Prostate Cancer

Dr. Virendra is a senior consultant urologist, andrologist, and transplant surgeon at Chandigarh healthcare, sector 16, Mohali and Apollo hospital sector 8c, Chandigarh.  In this video, he will talk about prostate cancer. 

What is prostate cancer?     

Prostate cancer is a cancerous growth in the prostate gland. People usually get the cancer after the age of 50. Most patients get in between the ages of 60-70.

Where is the prostate gland situated? 

The prostate gland is a male organ. It is situated below the bladder, in front of the rectum. It encircles the urethra. 

What is the function of a prostate gland? 

The main function of the prostate gland is to nourish the sperm and help increase the sperm count and mortality.  The cancerous growth in the prostate is multifocal. It can grow here, or here, or on the side.  This part of the prostate gland is called the inner gland. And this one is called the outer capsule. With growing age, the inner gland grows and the cancerous growth is developed in the outer capsule. 

Causes of prostate cancer

Prostate cancer is a cancerous growth in the prostate gland. The causes of the cancer are: 

1. Age: People usually get this cancer after the age of 50. Maximum of the patients that we have with prostate cancer are between the ages of 50-60. 
2. Race: This cancer is seen more in Africans and Americans compared to others. 
3. Hereditary: You are at high risk of getting prostate cancer if you have a family history of this disease. If your dad, brother, or uncle has prostate cancer then you are very likely to acquire it. 
4. Modifiable risk factors: There are modifiable risk factors for prostate cancer like obesity, smoking, etc. 

What are the symptoms of prostate cancer? 

Prostate cancer does not show any symptoms in the early stages. They start showing up at later stages of cancer. The symptoms themself are not very serious.  Which is why it goes unnoticed. 

Normally the symptoms are all urinary problems: 

• Painful urination, One has to put pressure while urinating,
• One has to put pressure while urinating,
• Incomplete urination, Having the urge to pee a lot during night time,
• Having the urge to pee a lot during night time,
• Blood in urine, blood in semen, Pain in the bones
• Pain in the balls 
• Weakness, Weight loss, are all symptoms of this cancer.
• Weight loss 
• These are all symptoms of this cancer. 

All these bladder-related symptoms are similar to old age bladder problems. There it is very difficult to detect prostate cancer at an early stage. Their prevention is the best option here. PSA is a hormone secreted by the prostate gland. There is a PSA test that measures the amount of PSA secreted. So it is recommended that a male above the age of 50 should get this test done, once every two years. Patients at high risk, the ones who have a history of this cancer in the family, should get the PSA test done yearly after the age of 45. 

Diagnoses of prostate cancer: 

There are two types of tests done to detect prostate cancer: 

Rectal examination 

The doctor would examine your prostate gland through your rectum, to check for lumps. This is called DRE. 

Second is the PSA test

If the PSA level is high and the prostate gland seems hard during the rectal examination then the patient might have prostate cancer. But these tests are not a very accurate diagnosis of prostate cancer. As the PSA level can increase due to infections, or sexual activity. Therefore, these tests cannot diagnose cancer.

Now if done the above-mentioned tests and done, and the doctor is doubtful that you may have this cancer; then for diagnoses, a prostate biopsy is recommended. With the guidance of ultrasound,  the doctor removes small samples of tissue from your prostate to test for cancer.

After completing the diagnosis, the doctor will then check if the cancer is limited to the prostate gland or has spread outside, in the bones, or any other part of the body. The biopsy tells us the grade of the prostate. It also tells us the type of cancer, if it is well-differentiated or poorly differentiated. There is a glycine score for this which is from 2 to 10. It is good if it is between 2-4 and poor if it’s between 8-10. This is how it is graded. 

for the workup, an MRI prostate, PSI, or pet scan and is suggested. This tells us at which stage cancer currently is. Normally there are four stages. The first and the second stage would mean that the cancer is inside the prostate gland. The third stage would mean that cancer has started spreading outside the gland. And the fourth stage is when cancer has spread to the bones. 

And the treatment is done considering the stage of cancer. Grade one and grade two cancer can be completely cured. It has a 90% cure rate. In the first few grades, it can be cured with surgery, which is called radical prostatectomy. This can be done using laparoscopy or a robot, or with radiation. The result is equivalent whether it is done with radiation or by surgery. 

In the third stage, the doctor gives radiation with hormone treatment. And in the fourth stage, medication, chemotherapy drugs are suggested. The hormone can be controlled by removing the testicles or with injections.  Prostate cancer is a slow-growing tumor. It usually happens in old age. If detected at an early stage it can be completely cured. 

Bottom line: 

After the age of 50, one should get a periodic PSA test done. And also get a rectal examination done by a urologist. Because early detection of the prostate can cure it.