Prostate cancer – symptoms, causes, diagnosis and treatment

Mr K P Gupta (name changed on request), a retired 63-year-old executive from Delhi came to us with a complaint of having to strain during urination. During his routine annual blood tests, he was found

By: Dr Ashwin Mallya | | Updated: June 10, 2014 6:40 pm

Mr K P Gupta (name changed on request), a retired 63-year-old executive from Delhi came to us with a complaint of having to strain during urination. During his routine annual blood tests, he was found to have a raised PSA value (prostate specific antigen). On asking for his family history, he told us that he had an uncle who suffered from prostate cancer. We advised an ultrasound which confirmed a 2 cm growth in the prostate gland which on biopsy turned out to be malignant. He underwent a surgery for removal of the prostate gland with the latest keyhole techniques and he is back to his normal active lifestyle within one month after the operation visiting his friends and going for walks in the evening which he cherishes. He has been advised to visit his doctor twice a year for follow up. In all likelihood he will go on to live his normal life span. So, as you can see, prostate cancer is not a death sentence. In this post, I shall try and explain more about it, its signs and symptoms and how it can be detected and treated Also Read - Mediterranean diet reduces the risk of prostate cancer progression: Study

The prostate gland (shown in picture) is an accessory sexual organ situated underneath the urinary bladder, in front of the rectum and covers a part of the urethra (the pipe through which urine is excreted). Its secretions form a part of the male ejaculate and nourish the sperm and keep the semen liquid. It is the size of a walnut in a normal adult male and increases in size with age. The development and growth of the prostate gland is dependent upon the male sex hormone testosterone. Also Read - 5 most common cancers in men and their risk factors

The main conditions that affect the prostate gland are infection (prostatitis), abnormal age related increase in size with age (also termed as BPH or benign hypertrophy of the prostate) and prostate cancer. Benign prostate hypertrophy (or BPH) is not cancer and does not cause cancer but can cause an increase in size of the gland leading to problems with urination and may require medications and in some cases even surgery. This article will mainly deal with Prostate cancer. Also Read - Why cancer risk is higher in men? The answer lies in the Y-chromosome

Prostate cancer is one of the leading causes of cancer in men above the age of 60. Most cases could be slow growing and may even go undetected and not cause any problem. Some could be aggressive and can spread to other parts of the body and are difficult to treat.

Symptoms of prostate cancer:

It usually presents with difficulty and pain during urination, blood in the urine along with sexual dysfunction. In many early cases there may be no symptoms and it may be detected incidentally on performing rectal exam, blood test, scan and biopsy. Advanced cases may present with bone pain in addition to the urinary symptoms.

Risk factors for prostate cancer:

Prostate cancer is very rare before the age of 40 but the risk increases with age and most cases are detected in the late 60s. Susceptibility to this cancer depends on various other factors:

Men who consume a diet rich in red meat and high fat dairy products and do not consume vegetables and fruits are more susceptible.
Men in the West, especially African-Americans are more susceptible than Asians
Obese men are more susceptible to it as compared to non-obese
A person is more susceptible to suffer from prostate cancer if he has a family history (if his brother or father suffered from the same). Genetic basis for prostate cancer has been identified and certain gene mutations can cause it.
There are some data linking prostate cancer to chronic prostatitis, sexually transmitted infections, smoking and alcohol consumption.

Diagnosis of prostate cancer:

Prostate cancer is most often detected in the early stages by a combination of clinical exam (rectal exam) and Serum PSA (Prostate specific antigen), a tumor marker that is useful in this disease. Further confirmation involves a biopsy of the prostate from the rectal route (most often) under local anesthesia and ultrasound guidance. This is a fairly painless procedure done usually by a Urologist and involves taking pieces from the prostate which will be examined under the microscope. If the diagnosis is confirmed a MRI scan of the pelvic area may be performed to look at the extent of disease. A chest X ray, ultrasound of the abdomen and bone scan may be ordered if there is suspicion of spread to these regions.

Fortunately in most cases, cancer of the prostate is not very aggressive and can be detected at a fairly early stage and treated by various modalities. The Urologist will make the decision regarding the modality of treatment to be used based on a combination of factors which includes age, physical fitness, co-morbidities, clinical stage of disease, biopsy findings and PSA levels.

Treatment options for prostate cancer:

Active Surveillance (wait and watch): No active treatment is done and the patient is followed up at regular intervals to see the progression of disease. This modality is used in elderly patients with short life expectancy and early disease.
Surgery: The operation performed to remove the cancerous tissue is called Radical prostatectomy. Depending on the extent, patient factors and expertise available it can performed via a fairly long cut in the abdomen, laparoscopically (key hole surgery) or even with Robotic surgical methods which is available at a few centres in India as well. The surgery has good success rates in expert hands but may have long term side effects like sexual dysfunction, urinary incontinence and narrowing of the urethra. Sometimes removal of the testes (orchidectomy) is advised in advanced disease to minimize the effects of testosterone on the growth and spread of cancer.
Radiotherapy: Can be administered as a primary modality via needles implanted into the prostate under ultrasound guidance or as an external beam. Radiation can be administered after surgery if the resection of cancer tissue has not been complete.
Hormone therapy: Medications that suppress testosterone levels are used as primary treatment and in advanced cases of prostate cancer.
Chemotherapy: In advanced cases, when the disease is not controlled with hormonal treatment the patient may be a candidate for chemotherapy wherein strong medications are used to kill the cancer cells and prevent spread.
Other local ablation treatments like Cryotherapy, Radiofrequency, High intensity focused ultrasound (HIFU) are used to treat early cancers or when the patient is not fit for a major surgery.

Read more about causes, symptoms, diagnosis and treatment of cancer.

The aforementioned treatments could be used singly or in combination depending on the clinical situation, patient factors and expertise available.

Regular follow-up as advised by the urologist with blood tests including PSA levels and imaging investigations will have to be adhered to prevent recurrence or progression of disease. Side effects of various modalities of treatment will have to be understood and may play a role in the decision-making process. With further advances in surgical techniques, hormonal, radiation and chemotherapy, adverse effects are minimised to a large extent. Leading a normal life with normal physical and sexual activity is possible with the available techniques in modern medicine.

Valuable information on prostate cancer can be found on www.pcf.org ( prostate cancer foundation) and www.cancer.gov

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Published : February 17, 2013 9:39 am | Updated:June 10, 2014 6:40 pm

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