Various treatment options for prostate cancer

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

What is prostate cancer?

When a prostate tumor develops as a result of aberrant cell development, it is called prostate cancer. The prostate is a gland that sits next to the bladder and encircles the urethra. It is situated in a man’s lower abdomen and has the shape of a walnut. Its primary job is to make seminal fluid.Prostate cancer treatment options may include surgery, radiation therapy, hormone therapy, chemotherapy, or active surveillance, determined by the cancer’s stage and patient’s health.

Prostate cancer arises whenever cells in the prostate gland start to grow out of control. Men alone possess the prostate gland. It produces a portion of the fluid that is found in semen.

The prostate is located in front of the rectum, the last segment of the intestines, and beneath the bladder, the hollow organ where pee is stored. Most of the fluid for semen is produced by seminal vesicles, a collection of glands located directly behind the prostate. The center of the prostate is where the urethra, the tube that transports urine and sperm to the outside world through the penis, passes through.

As a man matures, his prostate’s size may alter. It is roughly about the dimensions of a walnut in younger men, but it can get significantly larger in older men.

Most prostate cancers are discovered in their early stages when they are growing gradually. Thus, choosing a course of therapy usually does not require a rush. During this time, it’s crucial to discuss with your doctor the advantages and disadvantages of every possible course of therapy, as well as when it should start. The situation of today’s cancer is included in this conversation:

If your prostate-specific antigen (PSA) levels are increasing quickly or if you have symptoms
Does the malignancy have a bone metastasis?
Your medical background
Your standard of living
Your present sexual and urogenital health
Any further health issues you may have

There are some broad steps for the treatment of prostate cancer by stage, and your physician’s treatments will depend on these variables.

Below is a description of some of the typical prostate cancer treatments. Your care plan can also incorporate the critical cancer care practice of treating symptoms and side effects of prostate cancer.

Table of Contents

Prostate cancer types

Aggressive and non-aggressive prostate cancers are the two kinds of the disease.

Aggressive: Fast-growing prostate cancer is another name for aggressive prostate cancer. The tumor with this type of cancer grows quickly and is very likely to metastasize to other parts of your body, including your bones.
Non-aggressive: The growth of the tumor is substantially slower in prostate cancer that is non-aggressive or slow-growing. In some cases of non-aggressive prostate cancer, there is no tumor growth over time.

Prostate cancer symptoms and causes

Symptoms of prostate cancer:

The following are a few of the most typical prostate cancer symptoms.

Urination might be a challenge for you. Because the tumor's growth may put pressure on the urethra or the bladder, this is one of the most typical prostate cancer symptoms. It's possible that you won't be able to urinate or that it would be challenging. Particularly at night, you could feel the urge to urinate more frequently than usual. When urinating, you could occasionally realize that you are bleeding. When you urinate, you might also get a burning feeling.
Prostate cancer patients may struggle with sexual issues. When you ejaculate, you might observe a red discharge in your semen. Prostate cancer may result in erectile dysfunction for you. Ejaculating might be challenging because it is frequently uncomfortable. You might not ejaculate as frequently as you usually do. In other words, the volume of semen that is discharged may be much less.
Additional signs of prostate cancer exist. Your rectum may feel as though it is under strain. You can start having respiratory issues. Quite quickly, you might begin to feel quite exhausted. Your heart may begin to beat more quickly than usual. You can also feel lightheaded.
Be aware that occasionally, especially early on, you may not exhibit any symptoms of prostate cancer. However, you can begin to experience the previously mentioned symptoms if prostate cancer has progressed.

These are the several symptoms of prostate cancer.

Causes of prostate cancer:

Prostatecancer’s precise origin has not yet been identified with certainty. According to medical professionals, several things can cause prostate cancer. Male prostate cancer is brought on by the proliferation of malignant cells brought on by DNA abnormalities. The aberrant growth patterns
of the cancer cells are caused by DNA mutations. Until a tumor develops in the prostate gland, these cells continue to divide more quickly than your regular cells do. One thing to keep in mind is that these aberrant cells have a longer lifespan and can travel to other body parts when they
metastasize.

Do you have a prostate cancer risk?

These are harmful factors that increase your vulnerability to developing prostate cancer.
You have an increased risk of developing prostate cancer if you have breast or prostate cancer in your family.
As you become older, your risk of acquiring prostate cancer rises. Young males are rarely affected by prostate cancer. Older males are more prone to it.
Male African Americans have a higher risk of getting prostate cancer than white men. Prostate cancer is more common in some races of men than in others.
Your body's genetic alterations can sometimes make you more likely to develop prostate cancer than you already are.
According to research, men who do not consume sufficient amounts of vitamin D may be more likely than other men to get prostate cancer.
Your risk of getting prostate cancer is greatly raised if you are obese. Prostate cancer in obese men is typically harder to treat.
According to several research, men who consume red meat and high-fat dairy items more frequently have a higher risk of developing prostate cancer.

Screening and diagnosis of prostate cancer

Diagnosis of prostate cancer

Given that the early stages of prostate cancer do not usually present with many symptoms, it is crucial to undergo regular preventative screenings. You may wish to discuss prostate cancer screening with your doctor when you visit for your annual physical.Doctors advise having a
prostate cancer screening if you are over 40, especially if someone close to you has the disease.

Doctors advise getting screened for prostate cancer if you are 45, African American, and have a close relative who acquired the disease before age 65 since you have a significant statistical risk.

Several tests are employed for prostate cancer screening and diagnosis.

Examining your past and your body: To identify any past medical conditions and your general health history, your doctor will first ask you about your medical history. Your physician will inquire about your routines. To determine your general health, your doctor will evaluate your body through a physical examination.
Transrectal sonography: A probe is used in this form of ultrasonography. A probe is a tool the size of a finger. To inspect your prostate, it is placed into your rectum. The probe is used to produce ultrasonic echoes of your inside organs and tissues. This contributes to the creation of a sonogram, a detailed image of the body's tissues.
Digital rectal examination: This test for prostate cancer looks at your rectum. After lubricating it, your doctor will put a glove into your rectum. He can feel how your prostate is doing because of this. Through your rectal wall, the doctor can feel for lumps if there are any. Your doctor will be able to identify any other abnormalities through this test if there are any.
Magnetic resonance imaging (MRI) transrectally: This examination is performed to see if the cancer has progressed outside of the prostate to any surrounding tissues. The test produces images of your body's internal organs using radio waves, a magnet, and a computer. A probe that is placed inside your rectum is used for this test. Your doctor can observe your prostate and the surrounding tissues thanks to this test.
PSA test, or prostate-specific antigen test: Because the prostate is responsible for creating PSA in your body, the PSA level might indicate how well your prostate is doing. This examination measures the level of PSA in your blood. This test is done because men with prostate cancer typically have high blood levels of PSA. Be aware that prostate cancer is not always present merely because the PSA levels are high. High PSA levels can also result from other disorders.
Circumferential biopsy: This procedure can be done by your doctor to identify prostate cancer. Your prostate is reached by inserting a tiny needle via your rectum. A pathologist examines the prostate tissue after it has been removed and examines it through a microscope to check for any indications of malignant cells. Transrectal MRI or transrectal ultrasound can both be used to perform a transrectal biopsy.

A grade is assigned if the pathologist can locate cancer cells. This ranking explains the abnormalities of the cancer cells as well as their propensity to spread quickly. The Gleason score is the name of this rating. Your risk of developing prostate cancer is low if your score is less than
six. If the score is higher than that, your doctor will use your score and PSA level to study the cells.

Prostate cancer treatment

Prostatecancer in its early stages is cancer that has spread within the prostate but has not yet spread to the lymph nodes or bones. A very high chance of survival exists for men with early- stage prostate cancer. There are numerous therapy possibilities.

Your care strategy will take into account:

The stage and grade of the malignancy (Gleason score and TNM stage)
The risk level of your cancer (low, middle, or high risk)
Your condition and age
Your preferences about treatment's side effects and long-term impacts
Your intended treatments
The results of additional diagnostic testing

Consider your variety of prostate cancer treatment options after being diagnosed with the disease. Learn about the adverse effects of each medication as well as the chances of survival that each one offers. Be mindful of how treatment side effects will alter your life both right now and in years to come. If you can, seek a second or third opinion from a prostate cancer expert. By speaking with a radiation oncologist and a urologist, you can make an informed decision.

Find out about the training and reputation of the doctors who are willing to treat you. An experienced physician with a solid reputation will likely provide the finest care for you, especially if the course of therapy you select could result in side effects like bowel or urine incontinence. Learn about the programs your doctor offered to help with the after-treatment adverse effects. Discuss the experiences of other survivors.

If you choose a course of prostate cancer treatment, stay or get healthy during the interim. By your doctor’s advice, maintain a healthy weight, engage in regular exercise, abstain from smoking, and limit your alcohol consumption. You might be able to fight prostate cancer with this. There are several different sorts of therapies available if you have been diagnosed with prostate cancer. The optimal course of prostate cancer treatment for you will depend on your age, cancer stage, and general health.

If you are told that you have localized, early-stage prostate cancer, the following treatments might be worth discussing with your doctor. The usual methods of treating prostate cancer are as follows.

Active monitoring

Typically, older men who have medical issues but do not exhibit prostate cancer signs receive this form of treatment. It is for those whose screening test results indicate they may have prostate cancer. You will be closely observed during this sort of treatment until symptoms of prostate
cancer arise. Afterward, you receive treatment for the symptoms you display. You must undergo several tests and examinations so that your doctor can determine if the cancer is spreading or not.

If you have a malignancy that is tiny and slow-growing, active surveillance is preferable. Your doctor will request testing from you every few months to monitor your prostate cancer. A biopsy, an MRI, and a blood test to monitor your PSA are typically helpful tests. The majority of the
time, men under active supervision can prevent gastrointestinal, sexual, and urinary side effects.

Consider continuous monitoring as a medical intervention that aims to prolong the quality of your life as much as possible.

Some guys never require further medical care. It’s time to discuss additional treatment options, such as surgery or radiation therapy, if the PSA increases and a biopsy reveals that the cancer is spreading. ‘Definitive therapy’ is the term used to describe this type of treatment.

Attentive waiting

Tracking the malignancy while not treating it is possible with watchful waiting. It excludes routine biopsies, PSA tests, and other forms of active surveillance. The danger of cautious waiting is that the cancer can advance and spread in the interim between checkups. With elderly men with beginning prostate cancer who are more likely to pass away from other causes, watchful waiting is sometimes the best course of action. It is also for males whose other medical conditions would make it challenging for them to undergo radiation or surgery.

Radiation therapy and surgery are the two main therapies for early-stage prostate cancer. These therapies aim to permanently eradicate the malignancy. They both treat cancer with roughly the same degree of success. Choosing the right course of treatment for you can be discussed with
your doctor.

Surgery

Prostate cancer surgery is one of the therapy alternatives if you are healthy and your doctor discovers a tumor in your prostate. Different forms of surgery exist. One such procedure is a radical prostatectomy, which combines the perineal and retropubic prostatectomy forms of prostate surgery. The Pelvic lymphadenectomy, transurethral resection of the prostate (TURP), and nerve-sparing surgery are further surgical procedures.

Prostate surgery carries several dangers and problems, including impotence and incontinence. In a radical prostatectomy, the prostate, seminal vesicles, and surrounding tissue are surgically removed. The pelvic lymph nodes that flow through the prostate are frequently also removed.
Anesthesia is required for this treatment, and the hospital stay is brief.

Surgery for a radical prostatectomy comes in four different forms:

Radical Prostatectomy Accessed Laparoscopically (RALP). Five extremely small incisions (cuts) are created in the lower abdomen during this procedure, and tools and a tiny camera are directed through them to give the surgeon access to the prostate to be removed. One of the most popular procedures performed today for prostate cancer is RALP surgery.
Open radical prostate surgery in the back. Your lower belly will be sliced, and the prostate will be removed through this opening by your surgeon.
Radical Prostatectomy Perineal. Through a cut made between the anus and scrotum, the prostate is removed. Bleeding is uncommon because the intricate pelvic veins are avoided.
Radical prostate removal through laparoscopy. The prostate is removed during this procedure using a video camera and tiny surgical instruments that fit via belly cuts. Laparoscopic surgery with robotic assistance has mostly taken the place of this procedure.

Your surgeon will go over the final pathological report with you after the procedure. According to all the cancer that was present in your prostate, the pathologist’s report will provide you with your final Gleason Score.

As with any operation, there is a chance of bleeding, infection, and short-term pain. Erectile dysfunction (ED) and urinary incontinence (loss of urine control) are the main adverse consequences of this operation. Within a few months, the majority of men regain bladder control.

Erections can sometimes return for certain men, but not always. Your surgeon may recommend another specialist who can assist you in managing these side effects.

Radiation treatment

Radiation is used in this sort of treatment to kill cancer cells and stop them from proliferating. Radiation therapy comes in three varieties. They are radiopharmaceutical therapy, internal radiation therapy, and external radiation therapy. Men who receive radiation therapy may struggle with a variety of issues, including impotence and urinary issues. The prostate cancer stage, among other things, affects how the therapy is administered.

In radiation therapy, powerful radiation is used to destroy cancer cells.

Radiation therapy using an external beam (EBRT): The prostate is exposed to radiation from an external photon beam (x-ray), known as external beam radiation therapy (EBRT). For several weeks, the prostate receives only a little radiation in daily doses. Radiation to healthy organs, including your bladder and rectum, will be kept to a minimum by your medical team. With conformal radiotherapy (3DCRT), proton beam therapy (PBT), or stereotactic body radiation therapy (SBRT), more recent EBRT equipment produces three-dimensional images.
Brachytherapy for the prostate (internal radiation therapy): Internal radiation therapy called prostate brachytherapy targets the prostate from within the body. Using tubes or needles, radioactive material is inserted into the prostate. The two varieties of brachytherapy are:

For both, anesthesia and a brief hospital stay are required.

Urinary incontinence, gastrointestinal issues, and ED are typical radiation side effects. For most guys, bowel and urinary issues improve. Over two or more years, erections gradually soften. Your physician will go over these adverse reactions with you and offer management advice.
Consult your doctor to learn more about the impact of various radiation treatment options on your erectile function. Some therapies have a lower risk of causing ED. To reduce the prostate before beginning treatment, radiation therapy and hormone therapy may occasionally be combined. Or, to increase the effectiveness of the radiation, hormone therapy may be coupled with external beam therapy. Androgen Deprivation Therapy (ADT) is the term for hormone therapy.

ADT combats prostate cancer by reducing the body’s testosterone levels. Loss of testosterone aids in the battle against cancer but has serious side effects that can include libido loss, erectile dysfunction, hot flashes, changes in body fat, and emotional disturbances. There can also be
further physical changes. It is recommended to talk to your doctor about this.

Hormone treatment

Hormones are produced by glands and are found in the bloodstream. To prevent the cancer cells from proliferating and spreading further, hormone therapy involves either suppressing the action of hormones or removing them from the body. The use of estrogens, abiraterone acetate, antiandrogens, agonists of the luteinizing hormone-releasing hormone, orchiectomy, and medications are all examples of hormone therapy. Hormone therapy has several adverse effects, including nausea, hot flashes, itching, and weak bones.

Bisphosphonate medication

Drugs containing bisphosphonates are administered during this sort of therapy. Among them is zoledronate. When prostate cancer has gone to your bones, you will receive this treatment. Men who undergo procedures like orchiectomy or antiandrogen therapy have a significant risk of
bone loss. In these situations, bisphosphonate treatment is used to reduce the risk of breaking bones. These medications can be used to stop cancer from spreading to the bones, but this is still under investigation.

Chemotherapy

Drugs are used in this sort of treatment to either kill or inhibit the growth of cancer cells. These medications are administered to you either orally or intravenously so they can go into your bloodstream. Systemic chemotherapy is the name given to this kind of treatment. Regional chemotherapy is another sort of chemotherapy in which the medications exclusively target the designated regions. Depending on the characteristics of your cancer, your doctor will decide what kind of chemotherapy is required.

Biologic treatment

Sipuleucel-T is a prime example of a biological treatment. This is applied to the treatment of prostate cancer that spreads to numerous bodily parts. Utilizing your immune system to treat prostate cancer is known as biologic therapy. Your body is ready to utilize its anti-cancer
defenses throughout this form of treatment. To accomplish this, chemicals produced by your body or in laboratories are used.

These are the many prostate cancer treatment options available.

Authorized factors

After therapy is over, you might need to deal with after-effects. Together with your doctor, you will create a long-term strategy for additional testing. These tests ensure that you continue to be cancer-free.

Conclusion

There is no definite or established method to ward off prostate cancer. However, by making healthy decisions like maintaining a healthy diet and a regular exercise schedule, you can lower your risk of developing prostate cancer. Men who are in danger of acquiring prostate cancer are advised by doctors to make decisions about their lives that will improve their health. You should discuss preventative methods with your doctor if you have a high risk of getting prostate cancer so they can prescribe certain drugs and alternatives for risk reduction.