Prostate Cancer

A sign is something that can be observed and recognized by a doctor or healthcare professional (for example, a rash). A symptom is something that only the person experiencing it can feel and know (for example, pain or tiredness). Prostate cancer may not cause any signs or symptoms in its early stages because it is generally a slow-growing cancer. Symptoms appear once the tumour enlarges or grows into surrounding tissues and organs.

The signs and symptoms of prostate cancer can also be caused by other health conditions. It is important to have any unusual symptoms checked by a doctor.

Signs and Symptoms of Prostate Cancer are:

• Changes in bladder habits
  • Need to urinate often (frequency), especially at night
  • Intense need to urinate (urgency)
  • Difficulty in starting or stopping the urine flow
  • Inability to urinate
  • Weak or decreased urine stream.
  • Interrupted urine stream
  • A sense of incompletely emptying the bladder
  • A sense of incompletely emptying the bladder
• Blood in the urine or semen
• Painful ejaculation

Late Signs and Symptoms occur as the cancer grows larger or spreads to other parts of the body, including other organs.

Late Signs and Symptoms

• Bone pain (especially in the back, hips, thighs or neck)
• Weight loss
• Fatigue
• Low red blood cell count (anemia)
• Weakness or numbness in the legs or feet
• Loss of Bladder or Bowel Control

Treatment for prostate cancer is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the person with cancer to decide on a treatment plan

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for prostate cancer are based on:

• Type of Prostate Cancer
  • 95% of prostate cancers are adenocarcinomas, which are generally slow growing tumours
• Prostate-Specific Antigen (PSA) Level
  • A rapid increase in PSA over a period of time may indicate progression of the cancer and require more aggressive treatment
• Stage and Grade (Gleason score) of Cancer
  • A localized (within the prostate gland), low-risk, slow growing prostate cancer often requires no treatment. It may be closely monitored for evidence of any progression
  • A localized, intermediate-risk or high-risk prostate cancer is usually treated more aggressively with surgery or radiation therapy
• Metastasis
  • Prostate cancer that has spread outside the prostate gland is treated primarily with hormonal therapy. Radiation therapy is sometimes given to metastatic sites in bone Chemotherapy can be given when hormonal therapy has stopped working
  • The goal is to slow the progress and reduce the symptoms of the cancer (palliative therapy)
  • Surgery may sometimes be used to relieve symptoms like urine blockage
• Age and General Health of the Man.
  • The age and health of a man with prostate cancer can influence the choice of treatment – radical prostatectomy in an elderly man in poor health involves a higher surgical risk compared to a middle-aged man in good health.
  • Active surveillance may be an option for elderly men with coexisting illnesses
  • Treatment is often given to slow the growth of the cancer or relieve distressing symptoms like urinary obstruction or severe back pain
• Personal Preference for Treatment
  • A man may want to think about the side effects of treatment such as incontinence or erectile dysfunction. Quality of life including, sexual function, is very important to some men.

Making decisions about treatment can be difficult. It is very useful for a man with prostate cancer to be well informed about the details of his diagnosis and treatment options. This allows an informed discussion with the doctors so a man can choose the treatment option that is best for him.

• Active surveillance
  • Regular checkups are scheduled every 3 to 6 months
  • Checkups usually include a digital rectal examination (DRE), prostate-specific antigen (PSA) test and repeat prostate biopsies.
• Surgery
  • Radical prostatectomy – This is the most common surgery for removal of localized prostate cancer. It completely removes the prostate cancer.
  • Pelvic lymph node dissection – This is done at the time of radical prostatectomy to remove the lymph nodes in the pelvis. It is done for intermediate-risk and high-risk prostate cancer.
  • Transurethral resection of the prostate (TURP) – TURP relieves symptoms of urinary obstruction caused by an enlarged prostate pressing on the urethra.
  • This surgery is used in men with advanced prostate cancer or men who are not healthy enough for radical prostatectomy. This surgery does not cure the cancer.
• Radiation Therapy
  • The types of radiation therapy for prostate cancer are:
  • External beam radiation
  • Brachytherapy (internal radiation therapy).
  • Radiation therapy is usually combined with hormonal therapy in men who have high-risk prostate cancer
  • Hormonal therapy may be given for a period of time before and after the radiation therapy
• Radiation Therapy
  • Hormonal therapy for prostate cancer may include:
  • Luteinizing hormone–releasing hormone (LHRH) agonists
  • Luteinizing hormone–releasing hormone (LHRH) antagonists
  • Anti-androgens (block effects of androgens in the tissue)
  • Removal of the testicles (orchiectomy).
  • Hormonal therapy may be combined with radiation therapy in men who have high-risk prostate cancer
  • Hormonal therapy may be given for a period of time before and after radiation therapy
  • Hormonal therapy is sometimes given to men who have lymph node metastases found during radical prostatectomy. It is also given for prostate cancer that recurs after surgery or radiation.
• Chemotherapy
  • Chemotherapy is used in the treatment of castrate resistant prostate cancer (also called hormone-refractory prostate cancer.
• Bisphosphonates
• Biological therapy
• Follow-up after treatment is finished
  • It is important to have regular follow-up visits, especially in the first 5 years after treatment.