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Cancer / Oncology Treatments


Prostate Cancer

The cancer that takes place in the prostate of a man is known as prostate cancer. This cancer is most common type of cancer in men that develops slowly and remains limited to the prostate gland. This cancer rarely affects young men and is most commonly seen in older men over 50 years of age.

Types of Prostate Cancer

  • Small Cell Carcinoma: This is considered as the rare type of prostate cancer that firstly begins in specialized cells inside the prostate. Small cell carcinoma is difficult to diagnose in its early stages and it also does not increase prostate-specific antigen levels (PSA).
  • Adenocarcinoma: Adenocarcinoma is considered as the most common type of prostate cancer. This type of prostate cancer can spread to different areas (such as bones, lymph nodes or other organs) beyond the prostate. This is a slow growing type of prostate cancer.

There is no known cause of prostate cancer though it is associated to benign prostatic hyperplasia (BPH). The advancement in age can increase the chances of developing prostate cancer.

Symptoms of Prostate Cancer

  • Blood in semen or urine
  • Frequent urination, especially at night
  • Inability to urinate while standing up
  • Difficulty in stopping or starting a stream of urine
  • Leaking of urine while coughing or laughing
  • A burning or painful sensation at the time of ejaculation or urination
  • An interrupted or weak urinary stream

Symptoms of Advanced Prostate Cancer

  • Paralysis or weakness in the lower limbs, usually with constipation
  • Stiffness, deep or dull pain in the upper thighs, pelvis, lower back or ribs.  This is often followed by pain in the bones of those areas
  • Swelling of the lower extremities
  • Fatigue, vomiting or nausea
  • Loss of appetite and weight

Most often, prostate cancer diagnosis relies on screening tests, because the cancer typically does not produce symptoms in its early stages. In fact, about 40 percent of prostate cancer cases aren't detected until the cancer has spread beyond the prostate gland.

Screening tests are often part of a routine physical exam, especially in men over age 40. Surgical oncologists may also recommend screening tests because of symptoms pointing to a prostate problem. Screening tests include:

  • Digital Rectal Exam (DRE) - The surgical oncologists gently inserts a gloved, lubricated finger into the patient's rectum and by pressing against the rectal wall can feel the back wall of the prostate gland. About 70 percent of cancerous tumors develop near the outer portion of the prostate and can be detected through a DRE.
  • Prostate-Specific Antigen (PSA) Test - A sample of blood is analyzed for PSA, a substance produced in the prostate gland that helps liquefy semen. A small amount of PSA always circulates in the blood. High PSA levels, or levels that rise over time, could indicate prostate inflammation, enlargement, or cancer.
  • Biopsy - Depending on the result of a digital rectal exam and/or PSA, the surgical oncologists may recommend a biopsy. Several small tissue samples from different areas of the prostate are removed - usually using a needle inserted through the rectum or perineum (located between the scrotum and anus). A surgical oncologists administers a local anesthetic to minimize any pain and discomfort. The tissue is then examined under a microscope for the presence of cancerous cells. A biopsy is usually done in the clinic as an outpatient procedure and generally does not require hospital admission.
  • Chest X-ray - An X-ray can indicate if the cancer has spread to the lungs. Although less than 5 percent of prostate cancer spreads this far, lung cancer develops in about 25 percent of men with advanced prostate cancer.
  • Ultrasound - This test is generally performed in conjunction with prostate biopsy. Sometimes, prostate cancer can appear different from normal prostate tissue. The best way to determine the presence of prostate cancer is the combination of digital rectal exam, PSA level, and biopsied tissue.
  • Computed Tomography (CT) Scan - CT scans are most useful when combined with other tests. A CT scan can show abnormal lymph nodes in the pelvis and abdomen where prostate cancer tends to spread. But the test is not sensitive enough to identify microscopic or individual cancer cells in lymph nodes. CT scans, at this time, do not provide reliable enough information about the condition of the prostate or the stage of prostate cancer.
  • Magnetic Resonance Imaging (MRI) - Magnetic resonance imaging does not require radiation. It produces a detailed, three-dimensional picture of the body that can detect the spread of cancer to lymph nodes and bone and is better suited for detecting cancer in soft tissues than a CT scan and some other imaging tests. During a specialized form of MRI, called endorectal coil MRI, part of the device is inserted into the rectum to discern details that may determine if the cancer has spread beyond the prostate.
  • Bone Scan - Currently, this test is the most effective imaging procedure to determine the spread of cancer to bone. A low-grade radioactive drug is injected into a vein and is selectively taken up or absorbed by areas of new or rapid bone growth, possibly indicating cancer. The need for a bone scan test depends on a man's prostate cancer type and stage.
  • Grading and Staging - If cancer cells are found, surgical oncologistss will determine how quickly the cancer is growing and whether it has spread beyond the prostate. Additional blood or imaging tests may be necessary to determine the extent of the cancer.

Treatment approaches for prostate cancer range from prostate removal surgery, called prostatectomy, to non-surgical treatments such as radiation, Brachytherapy and hormone therapy. The choice of prostate cancer treatment depends on factors such as how fast the cancer is growing, how much it has spread, the age and overall health.

Men whose cancer is detected while confined to the prostate gland have an excellent chance for successful treatment with minimal or short-term side effects.

 

Surgery

 

Surgery is the mainstay of prostate cancer treatment. As a single treatment method - meaning that no radiation, chemotherapy or additional treatment is anticipated - surgery is an effective way to treat cancer confined to the prostate gland.

Surgical Oncologists use great care and proven techniques to remove the prostate (radical prostatectomy) while making every effort to spare the muscles and nerve bundles that control urination and sexual function.

 

External Beam Radiation Therapy

Radiation therapy uses high-powered beams or other radiation to kill cancer cells. Cancer cells are generally more sensitive to the harmful effects of radiation compared to normal tissues. Radiation may be used to treat most stages of prostate cancer, with or without surgery, depending on each patient's overall health and cancer severity.

 

Radiation after Surgery

 

Radiation therapy is also commonly used after surgery to treat the prostate bed (the area formerly containing the prostate). Pathologists examine the removed prostate under a microscope to determine whether any cancer cells possibly may not have been completely removed via surgery. If suspected traces of cancer are thought to remain, additional radiation therapy may be administered at some point following surgery.

Post-surgical radiation treatments reduce the chances of recurrence. Treatment usually begins within two to three months following surgery and lasts for six to seven weeks. Radiation therapy may also be administered if the PSA level rises after surgery. At all times, the patient is considered to be a member of the treatment team and is involved in decision making.

 

Brachytherapy Radiation

 

Brachytherapy involves the implantation of rice-sized radioactive seeds into the prostate to destroy the cancer. In Permanent Prostate Brachytherapy, implanted seeds are left in place, but their radioactivity decreases over time.

 

Hormone Therapy

 

When advanced prostate cancer can't be treated through surgery or other means, hormone therapy is an option. Hormone therapy reduces the supply of male sex hormones that make prostate cancers grow faster. In most cases, hormone therapy is not a cure but may help control prostate cancer. This can be done by surgery (Removal of both testis) or injection Goserelin to be taken life long.



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