Prostate Cancer Treatment Decision Guide

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Prostate Cancer

The prostate is a gland of the male reproductive system that is located just below the urinary bladder and in front of the lower part of the intestine. The prostate gland produces fluid that makes part of the semen.

Prostate cancer is a disease in which malignant cells are formed in the prostate gland. It is mainly found in elderly men.

The symptoms of prostate cancer are:

  1. Weak or interrupted flow of urine.
  2. Increase in frequency of urine especially at night.
  3. Pain or burning during urination.
  4. Blood in the urine or semen.
  5. Chronic pain in the back, pelvis or hips.
  6. Painful ejaculation.

Investigations for Prostate Ccancer

  1. Digital rectal examination
  2. Prostate specific antigen (PSA) test
  3. Transrectal ultrasound
  4. Prostate biopsy

The following investigations are done to find out if the cancer has spread to other parts of the body:

  1. Radionuclide bone scan
  2. MRI
  3. CT scan
  4. Seminal vesicle biopsy

Treatment Options for Prostate Cancer

The treatment of prostate cancer depends on the following factors:

  1. The stage of the cancer (whether it is restricted to the prostate or has spread to other tissues).
  2. The patient’s age and health.
  3. Whether the cancer has just been diagnosed or has recurred.

The prostate cancer treatment decision guide has multiple options which are discussed in the following sections. Many newer therapies have emerged which are also discussed.

Watchful Waiting

This is close monitoring for appearance of new symptoms or change in symptoms without giving any treatment. This is done in case of older males with other medical problems or in the very early stage of disease.

Surgery

Surgery is usually offered to patients who have good general health. It is especially preferred when the cancer is limited to the prostate and has not spread to the surrounding tissues or to distant sites. Surgery is usually of two types:

  1. Radical prostatectomy - In this, the entire prostate is removed along with surrounding tissue and seminal vesicles.
  2. Transurethral resection of prostate - In this, a portion of the prostate is removed to relieve the symptoms before other treatment is given. This is done in patients who cannot undergo radical surgery because of age or illness.

Radiation Therapy

High energy X-rays or other radiation is given to kill the cancer cells or keep them from growing. It is given as an adjuvant to surgery or as palliative treatment when the cancer has spread outside the prostate or to distant sites. There are two types of radiation therapy:

  1. External radiation - In this, a machine is used to deliver radiation to the tumor from outside the body.
  2. Internal radiation - In this, a radioactive substance is sealed in wires or needles and placed close to the tumor.

Hormone Therapy

In prostate cancer, the male sex hormone testosterone can help the cancer in growing. In hormone therapy, treatment is given to block these hormones so that cancer growth can be halted. The following hormones are used:

  1. Luteinizing hormone-releasing hormone agonists - Examples are leuprolide, goserelin and buserelin. They prevent the testicles from producing testosterone.
  2. Antiandrogens like flutamide and nilutamide.
  3. Drugs like ketoconazole that prevent the adrenal glands from making androgens.

Newer Treatments

  1. Cryosurgery - An instrument is used to freeze and destroy the prostate cancer cells.
  2. Chemotherapy - Drugs are used to kill the cancer cells or to prevent them from dividing.
  3. Biologic therapy - Substances produced by the body or in a laboratory are used to stimulate the body’s natural defenses against cancer.
  4. High intensity ultrasound.

Follow Up

Investigations need to be repeated at regular intervals in patients who have been treated for cancer to detect any spread as well as recurrence. This prostate cancer treatment decision guide should serve as a referral but the best treatment is customized for each individual and the doctor is the best judge for it.

References

  1. Prostate Cancer Treatment Options: A Guide to the Basics, 1999 by Connell Will.
  2. Textbook of prostate cancer: pathology, diagnosis and treatment, 1999 by Kaisary Amir.