What is Prostate Cancer Treatment?

English हिन्दी Bengali

What is the meaning of Prostate Cancer?  

Prostate cancer is a type of deadly disease that occurs in men. Just like breast cancer occurs only in women, prostate cancer occurs only in men. The risk of prostate cancer is higher for men who are above the age of 50. Worldwide, prostate cancers are one of the most commonly occurring cancers. 

The prostate is a walnut-shaped gland that produces the seminal fluid that transports sperms. Many prostate cancers progress slowly and are confined to the prostate gland, and do not cause any serious damage. However there are variants of prostate cancer that spread rapidly and need cancer treatment. If prostate cancer is diagnosed and treated at an early stage, then its complications can be reduced. 

Let us tell you in detail about prostate cancer in today’s article.

• What are the types of Prostate Cancer?
• What are the causes of Prostate Cancer?
• What are the symptoms of Prostate Cancer?
• What are the diagnostic tests for Prostate Cancer?
• What is the treatment of Prostate Cancer?
• How to care after Prostate Cancer treatment?
• What are the risks of Prostate Cancer treatment?
• What is the cost of Prostate Cancer Treatment in India?

What are the types of Prostate Cancer?

Prostate cancer is classified into the following types:

• Acinar adenocarcinoma – This type of cancer develops in the gland cells that line the prostate gland in males. It is the most common type of prostate cancer.
• Transitional cell/ Urothelial cancer – This type of cancer starts in the cells that line the tube carrying urine to the outside of the body ( urethra ). This type of prostate cancer starts in the urinary bladder and spreads to the prostate.
• Ductal adenocarcinoma – It starts in the cells that line the ducts or tubes of the prostate gland. However, it tends to grow rapidly and spread more quickly than other types of prostate cancers.
• Small cell prostate cancer – This type of prostate cancer is made up of small round cells (as viewed under the microscope )  and is a type of neuroendocrine variant of prostate cancer. 
• Squamous cell cancer – This type of prostate cancer develops from flat cells (squamous cells ) that cover the prostate gland. These are said to grow and spread even more rapidly than adenocarcinoma variant of the prostate gland cancer. 

( Know more about- What is Bladder cancer? Causes, Symptoms, Treatment, Cost )

What are the causes of Prostate Cancer?

The exact cause of prostate cancer is not yet known. However, it is the variations and mutations happening in the DNA of the prostate cells that leads to alterations and uncontrolled, abnormal cell divisions. This leads to prostate cancer. The abnormal cells grow more rapidly than the surrounding normal cells, forming the tumor. This tumor further attacks the nearby cells and tissues. Some abnormal cells can spread to other parts of the body (metastasis), leading to secondary cancers in other parts of the body (e.g.- bladder cancers).

However, there are certain risk factors that may be associated with prostate cancer:

• Old age – It is observed that the risk of prostate cancer increases with age in men. Men above 50 years of age are at a higher risk of developing prostate cancer.
• Genetics or Family history- If a person has a family history of prostate cancer or other cancers, the risk of prostate cancer is high. If the blood relatives like any sibling, or son or father, have or had prostate cancer, the risk increases more. Also, if there is a family history of breast cancer, i.e. the genes associated with breast cancer ( BRCA1, BRCA2 ), the risk of developing prostate cancer increases.
• Race- It has been observed that the risk of prostate cancer ( aggressive variants ) is more in Black people. 
• Obesity – According to the studies, there is a high risk of prostate cancer among obese people. Also, in such patients the chances are more of developing aggressive and rapidly spreading variants. The chances of recurrence after initial treatment, is higher in obese patients. 

(Know more about-What is Penile Burning Sensation?Causes,Symptoms,Treatment, Prevention)

What are the symptoms of Prostate Cancer?

Symptoms of prostate cancer may vary among different people. Apart from this, prostate cancer may not cause any symptoms in some people. However, most men show the following symptoms of prostate cancer:

• Blood in the urine

( Know more about- What is Blood in Urine? Causes, Symptoms, Treatment, Prevention )

• Trouble urinating
• Difficulty in emptying the bladder or decrease in force while urinating 
• Obstruction of urine flow
• Frequent urination at night
• Painful urination
• Backache or bone pain in the lower back region 
• Hip region pain or pelvic pain
• Unexplained weight loss 
• Fatigue or extreme tiredness
• Erectile dysfunction
• Painful ejaculation
• Blood in the semen
• Decreased libido ( sexual desires ) in men 

( Know more about- What is Erectile Dysfunction? Causes, symptoms, treatment )

If you experience any of these symptoms and the symptoms become severe and persistent, contact your doctor immediately.

What are the diagnostic tests for Prostate Cancer?

Prostate cancer can be tested based on the patient’s health status. First, the doctor will conduct a physical examination in which he will ask some questions about the medical history and cause of the disease. Apart from this, he may perform some other investigations,which are as follows- 

• Digital rectal exam (DRE) – This is the most common test to examine the prostate gland. The prostate is an internal organ that cannot be seen directly. In such a situation, a doctor inserts a gloved finger into the rectum to examine the prostate gland. Any abnormality associated with the size, texture or shape of the prostate gland can be identified with this test. Based on this test, further tests may be asked by the doctor. 
• Prostate-specific antigen test – A blood sample is drawn and examined for PSA, a substance that is produced by the prostate gland. Small amounts of PSA in the blood is normal. Higher levels of PSA detected in the blood may indicate prostate cancer or prostate infection or swelling or enlargement of the prostate gland. 

On the basis of the above tests, if any abnormality is detected with the prostate gland, then doctor may ask the patient to do the following tests to confirm the prostate cancer diagnosis-

• Prostate biopsy – In this test, a sample of cells is collected from the prostate gland for careful examination under the microscope in the lab.The prostate biopsy is done by inserting a thin needle into the prostate gland. After the biopsy, the doctor uses the Gleason score to determine the stage of prostate cancer.
• Transrectal Ultrasound- Here a small probe is inserted into the rectum which produces sound waves. These sound waves create a clear picture of the prostate gland. 
• MRI scans- This is done to get a clear picture of the prostate gland, which may help the surgeon to plan the surgery ( to remove the prostate tissue which has cancer ).
• Other tests – The doctor may recommend some other tests like Complete blood picture (CBC), other blood tests,etc.

2 commonly used techniques to determine the aggressiveness of the Prostate cancer, by examining the cancer cells in the prostate tissue biopsy,  are-

1. Gleason score- This is the most common scale used to determine the grade of prostate cancer, the range of the scale score is from score 2 to score 10. Eg- score 6 means a low grade prostate cancer, score 7 means medium grade prostate cancer and score 8-10 indicate high grade prostate cancer. 
2. Genomic testing- This determines the specific gene mutations that caused prostate cancer. This test is very useful in determining the long term success of prostate cancer treatment. 

Once the diagnosis of the prostate cancer is confirmed, the following tests may be done to determine if the prostate cancer has spread (metastasis)-

• Bone scans
• PET ( Positron emission tomography ) scan
• MRI ( of the pelvic region )
• CT scans ( of the pelvic region )
• Ultrasounds ( of the pelvic regions )

( Know more about- What is Vasectomy? Purpose, Method, Advantages, Disadvantages )

What is the treatment of Prostate Cancer?

There are various treatments available for prostate cancer. However, the treatment option depends on the stage and type of cancer. For example, how fast your cancer is growing, whether it has spread to other body parts, your overall health status, and the possible side effects of the treatment.

• Active surveillance – There are many cases in which prostate cancers grow slowly rather than rapidly. In such a situation, the person needs to get diagnosed. The doctor closely monitors the patient’s condition and uses prostate-specific antigen tests, blood tests, prostate biopsies and digital rectal tests, from time to time to check the progression of prostate cancer. If the cancer symptoms progress, the doctor may advise to go for surgical or radiation therapy for treatment.

This is the treatment method for patients having low grade prostate cancer, or if cancer has mild symptoms or grows very slowly. Also, this is the treatment of choice for aged cancer patients or patients having other medical conditions, who can not undergo prostate surgery.

• Surgery – If cancer has not spread outside the prostate gland, the surgeon may carry out a radical prostatectomy to remove the entire prostate gland, surrounding tissues and the nearby lymph nodes ( to prevent the spread outside the prostate gland ). It may involve using either a laparoscopic or robotic approach or open surgery.

It is used in the advanced grade of prostate cancer, along with other modes of treatment.

The technique of prostate surgery involves- 

1. Robot assisted laparoscopic prostatectomy- Here the surgical instruments, attached to the mechanical device, are inserted into the abdomen via the small incisions made in the abdomen. Most prostate cancer surgeries are done by this method.
2. Retropubic surgery- Here the surgeon makes a long incision in the lower abdomen, to remove the entire prostate gland. This is not commonly used, but may be required in certain types of advanced cases of prostate cancer.

• Radiation therapy – Radiation therapy is used to destroy cancer cells. It involves the use of high-energy X-rays or gamma rays to kill cancer cells. Radiation therapy includes two methods-

1. Internal radiation-  Also known as Brachytherapy, in this method small sized radiation seeds are placed inside the prostate tissue, which then delivers low dose radiation to the cancer tissues over long time periods. This is also used for low grade prostate cancer that is limited to the prostate gland.
2. External radiation (where the high powered radiation beam is directed at the prostate cancer by moving the machine around or outside the body, this is used to treat prostate cancer that is confined to the prostate gland or after the surgical removal of the prostate gland).

• Ablation Therapy– Here the cancer tissue is destroyed with either heat or cold method. 

1. Heat ablation method- Here the high intensity focussed ultrasound (HIFU) is used to concentrate the ultrasound energy at the prostate tissue. This heats it up and destroys the cancer cells.
2. Freezing ablation method- Cryotherapy or cryoablation for the prostate cancer, is a method where very cold gas is put and then cancer tissue is thawed. These alternate cycles of freezing and thawing kill the prostate cancer cells.

• Hormone therapy – The hormones that help cancer cells to grow are blocked so that they do not reach the cancer cells. Prostate cancer cells are dependent upon the testosterone hormone to grow and divide. The methods include- using medicines that reduce the production of testosterone, medicines that block the supply of testosterone, surgical removal of testicles to completely stop the production of testosterone. This method is used to treat advanced cases of prostate cancer, to reduce the size of cancer and is also used before radiation therapy. 
• Chemotherapy – Medications are given by intravenous injection or orally to kill cancer cells and reduce the size of the tumor. It is used to treat high grade and rapidly spreading prostate cancer, which has already spread to other body parts. 

( Know more about- What is Chemotherapy? Types, Purpose, Procedure, Aftercare, Cost )

• Immunotherapy– In this method, the body’s immune system is used to attack the cancer cells. It may involve- a) helping the immune cells to locate and attack the cancer cells ;   b) genetically engineering the immune cells outside the body in labs, and then reinjecting them back into the body, which then can find and kill the prostate cancer cells. 
• Targeted drug therapy-This method is used to treat advanced cases or recurring prostate cancer cases, where the specific cancer cells abnormalities are targeted using certain drugs. This causes the prostate cancer cells to die. 

( Know more about- What is Prostate Surgery? Purpose, Tests, Procedure, Aftercare, Cost )

How to care after Prostate Cancer treatment?

Following the prostate cancer treatment, the healthcare team will continue to monitor any recurrence, or any side effects, and manage the overall health of the patient. 

The doctor may do follow up care by doing regular physical examinations, medical tests, etc. 

Following steps are to be kept in mind after the prostate cancer treatment-

• One must look for any recurrence symptoms. Prostate cancer cells may remain hidden and may increase in number, leading to recurrence of cancer. Thus regular followup visits with the doctor are must, regular blood tests, imaging tests, etc must be done to prevent any recurrences. 
• One must watch out for any long term or late side effects of prostate cancer and treatment. This may include physical and emotional long term side effects. Accordingly, the treatment plan, and overall health improvement methods can be discussed with the doctor. Blood tests, scans, physical examinations, etc may be done to identify and manage these side effects.
• One must follow the basic health guidelines like maintaining healthy weight, exercising, taking a balanced diet, etc.
• One must include more fruits and vegetables in the diet, avoid fats and high calories foods.
• Adequate amounts of calcium and vitamin D must be supplemented.
• One must exercise a minimum for 150 minutes per week. 
• Reduce the alcohol intake and quit smoking.
• Followup appointments for screening of bladder, colorectal cancers, etc are important and must be done after the prostate cancer treatment.

( Know more about- What is Piles Surgery? Causes, Tests, Procedure, Aftercare, Cost )

What are the risks of Prostate Cancer treatment?

Some common late complications of Prostate cancer treatments are-

• Anemia (in patients receiving hormonal therapy)
• Bowel problems ( like blood in stools, uncontrolled bowel movements)
• Urinary problems ( unable to control the bladder, painful urination, etc. )
• Increased Blood pressure 
• Poor blood glucose control ( in diabetic patients receiving hormonal therapy )
• Depression
• Anxiety
• Bone problems 
• Hot flashes 
• Reduced sexual desires, improper sexual health, intimacy issues, etc.

( Know more about- What is low libido in men? )

What is the cost of Prostate Cancer Treatment in India?

The total cost of prostate cancer treatment in India can range from around INR 1,50,000 to INR 4,00,000. However, many prominent hospitals and doctors in India specialize in prostate cancer treatment. But the cost varies across different hospitals. 

If you are coming from abroad, apart from the cost of prostate cancer treatment, there will be an additional cost of living in a hotel and the cost of local travel. After the treatment, the patient is kept for 5 days in the hospital and for 7 days in the hotel for recovery. So, the total cost of prostate cancer treatment in India comes to be around INR 2,00,000 to INR 5,00,000. 

We hope that we could answer your questions regarding prostate cancer treatment through this article.

If you want to get more information and treatment of prostate cancer, you can contact the Surgical Oncologist.

We only aim to give you information through the article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice and correct treatment plan.