Prostate cancer is one of the most commonly diagnosed cancers that affect the prostate gland that produces some of the fluid in semen and plays a role in urine control in men. It can tighten and restrict the flow of urine through the urethra using thousands of tiny muscle fibers. The prostate is a gland found only in males. It is common in men over 50, especially in African-Americans and in men who eat unhealthy fatty food and/or it can be genetic also. Some of the symptoms of prostate cancer may include urinary problems with little or no urine passing, difficulty starting or stopping the urine, frequent urination, dribbling, pain or burning while urination, erectile problem, less ejaculation, blood in urine or semen, hip, pelvic or pain in abdomen, weight loss, bone pain and lower extremity swelling. Treatments for prostate cancer may include surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, vaccine therapy, and other medical therapies that can affect prostate cancer cell growth.
Treating cancer requires team of different types of doctors also known as multidisciplinary team that can work together to make a complete treatment plan that may combine different types of treatments. These treatment options depend on various factors including the type of cancer, stage of cancer, area of the tumor and its potential side effects, patient’s preferences and overall health. Doctor should discuss with their patient about the various treatment options affecting recurrence, survival, and quality of life. It is very important to find expert doctor who have a vast experience in treating prostate cancer.
The different type’s treatment options for prostate cancer may include:
· Active surveillance and watchful waiting – when the prostate cancer is found at an early stage and is growing slowly, treatment could cause more discomfort than the disease itself. At this stage doctor will recommend active surveillance or watchful waiting. In active surveillance, the cancer is closely monitored for signs that are worsening. If any signs of the cancer that is becoming aggressive, causing any pain, spreading to other parts or blocks the urinary tract are seen in the tests done during the active surveillance then patient should start receiving the treatment immediately. Watchful waiting is an option for old age men and those who has serious or life threatening illness. Men who are already on active surveillance and may have a short life expectancy can later switch to watchful waiting at some point to avoid repeated tests and biopsies.
If the cancer has spread to other parts of the body, then patient may need other types of treatments called systemic treatments to destroy the cancer cells located in the other parts of the body.
Surgery- is done to remove the cancerous tumor and some nearby healthy tissue before it starts spreading outside the prostate. Surgery type can be depending on the stage of the cancer, overall health of the patient, and some other factors. Some of the surgical options may include:
· Radical prostatectomy – in this procedure, the entire prostate and the seminal vesicles are removed surgically. Sometimes, lymph nodes in the pelvic region may also be removed. The procedure has a risk of sexual dysfunction. Nerve – sparing prostatectomy approach –if the cancer is tangled with the nerves on each side of the prostate that control erection, the nerves must be cut to remove the cancer. If both sides’ nerves are cut or removed, person will be unable to have an erection. If only one side nerves are removed then the patient may have less erectile function. And if neither nerve bundle is removed during the surgery, function may return but may take months to know if there is full recovery after the surgery. This is because the nerves will require some time to heel. Post surgery, it is very important to visit doctor regularly for post surgery follow ups that include physical exam, PSA tests, and digital rectal exams, biopsies which may help in early detection and treatment if the cancer comes back.
· Robotic or laparoscopic prostatectomy- is less invasive than a radical prostatectomy and may have shorter recovery time. The surgery is done through small incisions in the belly with the help of robotic arms with the guidance of surgeon’s hand motions into more precise action. This procedure requires special instrument and training. Not all hospitals do robotic surgery.
· Radiation therapy- High-powered energy is used in the prostate cancer radiation therapy to kill cancer cells. This therapy can be delivered in several ways:
· External beam radiation – in this therapy, radiation comes from outside the body i.e. patient will lie on a table while machine moves around the body, directing high-powered energy beams like X-rays or protons to the prostate cancer. This therapy is done five days a week for several weeks.
· Brachytherapy – in brachytherapy, radiation is given inside the body. Many rice-sized radioactive seeds are placed in the prostate tissue using a needle guided by ultrasound images. These radioactive seeds deliver a low dose of radiation over a long period of time. The implanted seeds don’t need to be removed as it stops emitting radiation after some time.
· Intensity – modulated radiation therapy (IMRT) – it is a type of external beam radiation therapy which uses CT scans to get the detailed image of the prostate before the procedure. Doctor can see the size, shape and location of the prostate cancer to determine the amount of radiation needed to destroy the cancer. In this, high doses of radiation can be directed at the prostate without increasing the risk of damaging the nearby organs.
· Proton therapy – also known as proton beam therap. Protons are used in this type of external beam radiation instead of x-rays. This proton therapy is also more expensive.
There are some side effects of radiation therapy such as painful, frequent or urgent urination, rectal problems like loose stools or pain while passing stools or erectile dysfunction
· Focal therapies – these therapies are less invasive treatments which destroy prostate tumors that are small in size by using heat, cold and other methods to treat cancer such as cryosurgery or cryotherapy or cryablation. The cancer cells are freeze with the help of metal probe which is inserted through a small incision in the area between the rectum and the scrotum. This procedure may also have effects on urinary and sexual function.
· Androgen deprivation therapy (ADT) – prostate cancer is driven by male sex hormone called androgens such as testosterones, so lowering the levels of these hormones can help in slowing down the growth of the cancer. These testosterones levels can be lowered by taking drugs which stops the functioning of the testicles (known as medical castration) or by removing the testicles (called surgical castration). Recurrent prostate cancer, metastatic prostate cancer or locally advanced cancer can be treated by using Androgen deprivation therapy (ADT). This therapy is given to the patient for a lifetime or till the time it stopped controlling the cancer, in this case other treatment options are considered. This ADT therapy also have some side effects that may include: