Prostate Cancer Diagnosis and Treatment

There is no single test to diagnose prostate cancer. Your doctor may use several tests to find out if you have prostate cancer. The tests include:

  • Ask for a urine sample to check for infection.
  • Take a blood sample to test your level of prostate-specific antigen (PSA) called PSA testing.
  • Examine your prostate by inserting a gloved finger into your bottom called digital rectal examination (DRE)

If the test shows an abnormality, your GP will refer you to a urologist for further evaluation. Your urologist may recommend a biopsy of the gland to confirm your diagnosis. Additionally, your urologist may suggest bone scans, computed tomography (CT) scans or magnetic resonance imaging (MRI) to find out if the cancer has spread.

Prostate Cancer Treatment Options

If you’re diagnosed with prostate cancer, your cancer care team will help you decide which prostate cancer treatment is the best for you. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects of treatments, your personal preferences, age and overall health.

Active surveillance and watchful waiting

If prostate cancer is in an early stage, a doctor may recommend active surveillance or watchful waiting.

Active surveillance

This aims to avoid unnecessary treatment of harmless cancers while still providing timely treatment for patients who need it.

Active surveillance involves having regular PSA tests, MRI scans and sometimes biopsy to ensure any signs of progression are found as early as possible.

If these tests reveal the cancer is changing or progressing, you can then make a decision about further treatment.

Men undergoing active surveillance will have delayed any treatment-related side effects, and those who eventually need treatment will be reassured that it was necessary.

Watchful waiting

This is often recommended for older men when it’s unlikely the cancer will affect their natural lifespan. If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment and wait to see if any symptoms of progressive cancer develop.

Watchful waiting may also be recommended if your general health means you’re unable to receive any form of treatment.

In either of these cases, you may just have hormone treatment to treat any symptoms caused by the prostate cancer.

Surgery

Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation. The type of surgery depends on the stage of the cancer and the patient’s overall health.

  • Radical (open) prostatectomy
    Radical prostatectomy is the most common type of surgery used to treat prostate cancer. It removes the entire prostate gland and some surrounding tissue.

    Radical prostatectomy is usually performed when the cancer has not spread far outside the gland. The surgery is done under general anesthesia, generally takes two to four hours and requires a hospital stay of one to two days.

  • Laparoscopic prostatectomy
    In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools.

    This type of surgery is less invasive than a radical prostatectomy and may shorten recovery time. Laparoscopic prostatectomy also causes less bleeding and less pain, but the sexual and urinary side effects are similar to those of a radical prostatectomy.

  • Transurethral resection of the prostate (TURP)
    This operation is most often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia (BPH). But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.

    During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. The operation usually takes about an hour.

    After surgery, a thin, flexible tube called catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.

    You will probably have some blood in your urine after surgery. Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.

Hormone therapy

Hormone therapy aims to stop or slow the growth of cancer cells by reducing the levels of male hormones, called androgens, in the body. Most prostate cancer cells require testosterone – the main androgen – to grow. By lowering the amount of testosterone in your body, the growth of cancer cells can be slowed down or stopped.

Hormone therapy can be given orally as a pill, or injection through the skin. Oral hormone therapy can be taken at home. Injections are usually given at a clinic or hospital.

Hormone therapy is frequently used alongside radiotherapy for locally advanced prostate cancer. You will be offered hormone therapy before, during and after radiotherapy. Hormone therapy can help shrink the prostate and any cancer that has spread, and make the treatment more effective.

Hormone therapy might also be used to reduce or prevent some symptoms of prostate cancer in men who cannot have surgery or radiation therapy.

Radiation therapy

Radiation therapy uses high-energy rays or particles to kill cancer cells. This treatment is often used to treat prostate cancer that has not spread beyond the prostate or has not spread very far.

Radiotherapy can also be used to slow the progression of prostate cancer that’s spread and relieve symptoms.

There are two main types of radiation therapy: external beam radiation and internal radiation therapy (brachytherapy).

  • External-beam radiation therapy
    External-beam radiation is the most common type of radiation treatment. It uses a machine to aims the radiation beams from outside your body at the area where the tumors are located.

    This type of radiation can be used to cure earlier stage cancers or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

    You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning.

  • Brachytherapy
    Brachytherapy, also known as internal radiotherapy, is a form of radiotherapy where the radiation dose is delivered by placing small radioactive pellets or seeds directly into the prostate or near the cancer cells. It is generally used only in men with early stage prostate cancer that is relatively grows more slowly.

    Low-dose-rate seeds are left in the prostate permanently and work for up to 1 year after they are inserted. However, how long they work depends on the source of radiation. High-dose-rate brachytherapy is usually left in the body for less than 30 minutes, but it may need to be given more than once.

    Brachytherapy may be used with other treatments, such as external-beam radiation therapy and/or testosterone suppression therapy.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to kill cancer cells. These drugs travel through the bloodstream to reach and destroy cancer cells in most parts of the body.

There are several standard drugs used for prostate cancer. These include:

  • Docetaxel (Taxotere)
  • Cabazitaxel (Jevtana)
  • Mitoxantrone (Novantrone)
  • Estramustine (Emcyt)

In most cases, docetaxel is often used as the first line anti-cancer drug, combined with the steroid drug prednisone. If this does not work, cabazitaxel is often the next chemo drug tried.

Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They help stop the disease from growing and spreading, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug used, the dose, the length of treatment and your overall health. Some common side effects of chemotherapy drugs include:

  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Loss of appetite
  • Hair loss
  • Sore mouth and throat
  • Easy bruising or bleeding

Most of these side effects usually go away once treatment has finished. However, some side effects may continue, come back, or develop later. Talk with your doctor if you have any side effect that bothers you or that does not go away. Your health care team will work with you to manage any side effect you are experiencing.

Immunotherapy

Immunotherapy is designed to boost a person’s own immune system to fight the cancer. It uses materials made either by the body or in a laboratory to improve or restore immune system function.

One immune therapy that has been approved by the FDA is a vaccine called sipuleucel-T (Provenge).

While sipuleucel-T does not appear to reduce PSA levels or stop prostate cancer growth, it may increase survival in patients with metastatic castration-resistant cancer who show few or no symptoms.

Common side effects of the vaccine include flu-like symptoms, diarrhea, fatigue, skin reactions, back and joint pain. They are associated with the infusion period and usually only last for a few days.

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