“All you need to know about Prostate Cancer”

— Get Well in India

Introduction

The surgery for prostate cancer removes the whole prostate and the prostate cancer cells inside it. The prostate is a gland that sits between the penis and the pelvis and produces the white sticky liquid that is mixed with sperm to make semen.

Other kind of cancers related to the prostate gland, includes:

  • Sarcomas
  • Small cell carcinomas
  • Neuroendocrine tumors
  • Transitional cell carcinomas

Prostate cancer occurs when abnormal cells develop in the prostate, forming a tumour which is malignant in nature. These cells multiply  and spread outside the prostate in the vicinity.

Prostate cancer generally grows slowly. The majority of men with prostate cancer live for many years or decades without painful symptoms, and without it spreading and becoming life-threatening.

Stages of Prostate Cancer: The stage of prostate cancer depends on whether the cancer has spread outside of the prostate or not or it is localised or early stage prostate cancer. But in another category of men, prostate cancer may grow more quickly and may also spread to other parts of the body. This is called advanced prostate cancer.

There are different stages of advanced prostate cancer:

  • Locally advanced prostate cancer: The cancer has extended beyond the prostate into bladder or rectum or seminal vesicles which produces semen.
  • Metastatic prostate cancer: The cancer has spread to distant parts of the body such as lymph nodes and bone.

Head doctors

Dr. Boman Dabur

Dr. Boman Dabur

Prostate Cancer Specialist
Dr. Rajesh Mistry

Dr. Rajesh Mistry

Cancer Specialist
  • Anatomy

    The prostate is a gland that stores urine. It is a gland of the male reproductive system. It is located in front of the rectum below the bladder. The size is of a chestnut. It is conical in shape. It consists of a base, an apex, anterior and posterior surfaces and two lateral surfaces.

    The main purpose of the prostate is to produce fluid for semen, which transports sperm during the male orgasm.

    There are distinct lobes that make up the structure of the prostate:

    • On the anterior end are the two lateral lobes. They are the largest lobes and meet at the midline of the prostate.
    • Posterior and medial to the lateral lobes is the much smaller anterior lobe which contracts to expel semen during ejaculation.
    • The median lobe which contains the ejaculatory ducts of the prostate.
    • The posterior lobe which forms a thin layer of tissue posterior to the median lobe and the lateral lobes.

    The prostate contains two main types of tissue: exocrine glandular tissue and fibromuscular tissue. Exocrine glandular tissue in the prostate is epithelial tissue specialized for the secretion of the components of semen. Most of the prostate is made of exocrine glandular tissue. Fibromuscular tissue is a mixture of smooth muscle tissue and dense irregular connective tissue containing many collagen fibers.

  • Symptoms

    If you have prostate cancer, you might experience the following symptoms:

    • Trouble urinating
    • Decreased force in the stream of urine
    • Blood in semen
    • Discomfort in the pelvic area
    • Bone pain
    • Erectile dysfunction

    These symptoms does not mean you have cancer, but if one or more of them are noticed for more than two weeks then you must see a doctor and get an immediate health screening.

  • Diagnosis

    In many cases, prostate cancer causes no symptoms till advanced stage. So to confirm the diagnosis, your doctor will ask you to do tests like TRUS prostate biopsy, MRI prostate, Cystoscopy, ultrasonography, CT-scan, blood test, Urine culture, intravenous pyelogram (IVP) .

    After looking at reports, your doctor might recommend periodic checks with Digital rectal exam (DRE) and the Prostate-specific antigen (PSA) test. If the PSA levels are Elevated, then it can be an indication of cancer, infection, inflammation or non cancerous enlargement. Transrectal Ultrasound is done for further diagnosis.

Stages & Treatment Details

On the basis of your test results, your treatment will be decided. If biopsy suggests a tumour then patient will need surgery. If biopsy results in benign then you will need TURP and if biopsy results in malignant then you will need radical prostatectomy.

The Gleason score is determined after biopsy from the samples taken from different areas of the prostate. It is a system of grading prostate cancer tissue, ranges from 2-10 indicating how likely a tumor will spread. A low Gleason score means cancer tissue similar to normal prostate tissue and its less likely to spread. A high Gleason score indicates tumor is more likely to spread .

Surgery:

TURP: Transurethral resection of the prostate (TURP) is a type of prostate surgery which aims to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).

A TURP operation does not cure the cancer. It helps with one of the most common symptoms of prostate cancer, which is difficulty passing urine. This happens when the enlarged prostate presses against the urethra, causing it to narrow.

Possible side effects of TURP include:

  • Problems urinating which improves over time
  • Stress incontinence
  • Blood in urine for the first couple of weeks
  • Urine infection
  • Slow urine flow caused by scar tissue
  • Erectile dysfunction

Radical Prostatectomy: A radical prostatectomy may be offered to men with localized prostate cancer who are otherwise fit and healthy. If the cancer has spread outside of the prostate, this operation may not be suitable.

During a radical prostatectomy, the whole prostate gland is removed with seminal vesicles along with the nearby lymph nodes.

Radiotherapy: It involves radiations to kill cancerous cells. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Radiotherapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms.

Radiation may be used:

  • As the first treatment for low-grade cancer when it is in the prostate gland.
  • As a combination of treatments for cancer that has grown outside of the prostate gland and into nearby tissues.
  • If there is any residual cancer or recurrence in the area of the prostate post surgery.
  • To reduce the size of the tumor, if the cancer is well spread and the tumour is big.

The two main types of radiation therapy are external beam radiation and brachytherapy (internal radiation).

  • External beam radiation: It kills cancer cells by destroying the genetic material that controls how cells grow and divide. It also kills the healthy cells which may result in side-effects. External beam radiation for prostate cancer uses high-energy beams, such as X-rays or protons, to kill cancer cells.
  • Brachytherapy: It is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It is also known as internal or interstitial radiotherapy The radiation can be delivered using a number of tiny radioactive seeds that are surgically implanted into the tumour. This is called low dose-rate brachytherapy.

Hormone therapy: It is often used in combination with radiotherapy or may also be recommended after radiotherapy to avoid recurrence of cancer cells. This therapy is not used to treat localised prostate cancer in men who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own. Hormone therapy can be used to slow the progression of advanced prostate cancer and relieve symptoms.

Chemotherapy: It is mainly used to treat prostate cancer that has spread to other parts of the body and which is not responding to hormone therapy. Chemotherapy destroys cancer cells by interfering with the way they multiply. Chemotherapy does not cure prostate cancer, but can keep it under control and reduce symptoms.

The main side effects of chemotherapy are caused by their effects on healthy cells, such as immune cells. They include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting. Many of these side effects can be prevented or controlled with other medicines, which your doctor can prescribe for you.

Your body needs time to recover as prostate surgery is a major surgery. Typically patients stay in the hospital overnight after surgery and then need to recuperate at home for one to two weeks before returning to work.

Most men can start to drive a few weeks after surgery. You should avoid lifting heavy weight for several weeks after surgery. It usually takes about six weeks for most men to feel back to normal.

Pain Control: You will be given pain medication by mouth and through a vein (intravenously) in your hand or arm.

Constipation: The combination of anesthesia, less physical activity, and narcotic pain medicine often creates problems with bowel function. You may be prescribed stool softeners or laxatives. Drinking fluids, walking, and eating frequent, small, easily digestible meals will help relieve constipation.

Swelling: You may experience fluid weight gain and swelling in your legs, lower abdomen, and scrotum. You will need to eat painkillers and rest fully.

Catheter: When you wake up after surgery you will have a urinary catheter. This is a tube inserted through your urethra into your bladder to drain urine. The catheter will be connected to a bag that is taped to your leg.

You need to take care while handling the catheter. You will probably need to keep the catheter for a week or two. After it is removed, you can start physical activity to strengthen your pelvic-floor muscles and help prevent or reduce incontinence.

Abdominal Drain: With removal of lymph nodes, you may have an abdominal drain to handle fluid that might collect in your abdomen. The tube will stay in place while you are in the hospital. It is important to take care of this as it drains away any lymph or urine that may temporarily leak into your pelvis.

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