Prostate Gland is an organ present in the male pelvis lying in close proximity to the urinary bladder and rectum. As age advances the prostate gland can enlarged which is benign in nature and known as benign prostatic hyperplasia (BPH). If there is a cancerous growth in prostate it is called as prostatic cancer. Enlargement of prostate gland whether benign or malignant compromises the lumen of the urethra (urinary passage) and leads to urinary symptoms.
Prostate cancer is one of the common cancers in men, especially in urban population, after lung and head and neck cancers. Most common age group is above 50 years, although it can also occur in younger men.
SIGNS AND SYMPTOMS
Predominantly it presents with urinary symptoms :-
- Urgency (one has to rush for passing urine)
- Hesitancy (difficulty in initiating urination)
- Increased frequency of urination
- Nocturia (increased frequency of urination after bedtime
- Poor or weak urine stream
- Dysuria (burning sensation during urination)
All these symptoms can also occur in men with BPH with increasing age as well. Additional symptoms of advanced prostatic cancer may include backache, unexplained loss of appetite or weight, and bone pains.
Prostate cancer is generally a slow growing cancer, so do not panic. Consult your Urologist or Oncologist when in doubt.
INVESTIGATIONS
The most commonly performed test is Serum Prostate Specific Antigen (PSA). It is a simple, cheap and easily available blood test, and is commonly used for screening for cancer prostate. As a part of screening it is recommended to do Serum PSA after the age of 40 years at yearly intervals. The value of PSA can be higher than normal in both BPH and Ca Prostate. Therefore one should not panic if ones serum PSA is on the higher side. High PSA does not always mean cancer prostate. One needs further test to confirm/rule out cancer. Ultrasound of the abdomen is done to assess size and nature of prostatic enlargement as well as to assess any retention of urine. Ultrasound guided biopsy should be obtained if one is symptomatic and serum PSA is high. Other investigations include MRI of Pelvis and Whole Body Bone Scan or prostate specific PET Scan (PSMA Scan).
TREATMENT
Treatment options depend on the stage at presentation and life expectancy of the patient.
- Very early stage cancer in an elderly gentleman with other major health issues can be managed with surveillance alone (no active treatment as it is a slow growing cancer).
- Early stage prostatic cancer in a more fit gentleman can be treated by Radical Surgery or Radiation Therapy (IGRT) equally effectively. Both forms of treatment have their pros and cons.
- Intermediate stage prostate cancer is managed with hormonal therapy and radiation therapy. For very advanced cancers treatment of choice is hormone therapy which can be in the form of removal of testis or hormonal injections at regular intervals.