Prostate cancer is one of the most common cancers among men, but spotting it early can make all the difference. Dr. Ravi Chandran K, Consultant, Uro Oncology and Robotic Surgery, Apollo Hospitals, Bangalore, shared with HT Lifestyle the key symptoms to watch for and treatment options that may help manage or even cure the disease. (Also read: Urologist shares common health problems in Indian men over 50 and how to prevent them: ‘Early detection is crucial’ )
“The prostate is a small gland located beneath the bladder that assists in semen production. Prostate cancer occurs when prostate gland cells start multiplying uncontrollably. Some prostate cancers grow relatively slowly and may not pose serious issues. Others can be aggressive and potentially life-threatening. The tough part is that most early prostate cancers do not present symptoms, hence the necessity of regular health checks for those at higher risk,” says Dr. Ravi.
What are the symptoms of prostate cancer
Early prostate cancer is typically symptom-free. As per Dr Ravi, the most common symptoms are:
1. Urinary problems
- Frequent urination, particularly at night
- Reduced or interrupted flow of urine
- Hesitancy or urgency
- Painful or burning urination
2. Presence of blood in urine or semen
3. New onset or exacerbation of erectile function
4. Pain and discomfort: Recurring pain in the lower pelvis, hips, or lower back may signify metastatic spread.
These symptoms can also present in benign prostatic hyperplasia (BPH) or infections, however, and thus must be carefully examined medically.
Tests for early detection and diagnosis
Early diagnosis can markedly enhance outcomes. Two screening tests are used most frequently:
- Prostate-Specific Antigen (PSA) Test: A blood test to measure the level of PSA. Elevated results may suggest prostate cancer, although other diseases such as BPH or prostatitis can also increase PSA.
- Digital Rectal Examination (DRE): A physical examination in which a physician examines the prostate via the rectum to identify abnormalities.
In case either of the tests is abnormal, additional testing is required:
- Multi-parametric MRI of the prostate
- Prostate biopsy (most often guided by ultrasound, with MRI fusion trans perineal biopsy being the most accurate mode of tissue diagnosis)
- Prostate-specific membrane antigen (PSMA) PET CT to look for distant disease spread
- Genetic testing in some selected situations
What are the options for treatment
Your treatment will depend on the stage of cancer, biopsy report, PSA level, age, health and preferences.
1. Active surveillance
Men with low-risk, slow-growing cancer, especially older men or those with multiple comorbidities, may prefer active surveillance (testing PSA levels regularly, repeat MRI, and possibly biopsies). Instead of treating cancer right away, it will be closely monitored and intervened on when it shows early signs of progression.
2. Surgery
Radical Prostatectomy is the complete removal of the prostate along with seminal vesicles, and typically the lymph nodes as well. Robot-assisted surgery is the current gold standard, where a fine balance between oncological and quality-of-life outcomes is well achieved.
The risks of surgery include urinary incontinence and erectile dysfunction. Many new techniques in prostate surgery, especially Robotic nerve-sparing techniques, have allowed many men to retain continence and sexual functioning with lower risk.
3. Radiation therapy
External beam radiation therapy (EBRT). or Brachytherapy, which are objects (seeds) put inside the prostate. Radiation can be utilised when prostate cancer is a localised disease or a locally advanced disease. Side effects include urinary, bowel, plus sexual side effects, which are also typically manageable as well.
4. Hormone Therapy (Androgen Deprivation Therapy)
The mechanism of hormone therapy is to reduce testosterone. Testosterone is the fuel for prostate cancer. Hormone therapy is typically utilised with radiation in cases of high-risk and advanced disease. Side Effects – hot flashes, fatigue and tiredness, reduced libido, potential loss of bone density/osteoporosis, and many metabolic changes.
5. Chemotherapy
High-risk, refractory or advanced prostate cancer patients would require chemotherapy. Medications such as docetaxel or cabazitaxel prove to slow down the progression and improve overall survival.
6. Targeted Therapy and Immunotherapy
Latest precision-guided therapies in advanced disease.
7. Radioligand Therapy
Advanced therapy using a radioactive molecule that targets prostate-specific markers like PSMA, now more common in metastatic disease.
Living with and beyond prostate cancer
Diagnosis of prostate cancer can feel overwhelming, but the good news is that prostate cancer is slow-growing, and survival is quite high, particularly with early detection. When confined to the prostate, around 95% will be alive and well at 5 years. Living beyond a cancer experience can bring challenges of its own, such as living with the effects of treatments, anxiety about follow-up, or even having to make significant lifestyle changes. To get support for these transitions, adding multidisciplinary care (uro-oncologist, oncologist, psychologist, physiotherapist, dietitian) is vital.
Conclusion
Prostate cancer is considerably more common in men than you may realise, and if caught early enough, awareness, timely detection, and access to the right interventions can often lead to curative treatment. All men, especially those over the age of 50 or those with risk factors, should consult a urologist/uro-oncologist about screening and remain vigilant in reporting changes in their urinary pattern. May this month spark more conversations, actions, and support around prostate cancer.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
