Prostate Cancer (Malignant Tumor of the Prostate Gland)

Definition

In men, a small walnut-shaped organ called the prostate gland generates the seminal fluid, which is important for nourishing and transporting sperms. Prostate cancer is a malignant tumor of the prostate gland. It is one of the most common types of cancer affecting men. In some patients, prostate cancer grows slowly whereas in others it may be aggressive and can spread quickly.

Symptoms

Prostate cancer may not present with any symptoms in its early stages. In advanced stages, it may cause following signs and symptoms:

  • Difficulty urinating (due to blocked urethra, the tube connecting the urinary bladder to the genitals)
  • Weak urine stream
  • Strained urination
  • Incomplete emptying of the bladder
  • Dribbling towards the end of urination
  • Presence of blood in the urine or the semen
  • Discomfort in the pelvic area
  • Swelling in the legs
  • Bone pain

If left untreated, prostate cancer can spread to other organs and bones, can cause weakness and weight loss, and can cause kidney problems by blocking the ureters (the tubes that carry urine from the kidneys to the bladder). Prostate cancer or its treatment can cause urinary incontinence or erectile dysfunction (ED).

Causes

The exact cause of prostate cancer is not well understood. The abnormal division and growth of prostate gland cells leads to prostate cancer. Some mutations can cause such changes in the cells. The rapidly growing abnormal cells accumulate to form a tumor, which can further grow and invade nearby tissue. Older age and a family history of prostate cancer increase the risk of prostate cancer.

Treatment

A digital rectal exam (DRE), an ultrasound, or a prostate-specific antigen (PSA) test can diagnose prostate cancer. If confirmed, a biopsy sample from the prostate gland is taken and used to stage the prostate cancer, in which the grade, the spread and the severity of the cancer is defined. Staging, overall health of the patients, and the course of the cancer decide the treatment options for a particular patient.

Treatment can be categorized as:

  • Active surveillance or watchful waiting: In case of elderly patients in their 70s or 80s, symptoms are monitored continuously and therapy is given only when required.
  • Definitive treatment: Aimed at curing prostate cancer, definitive treatment can have following options:
    – Radical prostatectomy involves making an incision in the lower abdomen. It is recommended to patients, in whom the tumor is confined to the prostate. If done laparascopically, prostate removal carries less risk of infections and has a faster recovery time.
    – Cryotherapy involves killing of prostate cancer cells by freezing and thawing it.
    – Radiation therapy is recommended to high-risk patients to achieve better local control.
    – Brachytherapy involves implanting radioactive seeds into the prostate, which emit radiation for 3 to 6 months before becoming inactive.
    – Palliative treatment: Palliative treatment aims to relieve the symptoms of prostate cancer, without affecting its cure.

A combination of anti-androgens (like flutamide, bicaltumide, nilatumide), chemotherapeutic drugs (like mitoxantrone, estramustine, taxanes), corticosteroids (like prednisone), ketoconazole, or docetaxel may be prescribed.

In case of tumor metastases, castration is recommended, which can be achieved either surgically (in a procedure called bilateral orchiectomy) or medically (with hormone therapy using luteinizing hormone-releasing hormone (LHRH) agonists like leuprolide).

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