is a common and potentially curable disease when diagnosed early.

• Routine screening and awareness are essential, especially for men over 50.

• A multidisciplinary treatment approach, ranging from active surveillance to advanced therapies, offers favorable outcomes.

• Adopting a healthy lifestyle and staying informed are crucial to prevention and maintaining an improved quality of life.