04/05/2020
Prostate Cancer Update
Prostate cancer incidence is increasing in India. This is a age related malignancy and seen in elderly males. Patient can be detected incidentally with raised Prostate Specific Antigen(PSA). Most of the patient comes with symptoms related to urinary tract like frequent urination,difficulty in passing urine,urinary incontinence and rarely constipation. Many of theses patient have pre-existing benign prostatic hyperplasia(BPH). Raised PSA is not always indicative of cancer(Fig 1), hence it should be followed by digital re**al examination(DRE)(Fig 2)by the physician and if required transre**al ultrasound(TRUS) guided biopsy from prostate.
Further investigation like MRI or bone scan should be decided by the treating oncologist.Screening with PSA remains controversial and can be done on patient at risk, especially with family history.
Once diagnosed as prostate cancer, these patients are categorized as low, intermediate and high risk ,considering the findings of biopsy, PSA and MRI/bone scan. Treatment differs for different categories. Age as well as life expectancy also plays role in decision making. Very low and low risk patients can be kept under close monitoring with frequent tests. Few low risk and intermediate risk patient have treatment options of surgery or brachytherapy or external beam radiotherapy. This category of patient can be offered highly precise stereotactic radiotherapy (SBRT) (Fig 3)as the sole modality of treatment which gets over in a week time without any invasive procedure or hospitalization.
Few intermediate risk, high risk and few low burden metastatic patients are treated with hormone therapy called androgen derivation therapy(ADT) followed external beam radiotherapy.
Treatment is relatively comfortable for patient without much side effects.
High burden metastatic carcinoma prostate patient are usually offered ADT with or without chemotherapy.
Usually carcinoma prostate is a slow growing tumor with better prognosis than other cancer even in metastatic stage. Patients first comes to urologist and treatment for cancer is offered by combined approach of urologist, radiation oncologist and medical oncologist.
