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.
Multimodal strategies combining Surgery(RP) plus RT and HT are used in high-risk patients and in some RT plus HT only. In locally advanced prostate cancer, HT followed by RT is offered more commonly and RP as part of multimodal therapy is selectively offered.
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.
In all stages, follow-up is important, and your doctor will chart the protocol.