It is commonly diagnosed male cancer. There is no specific cause and in a few it is hereditary.
Men with prostate cancer(PCa) can have either no symptoms or urinary complaints – frequency, difficulty to pass or blood in urine. In advanced disease – backache, weight loss, cachexia and loss of appetite.
PCa diagnosis includes digital rectal examination, PSA blood test, multiparametric-MRI and prostatic biopsy. Later, a PSMA PET scan to detect the spread in other distant body parts. These help us to risk stratify and grossly divide the disease into 3 categories – localised [confined to the prostate], locally advanced [spread around the prostate] and metastatic [ spread to distant parts in the body]. Additionally, genetic mutation testing is recommended in advanced PCa cases.
At this juncture, the patient is offered a multidisciplinary consult with Uro-oncosurgeon, Radiation oncologist, Medical oncologist, pathologist and radiologist. Patient and caregiver are counselled about the disease, its stage, prognosis, treatment options and side-effects of treatment. Factors influencing treatment include age, life expectancy, health status, presence of other debilitating diseases – heart disease, prior cancers, and patient’s choice of therapy – if applicable.
Localised PCa patients are under “Active surveillance” [ close observation] or Surgery – Radical Prostatectomy(RP) or Radiation Therapy (RT). Surgery is usually “robotic” RP – involves removal of the prostate, seminal vesicles and lymph nodes. The post-operative pathology report guides further decision-making. RT to prostate is either external beam(IMRT/IGRT) or internal (Brachytherapy). Along with RT, hormonal therapy(HT) monthly or 3 monthly injections. Nowadays, Proton therapy is also available.
In metastatic prostate cancer, treatment goals include – disease control and good quality of life. Hormone therapy [reduction of testosterone] combined with tablets- Abiraterone acetate / Enzalutamide / Apalutamide / Darolutamide or Docetaxel chemotherapy are started in first-line treatment. As disease advances, above drugs which are not yet used and Olaparib, Cabazitaxel and Lutesium-PSMA therapy are the next options. Many PCa patients live their normal lives with treatment; small numbers succumb to cancer. A healthy diet, aerobic exercise and maintaining bone health are essential.