Prostate cancer

Diagnosis

Screening tests for prostate cancer

The following screening tests may be performed to detect prostate cancer:

• Digital rectal exam. The doctor inserts a lubricated gloved finger into the rectum to palpate for the prostate which is just alongside the rectum. If the prostate gland feels like there are unusual changes on its shape, texture or size, further tests may be performed.
• Prostate-specific antigen (PSA) blood test. High amounts of PSA in the blood indicates an infection, enlarged or inflamed prostate. Moreover, it also indicates prostate cancer.

Diagnosing prostate cancer

When prostate cancer screening results to any abnormalities, the following tests may be done to detect prostate cancer:

• Transrectal ultrasound. A small probe is inserted into the rectum and create images of the prostate gland using sound waves.
• Magnetic Resonance Imaging (MRI). Creates more detailed images of the prostate gland and guides the doctor to extract prostate tissue samples.
• Prostate biopsy.  Collects a sample of the prostate gland tissue to test for the presence of cancer by inserting a thin needle.

Determining the aggressiveness of prostate cancer

The cancer cells present in the prostate is graded based on the aggressiveness of the disease as follows:

• Gleason score. The scoring combines two numbers and ranges from 2 to 10 based the disease aggressiveness. Two being nonaggressive and 10 is the most aggressive.
  A score assessment of 6-10 is used to indicate prostate cancer. This is the most common evaluation of prostate cancer grade. The score of 6 is a low-grade cancer. A score of 7 is a medium-grade cancer. A score of 8, 9, or10 is a high-grade cancer.
• Genomic testing. Detects which gene mutation is present in the prostate cancer cells and helps determine the disease prognosis.

Determining the stage of prostate cancer

After prostate cancer has been diagnosed, further testing will be done to determine the extent of cancer such as:

• Bone scan
• Ultrasound
• Computerized Tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET) scan

The doctor will decide which test should be performed in each case. Cancer will then be staged from I to IV. The lowest stage means that the cancer is only located locally in the prostate. Stage IV indicates that the cancer has spread to other parts of the body outside of the prostate.

Treatment

Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, whether it has spread and your overall health, as well as the potential benefits or side effects of the treatment.

Active surveillance

Treatment may not be needed immediately. Some cases don’t need treatment but active surveillance is recommended. This means regularly undergoing blood tests, rectal exam and prostate biopsy to observe cancer progression. If cancer has progressed, treatment may be done by surgery or radiation therapy.

Surgery

Surgery can be done on cancer that is detected locally in the prostate or may also be done in the advanced stage of cancer combined with other treatments. The prostate gland may be removed together with its surrounding structures including the lymph nodes (radical prostatectomy).

The following surgical techniques may be used:

• Robot-assisted laparoscopic prostatectomy. A small medical device (robot) is inserted into the small incisions in the stomach through your abdomen to access the prostate. This is a common procedure done in prostate cancer.
• Retropubic surgery. A long incision is made in the abdomen to access and remove the prostate gland. This technique is less commonly utilized.

Radiation therapy

The body is exposed to a high radiation to fight cancer cells. There are two types of radiation therapy available such as:

• External beam radiation therapy can be done if cancer is locally found only in the prostate. This technique can be applied to kill or prevent spreading from any remaining cancer cells. High-powered energy beam is given to the body for five days in a week for several weeks or it can also be done in a short time but higher doses of radiation are administered.
• Brachytherapy is a treatment option for cancer that hasn’t spread beyond the prostate. Radioactive sources (rice-sized seeds) are inserted into the prostate to kill cancer cells. The seeds produce low doses of radiation over a long period of time.

A combination of both may also be utilized by the doctor.

Focal therapy

This is the latest treatment option which only targets the part of the prostate with cancer if it has not spread. Examples are High-Intensity Focused Ultrasound (HIFU), cryotherapy, laser ablation and photodynamic therapy.

Freezing or heating prostate tissue

This therapy is called ablation which uses heat or cold to break up prostate tissue. The following techniques are done:

• Cryoablation or cryotherapy uses extremely cold gas to freeze the prostate cancer to destroy cancer cells and it may destroy healthy tissues around it.
• HIFU treatment kills prostate cancer tissues by heating them using intense ultrasound energy.

These treatments may be utilized if surgery is not applicable to treat smaller prostate cancer as well as advanced stages if other therapy like radiation therapy is not an option.

Systemic therapies

Systemic therapies are advised by the doctor if the cancer has spread outside the prostate gland which includes chemotherapy, androgen deprivation hormone and immunotherapy.

Hormone therapy

This therapy prevents the body’s release of testosterone (male hormone) which provokes growth because prostate cancer. It will then lead to the death of cancer cells.

The following are examples of hormone therapies:

• Medications that stop your body from producing testosterone.  Luteinizing Hormone-Releasing Hormone (LHRH) or Gonadotropin-Releasing Hormone (GnRH) agonists and antagonists are indicated to stop the cells from accepting signals to take in testosterone which prevents the testicles from creating testosterone.
• Medications that block testosterone from reaching cancer cells.  Anti-androgens are usually prescribed in combination with LHRH agonists as LHRH agonists may cause a short-term rise of testosterone levels before its level deteriorates.
• Orchiectomy. Removes the testicles to rapidly decrease the body’s testosterone levels. This procedure is permanent and cannot be reversed.

Hormone therapy may be utilized prior to surgery to destroy cancer that has not yet spread outside the prostate by decreasing the cancer size and also used for advanced stage prostate cancer to facilitate shrinkage of cancer and slow down its growth.

Targeted drug therapy

Medications are used to focus only on specific abnormalities in the cancer cells. Targeted therapy inhibits the abnormalities and kills the cancer cells.