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A Comprehensive Guide to Prostate Cancer - CancerMitr

PROSTATE CANCER

Prostate cancer is one of the most commonly reported cancers among men above 65 years of age. It is the fifth most commonly reported cancer in the world and the sixth leading cause of death among men globally. Due to the prevalence of cancer screening and testing, notably the PSA (prostate-specific antigen) test, prostate cancer is most frequently reported in countries such as Australia, New Zealand, Western and Northern Europe, and North America.

While there are only a few population-based registries in India, prostate cancer is unquestionably one of the top ten most reported malignancies there. However, the real statistics are still up for debate.

Continue reading this article to get an overall idea about prostate cancer.

What Is Prostate Cancer?  

Prostate cancer is a condition where abnormal tumour cells form in the prostate gland. The prostate gland is located just below the bladder in men, and its primary function is to secrete substances that nourish and transport sperm. It is as big as a walnut and surrounds the urethra, just under the bladder. This gland contains an enzyme called 5-alpha reductase, which converts testosterone into DHT (dihydrotestosterone).

Cancer is a disease characterized by abnormal cell division and the growth of a mass of cells known as a tumour. This tumour divides abnormally, breaks away, spreads, and creates new tumours in various regions of the body. Like other kinds of cancer, prostate cancer is life-threatening and should be treated as soon as possible.

What Are the Different Types of Prostate Cancer?

Prostate cancer types are categorized depending on their point of origin. The various types of prostate cancer are as follows:

Adenocarcinoma: It is the most commonly reported prostate cancer. It develops in the gland cells that line the prostate and the tubes of the prostate gland. There are two types of adenocarcinomas:
– Acinar adenocarcinoma of the prostate: This is the most reported adenocarcinoma of the prostate and develops in the gland cells that line the prostate.
– Ductal adenocarcinoma of the prostate: It develops in the cells that line the prostate gland ducts and grows slowly. According to research, it can take up to eight years for ductal adenocarcinoma of the prostate to spread.

Transitional Cell Carcinoma of the Prostate: Also known as urothelial carcinoma of the prostate, transitional cell carcinoma begins in the cells that line the urethra (the prostate gland surrounds the urethra, below the bladder). It begins in the bladder and then slowly spreads into the prostate. It is a rarely reported prostate cancer, accounting for only 2-4% of all reported prostate cancers.

Squamous Cell Carcinoma of the Prostate: It is a type of cancer that begins in the flat cells that cover the prostate gland and grows and spreads quicker than adenocarcinoma.

Small Cell Prostate Cancer: It is a form of neuroendocrine cancer that grows swiftly in comparison to other tumours. It is most typically documented in advanced stages of cancer as a result of treatment resistance.

Prostate Sarcoma: It is a rare type of malignant tumour that forms in the prostate gland. This type of cancer arises from the mesenchymal cells, which are located in and around the prostate gland.

Cancerous growth in Pancreas

What Are the Notable Signs and Symptoms of Prostate Cancer? 

– Frequent urge to urinate, especially at night
– Interrupted flow of urine and the need to strain while urinating
– Blood in the urine
– Erectile dysfunction
– Pain or burning sensation while urinating
– Discomfort while sitting (due to an enlarged prostate)
– Pain in the back, pelvis, thighs, bones, or shoulders
– Swelling or fluid buildup in the legs or feet
– Fatigue
– Unexplained weight loss
– Change in bowel habits

It is important to note that some of these symptoms are similar to benign prostatic hyperplasia (BPH), an age-related condition characterized by the growth of the prostate gland.

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What Are the Different Stages of Prostate Cancer?

Prostate cancer is staged under the TNM staging system developed by the American Joint Committee on Cancer (AJCC), depending on the results from the PSA (Prostate Specific Antigen) tests. It focuses on the tumour’s size (T), whether cancer has spread to nearby lymph nodes (N), and whether it has spread to distant sites or metastasized (M).

There are four important prostate cancer stages:

– Stage I: Tumour is localized, and PSA levels are low.
– Stage II: Tumour is localized in the prostate gland region but is bigger than stage I, and PSA levels are medium.
– Stage III: Cancer has spread to lymph nodes, and PSA levels are high.
– Stage IV: Cancer has spread to distant sites or metastasized.

Are you having unusual back pain? Urine that is dark in colour? Tiredness or a loss of appetite?

Don’t be concerned! Early testing and screening provide the necessary answers. But, even if you face these difficulties, CancerMitr is here to help you navigate the path from disease discovery to recovery. To learn more about our services, please visit our website.

What Are the Different Grades of Prostate Cancer?

The most commonly used prostate cancer grading system is the Gleason grading system. The cancerous tumour is evaluated after being examined under a microscope, depending on how similar it is to healthy cells. The medical experts assign a value depending on how similar the cancer cells look to normal ones. Gleason scores are as follows:

– Gleason X: The score cannot be determined.
– Gleason 6 or lower: Cancer cells are well-differentiated or look similar to healthy cells.
– Gleason 7: Cancer cells are moderately differentiated or look somewhat similar to healthy cells.
– Gleason 8-10: Cancer cells are poorly differentiated or undifferentiated because they look very different from healthy cells.

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How Is Prostate Cancer Diagnosed?  

Medical experts feel the patient’s abdomen, penis, and testicles for anything unusual, depending on the symptoms specified by the patient. Certain blood tests and imaging tests help in diagnosing the disease in its early stages. Some of the diagnostic methods are as follows:

Digital rectal examination (DRE) is a method where medical experts try to feel the presence of tumours or any other abnormalities by feeling the patient’s rectum. This method need not be reliable when it comes to detecting early-stage prostate cancer.

Prostate-specific antigen (PSA) test is a lab test that checks for the presence of PSA proteins in the blood. Higher levels suggest possible inflammation, benign prostate hyperplasia (BPH), and cancerous tumor growth. There is another test that checks for free PSA or prostate-specific antigens found in the bloodstream that are not bound to proteins.

Transrectal ultrasound (TRUS) is a type of ultrasound test in which a medical professional inserts a probe into the patient’s rectum, where sound waves bounce off the tumor and form a picture.

It is an imaging test that combines magnetic resonance imaging (MRI) and TRUS. Computer software compares data from both MRI and TRUS to generate a 3-dimensional image with the precise location of the tumour in the prostate gland.

Medical experts use various imaging tests, including CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and whole-body bone scans, to check if the prostate cancer has metastasized to other body parts.

What Are the Various Treatment Methods for Prostate Cancer?  

Surgery

Surgery is a crucial method to treat prostate cancer. Often, medical experts remove the prostate gland and the nearby lymph nodes. A urologic oncologist or surgical oncologist performs the operation.

  • Radical (open) prostatectomy: The entire prostate gland and seminal vesicles, along with nearby lymph nodes, are surgically removed.
  • Robotic or laparoscopic prostatectomy: A less invasive surgical process where small keyhole incisions are made on the patient’s abdomen, through which the surgeon removes the prostate gland.
  • Bilateral orchiectomy: A surgical procedure where both testicles are removed.
  • Transurethral resection of the prostate (TURP): A surgical procedure to treat urinary blockage, not meant to treat prostate cancer but other urologic cancers or conditions requiring prostate tissue removal.
Radiation therapy

It is a cancer treatment process that involves the use of high-energy rays to target and destroy cancer cells. The most common type of radiation treatment is External-Beam Radiation Therapy, where a beam of X-rays is shot from the machine to the body part with a cancerous tumour. However, prostate cancer is often treated with brachytherapy or internal radiation therapy, where the radioactive sources or “seeds” give off radiation around the spots where they are inserted.

Proton Therapy

It is a type of external beam radiation therapy that uses protons instead of X-rays to target and destroy cancer cells. However, according to researchers, proton therapy is not as effective as traditional radiation therapy when it comes to treating prostate cancer. But, medical experts often suggest it as an option for patients.

Chemotherapy

Chemotherapy is a treatment process where powerful drugs are administered into the patient’s body to target and kill cancerous cells. It is administered before therapy to prevent malignant cells from dividing and to reduce them as much as feasible to facilitate surgery, a process called neoadjuvant chemotherapy. It is also given to patients following treatment processes such as surgery and radiation therapy to prevent metastasis by eliminating cancer cells that have spread from their original location.

Androgen Deprivation Therapy

The growth and spread of prostate cancer cells are driven by a male hormone called androgen. The most common form of androgen is testosterone. Prostate cancer’s growth can be controlled by lowering the testosterone levels in the body. Medical experts surgically remove the testicles, called surgical castration, or administer medications to inhibit or turn off the testicular functions, called medical castration.

Targeted Therapy

It is a process that focuses on destroying the cancer and its ability to grow and survive by targeting genes, proteins, or the tissue environment that contributes to its growth. This type of treatment is useful because it limits the damage done to healthy cells.

Immunotherapy

It is a process where the body’s natural defenses are enhanced to target and destroy cancerous cells. Immunotherapy is suggested for those cancer patients who are not responding to androgen-deprived hormone therapy.

What Are the Different Side Effects of Prostate Cancer Treatment?

Common side effects of prostate cancer treatment include:

  • Fatigue
  • Sores in the mouth and throat
  • Bowel health issues like constipation or diarrhoea
  • Nausea and vomiting
  • Constipation
  • Bleeding or blood clotting issues
  • Peripheral neuropathy
  • Brain or memory issues
  • Appetite loss
  • Pain
  • Hair loss

Androgen deprivation therapy can lead to serious health issues like erectile dysfunction, hot flashes, and gynecomastia. Testosterone imbalance causes other health issues like osteoporosis, loss of muscle mass, weight gain, memory loss, and heart health conditions. Surgery can lead to the inability to urinate, blockage, or even bleeding or burning while urinating.

What Are the Various Supportive Therapies for Prostate Cancer Patients?  

Mental Health Treatment: Patients tend to suffer from body image issues and other mental health diseases like stress and depression as a result of androgen deprivation. Mental health diseases require adequate attention and treatment, along with counselling. Patients and caregivers can approach psychologists who deal with cancer patients. Click here for mental health services.

Testicular Prosthesis Surgery: Testicular prosthesis surgery is a process where an artificial implant is placed in the scrotum after surgical castration. Patients who have had both their testicles removed as per the surgical castration treatment to reduce exposure to androgens can have their scrotum appearance retained through this process. This process helps the patient cope with their physical appearance and regain self-esteem. Click here for surgery and other services.

Kegel Exercises: Kegel exercises, or pelvic floor exercises, strengthen the pelvic floor muscles. It is a process where men pretend to urinate and then hold it by relaxing and tightening the muscles that control urine flow. Men who have undergone surgery, radiation therapy, or any treatment that causes urinary health problems and muscle health issues can make use of this exercise. As per experts, it is one of the most effective ways to control incontinence without the need for medication or surgery.

Acupuncture and Acupressure: Patients who experience numbness, pain, and fatigue can make use of treatment options like acupuncture and acupressure. Acupuncture is a treatment process where medical experts insert thin needles into the skin to treat various health issues. Acupressure is an alternative to acupuncture, where various acupuncture pressure points are pressed with fingers to ensure energy flow.

Ozone Penis Rejuvenation: It is a procedure where ozone is supplied to the penis to reach a healthy circulation level. It enhances the firmness of the penis and improves circulation and sexual performance.

What Lifestyle Changes Are People with Prostate Cancer Expected to Make?

Intermittent fasting helps in slowing down tumor growth and coping with symptoms like nausea and vomiting. Patients can try 16:8 fasting with 16 hours long fast and food consumption within 8 hours. Fasting reduces glucose levels in the blood, affecting the growth of cancer. However, it is imperative to seek advice from a suitable onco-dietician to know whether it is safe to undergo intermittent fasting.

To replenish their healthy cells with vitamins and minerals, patients should consume more fruits, vegetables, nuts, herbs, beans, and whole grains. Lean protein options like Greek yogurt, peas, and lentils help in maintaining muscle mass. It is better to avoid spicy and acidic food items until the nausea and vomiting symptoms subside. Patients should try having smaller portions of food frequently rather than three heavy meals.

It is better to quit smoking because it eases the side effects of radiation and chemotherapy. Patients who have quit smoking are less likely to get certain urinary tract health issues after radiation therapy. There are nicotine gums, patches, and medications that can help people quit smoking.

Patients should talk to their doctors about whether it is safe to consume alcohol during prostate cancer treatment. Alcohol can irritate the bladder and worsen nausea and vomiting.

What Are the Important Follow-Up Care Steps After Prostate Cancer Treatment?

Patients should communicate with their doctors about complications they experience after treatment, such as urinary problems, stiffness in the penis, pain (in the abdomen, hips, pelvis, or back), loss of strength in leg muscles, blood in urine, bleeding from the anus or rectum, and breathlessness.

Patients who have undergone surgery, radiation therapy, or hormone therapy are expected to schedule follow-up visits every 3-6 months for the first five years. If the cancer does not recur after five years, then patients can visit the doctor once every year. During the follow-up visits, the medical practitioner conducts DRE and PSA tests, followed by imaging tests in case of suspicions.

In conclusion,

Early detection plays a crucial role in controlling and potentially curing prostate cancer, similar to other cancers. Recognizing symptoms such as difficulty in urination or blood in urine is vital and should never be ignored. For men over 50, urologists often prioritize prostate health, especially when urinary issues are present. Regular PSA tests are instrumental in early diagnosis, thereby increasing the chances of successful treatment and management of prostate cancer. Through vigilant monitoring and timely medical intervention, the prognosis for prostate cancer can be significantly improved.

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