1.What is the prostate ? 

The prostate is a small, walnut-sized gland situated at the base of the bladder in men. It comprises two symmetrical lobes and encircles the initial section of the urethra, the tube that transports urine from the bladder to the penis. Additionally, the urethra carries semen, the fluid that contains sperm. 

2.What is prostate cancer? 

Prostate cancer is a disease that occurs when cells in the prostate gland grow uncontrollably Prostate cancer can develop in different ways and from various types of cells within the prostate gland.  Types of Prostate Cancer 

• Adenocarcinoma 

  • Adenocarcinoma: is the most common type of prostate cancer. It develops from the gland  cells in the prostate that produce prostate fluid, which is a component of semen. 
  • Acinar Adenocarcinoma: This is the most prevalent subtype of adenocarcinoma  and usually grows in the small ducts of the prostate gland. 
  • Ductal Adenocarcinoma: A less common and more aggressive subtype that  originates in the ducts of the prostate gland. 

Small Cell Carcinoma

Small Cell Carcinoma is a rare and aggressive form of prostate cancer that develops from  neuroendocrine cells, which are part of the hormone-producing system. This type of cancer often does  not produce elevated PSA levels and may be more challenging to diagnose early. 

  • Neuroendocrine Tumors 

Neuroendocrine Tumors are another rare form of prostate cancer that arise from neuroendocrine cells.  These tumors can be similar to small cell carcinoma but may have diFerent biological behaviors and  treatment responses. 

  • Transitional Cell Carcinoma 

Transitional Cell Carcinoma (also known as urothelial carcinoma) typically starts in the cells lining the  urethra and can spread to the prostate. This type of cancer is more commonly associated with the  bladder and urinary system than with the prostate itself. 

  • Sarcomas 

Sarcomas of the prostate are extremely rare and develop from the connective tissues in the prostate,  such as muscles, fat, or blood vessels. Sarcomas tend to be more aggressive and may require diFerent  treatment approaches compared to other types of prostate cancer. 

3.What symptoms are associated with prostate cancer? 

Prostate cancer often develops slowly and may not cause noticeable symptoms in its early stages.  However, as the cancer grows, it can lead to various symptoms that aFect the urinary system, sexual  function, and overall health. Recognizing these symptoms early can be crucial for timely diagnosis and  treatment. 

Urinary Symptoms

Prostate cancer can affect the prostate gland and surrounding tissues, leading to urinary issues, such as: 

  • Frequent Urination: An increased need to urinate, especially at night (nocturia). 
  • Difficulty Starting Urination: Trouble beginning the flow of urine. 
  • Weak or Interrupted Urine Flow: A urine stream that is weak or stops and starts.
  • Incomplete Bladder Emptying: Feeling that the bladder is not completely empty after  urinating. 
  • Pain or Burning Sensation During Urination: Discomfort or pain when urinating. o Blood in the Urine (Hematuria): Presence of blood in the urine, which may appear pink,  red, or brown. 

Sexual Symptoms 

Prostate cancer can also impact sexual function, causing: 

  • Erectile Dysfunction: DiFiculty achieving or maintaining an erection. 
  • Painful Ejaculation: Discomfort or pain during ejaculation. 
  • Blood in the Semen: Presence of blood in the semen, which may appear pink or red. • Other Symptoms 

As prostate cancer progresses, it can cause additional symptoms, including: 

  • Pain or Discomfort in the Pelvic Area: Persistent pain in the lower back, hips, or thighs.
  • Bone Pain: Pain in the bones, especially in the back, hips, or legs, which may indicate that the  cancer has spread to the bones (metastasis). 
  • Unexplained Weight Loss: Loss of weight without trying, which can be a sign of advanced cancer.

4. How Prevalent is Prostate Cancer in India? 

Prostate cancer is becoming increasingly common in India, though its prevalence is lower compared to  Western countries. Here are some key statistics about prostate cancer in India: 

  • Incidence: According to the Globocan 2020 report by the International Agency for Research on  Cancer (IARC), prostate cancer is the second most common cancer among men in India. It  accounts for about 6.8% of all cancer cases in men. 
  • New Cases: In 2020, there were an estimated 41,532 new cases of prostate cancer in India.
  • Deaths: The same year, prostate cancer caused approximately 26,561 deaths in the country.
  • Age Factor: The incidence of prostate cancer increases with age, and it is most commonly  diagnosed in men over 65 years of age. 

Regional Variations

The prevalence of prostate cancer varies across diFerent regions in India. Urban areas tend to  have higher rates compared to rural areas, possibly due to better access to diagnostic facilities  and increased awareness. 

Source: ESMO

5.What are the causes of prostate cancer? 

Several factors can increase the risk of developing prostate cancer,including: 

• Age: The risk increases significantly after age 50. 

• Family History: Having a father or brother with prostate cancer more than doubles a man’s risk of  developing this disease. 

• Race: African-American men are at higher risk and often develop prostate cancer at a younger  age. 

• Genetics: Certain inherited gene mutations may increase the risk. 

• Diet and Lifestyle: A diet high in red meat and high-fat dairy products and low in fruits and  vegetables may increase the risk. 

6.How is Prostate Cancer Diagnosed? 

Diagnosing prostate cancer involves several steps and tests to determine whether cancer is present and  to understand the extent of the disease. Here’s an overview of the common methods used to diagnose  prostate cancer. 

Screening Tests 

Screening tests are used to detect potential signs of prostate cancer in men who do not have symptoms.  The two main screening tests are: 

• Prostate-Specific Antigen (PSA) Test: This is a blood test that measures the level of PSA, a protein produced by the prostate gland. Higher-than normal levels of PSA can indicate prostate cancer, but they can also be caused by other prostate conditions, such as benign prostatic hyperplasia (BPH) or prostatitis. Elevated PSA levels may prompt further testing. 

• Digital Rectal Exam (DRE): During this physical exam, a healthcare provider inserts a  gloved, lubricated finger into the rectum to feel the prostate for any irregularities or hard areas that might indicate cancer. While DRE can help detect abnormalities, it is often used  in conjunction with the PSA test for a more comprehensive assessment. 

Diagnostic Tests 

If screening tests suggest the possibility of prostate cancer, additional diagnostic tests are performed to  confirm the diagnosis: 

• Prostate Biopsy: A biopsy involves taking small samples of prostate tissue to be examined  under a microscope for cancer cells. This is typically done using a needle guided by  ultrasound (transrectal ultrasound or TRUS biopsy). The procedure can be done in a  doctor’s oFice or outpatient setting. A pathologist then examines the tissue samples to  determine if cancer is present and to assess the aggressiveness of the cancer. 

Imaging Tests 

Imaging tests may be used to provide more information about the extent of the cancer: 

• Magnetic Resonance Imaging (MRI): An MRI scan provides detailed images of the prostate and surrounding tissues. It can help in planning a biopsy or evaluating the extent of cancer. 

• Bone Scan: If there is a concern that prostate cancer may have spread to the bones, a bone scan can help detect areas of bone that might be affected by cancer. 

• Computed Tomography (CT) Scan: A CT scan can provide detailed cross-sectional images  of the body and help determine if the cancer has spread to other areas. 

7.How will the treatment plan for prostate cancer be  determined? 

Once prostate cancer is diagnosed, further tests are done to determine the stage and grade of the cancer 

Gleason Score: The Gleason score is used to grade prostate cancer based on how much the cancer cells  resemble normal prostate cells. It ranges from 6 to 10, with higher scores indicating more aggressive  cancer.

Staging: 

Staging to assess the size and spread of cancer is represented by a combination of letters and numbers.  For prostate cancer, there are four stages, ranging from I to IV. Typically, a lower stage indicates a more  favorable outcome (or prognosis) for the patient. The TNM staging system evaluates: 

• Tumor Size (T): The size of the cancer or tumor. 

• Lymph Node Involvement (N): Whether the cancer has spread to nearby lymph nodes. • Metastases (M): Whether the cancer has spread to distant parts of the body. 

Staging assists in identifying the most suitable treatment options for prostate cancer.

Genetic Testing 

If you have a significant family history of prostate, breast, colon, ovarian, or pancreatic cancer, or if you  have been diagnosed with metastatic prostate cancer, you might undergo genetic testing to identify  specific gene mutations. Certain mutations, such as those in the BRCA1 and BRCA2 genes, can provide  information about the cancer’s aggressiveness and help determine the most eFective treatment options  for you. 

8.What are Treatment Options for Prostate Cancer ? 

When it comes to treating prostate cancer, several options are available, each tailored to the specific  characteristics of the cancer and the patient’s overall health. Here’s an overview of the main treatment  options: 

Active Surveillance 

  • What It Is: A strategy for monitoring prostate cancer without immediate treatment.
  • When It’s Used: Often recommended for slow growing (low-risk) cancers that are not currently causing symptoms. 
  • How It Works: Regular check-ups with PSA tests, digital rectal exams, and sometimes biopsies to monitor any changes in the cancer. 

Surgery 

  • Prostatectomy: A surgical procedure to remove the prostate gland and sometimes nearby lymph nodes. 
  • Radical Prostatectomy: Removes the entire prostate gland and surrounding tissue. 
  • Robotic-Assisted Surgery: Uses robotic technology for a minimally invasive procedure with smaller incisions and potentially quicker recovery. 

Radiation Therapy:  

  • External Beam Radiation Therapy (EBRT): Delivers high-energy rays to the prostate from  outside the body, targeting cancer cells. 
  • Brachytherapy: Involves placing radioactive seeds inside or near the prostate to target  cancer cells directly. 

Hormone Therapy:  

  • What It Is: Treatment that reduces or blocks the eFects of male hormones like  testosterone, which can fuel cancer growth. 
  • How It Works: Involves medications that lower hormone levels or surgical removal of the  testicles (orchiectomy) to reduce hormone production. 

Chemotherapy: 

  • What It Is: Uses drugs to kill or slow the growth of cancer cells. 
  • When It’s Used: Typically for advanced prostate cancer or when hormone therapy is no longer effective. 
  • Administration: Drugs can be given intravenously (through a vein) or orally (by mouth). 

Targeted Therapy 

Targeted therapies are medications designed to interfere with specific biological processes that promote  the growth of cancer cells. For example, Olaparib is a targeted therapy that inhibits an enzyme involved in  DNA repair. It is used to treat some men with metastatic prostate cancer who are not responding to  hormone therapy and have mutations in the BRCA1 or BRCA2 genes. 

Radionuclide Therapy 

Radionuclide therapy combines a targeted agent that attaches to markers on tumor cells with a  radioactive substance. This approach allows for the precise delivery of radiation to the tumor while  minimizing damage to surrounding healthy tissues. Examples include: 

  • Radium-223: A radioactive substance used for bone-targeted radiotherapy. 
  • Lutetium-177: Used in combination with PSMA (Prostate-Specific Membrane Antigen) to  target and deliver radiation to prostate cancer cells that express PSMA. 

• Bone Health in Prostate Cancer 

  • Denosumab and Zoledronic Acid: These medications help prevent fractures in patients  with bone metastases. 
  • Palliative Radiotherapy: Used to alleviate pain caused by bone metastases.

How will prostate cancer impact quality of life? 

• Potential complications of prostate cancer include: 

  • Urinary Obstruction: This can result in acute kidney injury or chronic kidney disease.
  • Sexual Dysfunction: For example, erectile dysfunction may occur.
  • Cancer Spread (Metastases): This can lead to bone pain, fractures, or spinal  compression. 
  • Hormonal Treatment Side Effects: Possible effects include hot flashes and breast  enlargement (gynecomastia). 

9.What potential side effects can arise from treatment? 

Prostate cancer treatments can have various side eFects, which depend on the type of treatment and  individual patient factors. Here are some potential side eFects associated with diFerent treatments: 

Surgery (Radical Prostatectomy):  

  • Urinary Incontinence: Difficulty controlling urine flow, which may improve with time or  require additional treatments. 
  • Erectile Dysfunction: Trouble achieving or maintaining an erection, which can be  managed with medications or therapies. 
  • Infertility: Loss of the ability to conceive due to removal of the prostate. 
  • Lymphedema: Swelling in the legs or genital area if lymph nodes are removed.

Radiation Therapy:  

External Beam Radiation Therapy (EBRT): 

  • Fatigue: General feeling of tiredness. 
  • Skin Irritation: Redness, dryness, or discomfort in the treated area. 
  • Urinary Problems: Increased frequency, urgency, or discomfort during urination. 
  • Bowel Issues: Diarrhea, rectal bleeding, or discomfort.

Hormone Therapy:  

  • Hot Flashes: Sudden warmth or sweating. 
  • Reduced Libido: Decreased interest in sexual activity. 
  • Erectile Dysfunction: Difficulty achieving or maintaining an erection. 
  • Fatigue: General tiredness. 
  • Weight Gain: Potential increase in body weight. 
  • Bone Loss: Increased risk of osteoporosis and fractures. 

Chemotherapy:  

  • Nausea and Vomiting: Upset stomach or vomiting. 
  • Fatigue: Feeling unusually tired. 
  • Hair Loss: Loss of hair on the head and body. 
  • Increased Risk of Infections: Due to reduced white blood cell counts.
  • Appetite Changes: Loss of appetite or weight fluctuations. 

Immunotherapy:  

  • Flu-like Symptoms: Fever, chills, or fatigue. 
  • Skin Reactions: Rashes or itching. 
  • Digestive Issues: Diarrhea or abdominal pain. 
  • Endocrine Disorders: Potential effects on thyroid or adrenal glands.

Targeted Therapy:  

  • Fatigue: Feeling unusually tired. 
  • Nausea and Vomiting: Upset stomach or vomiting. 
  • Skin Problems: Rashes or dry skin. 
  • Liver Issues: Potential effects on liver function. 

Cryotherapy:  

  • Urinary Symptoms: Difficulty urinating or blood in the urine. 
  • Erectile Dysfunction: Difficulty achieving or maintaining an erection.
  • Pain: Discomfort in the pelvic area. 

10. What is the Outlook for Prostate Cancer ? 

The outlook for prostate cancer varies based on several factors, including the stage and grade of the  cancer, the patient’s age and overall health, and how well the cancer responds to treatment. Here are  some key points about the outlook for prostate cancer: 

General Prognosis 

  • Localized Prostate Cancer: When detected early and confined to the prostate, the  prognosis is generally excellent. The 5-year relative survival rate for localized prostate  cancer is nearly 100%. 
  • Regional Prostate Cancer: If the cancer has spread to nearby areas but not distant parts  of the body, the 5-year relative survival rate is also nearly 100%. 
  • Distant Prostate Cancer: When the cancer has spread to distant parts of the body, such  as bones or other organs, the 5-year relative survival rate drops significantly, to around  30%. 

Factors Influencing Prognosis 

  • Gleason Score: This score, which ranges from 2 to 10, indicates how aggressive the cancer  is. Lower scores are associated with a better prognosis. 
  • PSA Levels: Prostate-specific antigen (PSA) levels can indicate the presence and  progression of prostate cancer. Lower PSA levels are generally associated with a better  outlook. 
  • Age and Health: Younger patients and those in good overall health tend to have better  outcomes. 
  • Response to Treatment: How well the cancer responds to treatments such as surgery,  radiation, hormone therapy, or chemotherapy can significantly affect the outlook.

Overall, the outlook for prostate cancer is generally positive, especially when it is detected early and  treated effectively. Regular screenings and advances in medical treatments continue to improve the  prognosis for many men diagnosed with this disease.