What is Prostate Gland ?
The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder, the organ that stores urine. It is about the size of a chestnut and somewhat conical in shape, and consists of a base, an apex, an anterior, a posterior and two lateral surfaces.
What is the function of Prostate gland?
The prostate surrounds the urethra, the tube that carries sperm and urine out of the penis. The main purpose of the prostate is to produce fluid for semen, which transports sperm during the male orgasm.
Why Does The Prostate Enlarge?
Prostate enlargement can occur in both benign (non cancerous) and malignant (cancerous) conditions. The most common cause of prostate enlargement is benign prostatic hypertrophy (often called BPH).
BPH is a benign enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra through which urine and semen exit the body.
Other causes of prostate enlargement include prostate cancer and prostate infection (prostatitis).
What is Prostate cancer?
Prostate cancer forms in the cells of the prostate. Though several types of cells are found in prostate, almost all prostate cancers develop from glandular cells (adenocarcinomas). Other types of prostate cancers are very rare .
Prostate cancer is usually a very slow growing cancer and most patients do not have significant symptoms until the cancer reaches an advanced stage.
Most men with prostate cancer die of other unrelated causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous.
How common is Postate cancer?
In western countries, prostate cancer is the most common cancer in men and is responsible for the second highest number of deaths after lung cancer.
Prostate is the second leading site of cancer among males in large Indian cities like Delhi, Kolkata, Pune and Thiruvananthapuram, third leading site of cancer in cities like Bangalore and Mumbai and it is among the top ten leading sites of cancers in the rest of the population based cancer registries (PBCRs) of India. The data shows that almost all regions of India are equally affected by this cancer .
The incidence rates of this cancer are constantly and rapidly increasing in all the PBCRs. The cancer projection data shows that the number of cases will become doubled by 2020 .
Is the prostate cancer Life-threatening?
The affect of harboring a prostate cancer on lifespan of an individual depends on the stage of the disease.
Introduction of PSA (prostate specific antigen) blood test, has enabled the detection of this disease at an early stage. This has increased the chances of complete cure in patients having early stage of disease. As a result, the death rate from this disease has shown a steady decline.
Owing to earlier diagnosis, latest research, development of newer methods of treatment and the introduction of modern technology such as robotic surgery, prostate cancer is now considered to be curable or at least controllable condition. It is now possible for most men with prostate cancer to live long lives or even their entire natural life span.
What are the treatment options for Prostate cancer?
The ideal treatment for prostate cancer depends on the stage of the disease and overall medical condition and performance status of the patient. Given the multitude of treatment options available, it is important to understand and to discuss with the UroOncologist the treatment option that suits that particular patient the best.
What Are The Tests To Find Prostate Cancer
Digital rectal exam (DRE)
DRE is a physical exam wherein physician uses a adequately lubricated gloved finger inserted through the rectum to feel for any suspicious or hard areas in your prostate gland. DRE has an integral role in diagnosis of Prostate cancer. Presence of any hard or nodular areas even in the presence of normal PSA value may signify presence of cancer and warrant a biopsy.
PSA blood test
PSA (prostate specific antigen) is a substance which is normally produced by prostate gland. It serves as a tumor marker in blood which is usually raised in malignancy. It can be measured as a simple blood test. If PSA level is high for age when other benign causes of elevated PSA (such as prostatic infection or inflammation) are ruled out, prostate biopsy is needed to see if the increase is because of cancer or not. PSA may be raised in many benign (non cancerous) conditions and on the contrary some less common varieties of Prostate cancer occur even with normal PSA.
The diagnosis of prostate cancer is confirmed only with biopsy. Biopsy is done with the help of Ultrasound guidance. A thin needle is used to remove many small tissue samples from your prostate.
If cancer is found, biopsy score provides an insight into whether the cancer is slow-growing or aggressive (fast-growing). Other staging investigations may then be required to evaluate whether it has spread outside the prostate.
What are the follow up tests after treatment.
The follow-up testing will depend on many factors, including treatment selected. Regular PSA blood tests, biopsies as needed and imaging tests are used after treatment to see if the cancer has returned. Because the PSA level tends to go up and down after radiation, more PSA tests may be needed to know for sure if the cancer has returned.
Frequently asked questions?
What are the treatment Options available?
ACTIVE SURVEILLANCE (AS) / (WATCHFUL WAITING)
What it literally means ?
Active Surveillance means patient lives with prostate cancer without any active intervention. However, patient remains in close follow up and is tested regularly to see if it becomes worse.
How is patient followed up in AS
Patient undergoes a rectal exam and PSA blood test every 3-6 months, and a biopsy once a year. For each biopsy, your doctor will insert a thin needle into your prostate to remove about 12 tissue (or sometimes more) samples for testing.
The cancerous prostate gland along with surrounding tissues (mostly including lymph nodes) is removed by a surgery. The removed gland and surrounding tissue Test results will let your doctors know how much cancer you had, and if it was all removed.
Modalities of surgery
Benefits of da Vinci® Robotic Surgery
Surgery for prostate cancer is best done robotically now which is the standard of care. When available, da Vinci Surgery offers the following potential benefits compared to open surgery:
RADIATION THERAPY (RT)
What is radiation therapy for prostate cancer ?
A radiation oncologist will try to kill the cancer cells using high-dose radiation to the prostate, but will not remove the prostate.
Types of RT
Potential side effects of external beam radiation therapy for prostate cancer may include:
the volume of semen