Prostate Cancer in India

Prostate cancer occurs when cells in the prostate gland divide rapidly and uncontrollably. The prostate gland is present only in males. Its function is to produce semen fluid to carry the sperm. 

The location of your prostate gland is below the bladder and in front of your rectum. When you are young, the gland will only be the size of a walnut, but increases in size as you age.

It is one of the most common cancers in men. You have a ten percent chance of having it during your life. 

There are tests to detect prostate cancer in the early stages. It helps in improving the success of treatment.

Most of the early symptoms appear when you pass urine. Obstruction to the flow of urine is the most common one.

Removal of the gland by surgery is the most common treatment. Other treatments include radiation, chemotherapy, immunotherapy, etc.

Symptoms of Prostate cancer

If you have prostate cancer, you will have problems with urination. It is because the urethra, the tube that connects your urinary bladder to the penis, passes through the prostate. As the prostate increase in size, it puts pressure on the urethra to cause problems while passing urine.

Prostate cancer can be asymptomatic in many cases.  

Some of the common early symptoms are

• An increase in the frequency of urination- It is present during the day as well as the night.
• Difficulty while passing urine- You may have a very weak flow than usual. Also, you may have to strain to empty your bladder. Even after straining, you may feel as if more urine is remaining in the bladder.
• Inability to control your bladder- As the problem advances, you will find it difficult to control your urge to urinate. You may need to pass urine the moment you feel like doing so. Trying to hold it even for a short time becomes a major problem.
• Pain while urinating
• Presence of blood in urine or semen

Prostate cancer will spread to other parts of the body as it advances. Some of the symptoms then are

• Pain in the bones of the lower back
• Feeling very tired without a reason
• Difficulty in breathing
• Losing weight without any reason

Types of Prostate cancer

About 95% - 99% of all prostate cancers are adenocarcinomas. These can be of two types – Acinar adenocarcinoma, which develops in the cells that line the prostate. The other type, Ductal adenocarcinoma, which begins in the cells that line the ducts of the prostate gland, spread faster.

Sarcomas, small Cell, and transitional carcinomas are a few other types of prostate cancer.

Prostate Cancer Stages

1. Stage I- These prostate cancers are small and have not grown outside the prostate. 
2. Stage II- The cancer is limited to the prostate but has become larger.
3. Stage III-Cancer has grown beyond the prostate. 
4. Stage IV-Cancer has spread to nearby structures like bladder or rectum, the lymph nodes and distant organs like bones, lungs, brain, etc. 

Cause and risk factors

The exact cause of prostate cancer is still not known. The risk factors for prostate cancer are:

• Age- more commonly found in those above the age of 60.
• Family history- Having a father or brother with prostate cancer doubles the risk. 
• Ethnicity- It is more common in African and Afro- American population.
• Gene changes- Inherited mutations of the BRCA1 or BRCA2 genes raise the risk of men.
• Diet- Diet rich in red meat and dairy products may increase the risk.
• Obesity
• Smoking
• Exposure to certain chemicals 
• Inflammation of the prostate

Diagnosis of prostate cancer

If you have any of the symptoms of prostate cancer, your doctor will make you do a few tests.

• Digital rectal examination- Your doctor will insert a gloved- finger through your rectum to feel the prostate gland. If there is any enlargement, your doctor will be able to feel it
• Prostate-Specific Antigen (PSA) test- Prostate produces PSA, a protein that is present in the blood. If there is an enlargement of the prostate as in prostate cancer, the amount of PSA in blood will be higher. If your blood test shows more than normal of PSA, you will have a biopsy.
• Biopsy- Your doctor will take a tissue sample from your prostate and look for cancer cells in it by using a microscope. The presence of cancer cells confirms prostate cancer

Treatment for Prostate cancer

Your prostate cancer treatment will depend on the stage of the disease. If your cancer is growing very slowly and your symptoms are few, the doctor may postpone your treatment. You will have periodic check-ups to assess the extent of the enlargement. You will have treatment once the doctor feels that the cancer is getting aggressive.

Surgery for prostate cancer

Surgery is the most common treatment for cancer that is limited to the prostate. During the operation, the surgeon will remove the prostate gland altogether and surrounding lymph nodes. You will have general anesthesia, which will put you to sleep during surgery. The surgeon will then remove your prostate gland along with the seminal vesicles. The duration of the operation will be around two hours. Your recovery will take around a week to ten days. 

You will have either open surgery or a laparoscopic or ‘keyhole’ surgery. Robotic surgery is the latest type of surgery for prostate removal. 

In open surgery, your surgeon will make a long incision in your pubic area to reach the prostate gland. 

In keyhole surgery, there will only be two or more small incisions. The benefits are faster recovery time, fewer risks, and complications. 

In robotic surgery, the surgeon uses robotic arms to remove the prostate. Your surgeon carries out the operation by controlling these arms with the help of a console and monitor. The main advantage of the surgery is its high precision level. Complications are fewer with this surgery.

Prostate removal surgery, in general, has a few risks. These include

• Problems with urination
• Erection and other sexual problems 
• Change in the length of the penis

Radiation treatment for prostate cancer

It uses high-energy X -rays to destroy your tumor. There are different types of radiation treatment, according to the source, strength, and precision. The main types are

1. IMRT- Intensity-modulated radiation therapy
2. IGRT- Image-guided Radiation Therapy
3. SBRT/ SRS- Stereotactic body radiation therapy/ Stereotactic radio-surgery

You will have the treatment in cycles with periods of rest in between. The gap is to help you to recover from the side-effects. 

Brachytherapy is internal radiation treatment. In this treatment, your surgeon will keep a radioactive pellet close to cancer. The pellet will emit radiations that help to destroy the tumor. The side effects are very less with this method.

Hormone therapy for prostate cancer

In this treatment, you will have medicines to reduce the levels of your sex hormones, mainly testosterone. It helps to prevent the tumor from becoming larger as cancer cells feed on these hormones to grow and divide.

You will have this treatment if surgical removal of your tumor is not possible, or if it has come back after treatment. It also helps to shrink the tumor before surgery or radiation. This therapy will be either in the form of tablets or as an injection.

Chemotherapy for prostate cancer

In this treatment, you will have medicines that help to destroy the cancer cells. You will take the medicines through the mouth or as an injection through the veins. 

The duration of treatment will be for a few days, called a ‘cycle’. Then, you will have a period of rest to help you to recover from the side-effects. The number of cycles will depend on the stage of your disease.

Immunotherapy 

It is a newer form of treatment. They are directed precisely against cancer cells, so there will not be any impact on healthy cells. It also boosts the human body immunity to fight cancer