An Introduction to Prostate Cancer

By Dr. Tushar Aditya Narain in Uro-Oncology

Mar 23 , 2023 | 2 min read

Prostate cancer is among the most common malignancies affecting the elderly male population. Almost 1 in 10 males would be affected by it in their lifetime. It generally affects males after the age of 50 years but men with a family history of prostate cancer can be affected even at a much younger age.

Diagnosing this cancer at its initial stages is of extreme importance, like in any other cancer, but more so in prostate cancer, as it provides a window for a complete cure from this cancer and normal life expectancy following radical therapy for early stages.

Most of these cancers are asymptomatic, to begin with, in their earlier stages. However, the common presenting symptoms with which patients come to us are new onset difficulty in passing urine, poor urinary stream, frequent urination, blood in urine, urinary retention and back aches or bony pains, the latter seen in advanced and metastatic stages of the disease.

A simple blood test called the Prostate Specific Antigen test can indicate whether the patient has prostate cancer or not, and this can be confirmed with a histopathological examination, also known as the biopsy of the prostate. The biopsy is usually done through the rectal passage under ultrasound guidance and is a daycare procedure. An MRI and a PSMA PET scan also help in picking up this cancer and in staging the disease.

Treatment depends on the stage of the disease. Localized prostate cancer can be totally cured with surgery, which is now performed using a robot. Robotic radical prostatectomy provides a minimally invasive approach for treating prostate cancer in which the whole prostate, along with seminal vesicles, are taken out, and the patient is usually discharged the next day of the surgery. Blood loss during a robotic surgery is minimal as compared to an open procedure.

The recovery is hastened by the avoidance of large incisions, as just five small keyholes are made for the whole surgery. The functional outcomes for the patient, which are the return of urinary continence and preservation of erections, are excellent as the robot allows meticulous surgery to be performed owing to its magnified 3-D vision during the surgery. Robotic surgery has become the gold standard approach for surgically treating localized prostate cancer as it allows our patients to return to their day-to-day activities within a couple of days.

Most of the patients would be completely treated with surgery alone and would not require any additional therapy apart from a regular follow-up with Serum PSA levels. Patients with locally advanced disease may require adjuvant hormone and radiation therapy after the surgical removal of the prostate, depending upon the final histopathology report.

Patients with metastatic and advanced disease require hormone therapy through three monthly injections or removal of their testes, other anti-androgen therapies, and chemotherapy. Newer drugs have brought about a paradigm shift in the landscape of the management of advanced disease and promise hope to these patients.