Prostate Cancer

The prostate gland is a walnut-sized organ located below the bladder and in front of the rectum. It plays an essential role in male reproduction by producing fluid that nourishes and transports sperm. The urethra, which carries urine out of the body, passes through the prostate. This anatomical relationship explains why prostate conditions, including cancer, can cause urinary symptoms.

Prostate cancer develops when abnormal cells grow uncontrollably within the prostate gland. Not all prostate tumors are cancerous—some may be benign (such as BPH, benign prostatic hyperplasia), while others may be malignant and capable of spreading to other organs.

1. Localized (Early-Stage, Stage I & II) – Cancer is confined to the prostate and has not spread.
2. Locally Advanced (Stage III) – Cancer has spread outside the prostate to nearby tissues but not distant organs.
3. Advanced (Stage IV) – Cancer has metastasized to lymph nodes, bones, or other organs.

“Early detection is key, as localized prostate cancer has a high cure rate when treated appropriately”

✔ Age – Risk increases after 50 years and is highest in men over 65.

✔ Family History – A father or brother with prostate cancer significantly raises the risk.

✔ Ethnicity – More common in African American men and less frequent in Asian men.

✔ Genetic Mutations – BRCA1, BRCA2, and other inherited mutations can increase susceptibility.

✔ Lifestyle Factors – Obesity, poor diet, and smoking may contribute to higher risk.

Many cases of early-stage prostate cancer are asymptomatic, which is why routine screening is important. When symptoms occur, they may include:

• Frequent urination, especially at night
• Difficulty starting or maintaining a urine stream
• Weak or interrupted urine flow
• Blood in the urine or semen
• Painful ejaculation
• Persistent pain in the lower back, hips, or thighs

It is important to note that these symptoms can overlap with benign conditions like BPH (Benign Prostatic Hyperplasia) or prostatitis. A proper medical evaluation is necessary for an accurate diagnosis.

• Prostate-Specific Antigen (PSA) Test – Measures PSA levels in the blood; elevated levels may indicate cancer but can also be due to benign conditions.
• Digital Rectal Exam (DRE) – A doctor checks the prostate for irregularities by inserting a finger into the rectum.
• MRI & Imaging Tests – Used to evaluate suspicious areas before biopsy.
• Prostate Biopsy – Tissue samples are taken and examined under a microscope to confirm cancer.

• Prostate cancer treatment is highly individualized, based on the stage of the disease, the patient’s overall health, and personal preferences. A multidisciplinary team of Uro-Oncologists, medical oncologists, and radiation specialists should work together to determine the most effective treatment approach while minimizing side effects and maintaining quality of life.

🔹 Who is it for?

• Patients with low-risk, slow-growing prostate cancer (Gleason 6, low PSA, localized disease).
• Older patients or those with other health conditions who may not benefit from aggressive treatment.

🔹 What does it involve?

• Regular PSA tests, MRI scans, and prostate biopsies to monitor for signs of progression.
• No immediate treatment, reducing the risk of unnecessary side effects.
• Transition to active treatment if the cancer shows signs of growth or increased aggressiveness.

🔹 Key benefits:

✔ Avoids potential side effects of surgery and radiation.

✔ Allows men with low-risk prostate cancer to maintain their quality of life.

✔ Provides a safe alternative for older patients or those with other medical conditions.

🔹 Risks:

✔ Cancer may progress in some cases, requiring delayed treatment.

✔ Requires strict follow-up and patient compliance.

🔹 Who is it for?

• Patients with localized or locally advanced prostate cancer.
• Younger, healthier patients seeking a curative option.

✅ Advantages of Robot Assisted Surgery 

• Minimally invasive with robotic technology for greater precision and quicker recovery.
• Less blood loss, shorter hospital stay, and smaller incisions.
• Uses small incisions and a camera but with robotic assistance.

✅ Open Radical Prostatectomy:

• Traditional approach with direct visualization and access to pelvic structures.

🔹 Potential Side Effects & Management:

• Urinary incontinence: Improves over time with pelvic floor therapy.
• Erectile dysfunction (ED): May be managed with nerve-sparing surgery, medications, or penile rehabilitation therapies.
• Reduced ejaculation: Common after prostate removal.

🔹 Key benefits:

✔ Curative option for localized disease.

✔ Advances in surgical techniques have reduced complications.

🔹 Risks:

• Surgical recovery period (2-6 weeks).
• May require additional treatment if cancer is found beyond the prostate.

🔹 Who is it for?

• Patients with localized or locally advanced prostate cancer who wish to avoid surgery.
• Older patients or those with medical conditions preventing surgery.
• Can be used after surgery if cancer remains or recurs.

🔹 Types of Radiation Therapy:

✅ External Beam Radiation Therapy (EBRT):

• High-energy radiation targets the prostate from outside the body.
• Modern techniques (IMRT, IGRT, SBRT) minimize damage to surrounding tissues.

✅ Brachytherapy (Internal Radiation):

• Radioactive seeds are implanted inside the prostate to deliver continuous radiation.
• Ideal for low-risk, localized prostate cancer.

🔹 Potential Side Effects:

• Urinary symptoms (burning, frequency, urgency).
• Bowel issues (diarrhea, rectal irritation).
• Sexual side effects (ED may develop over time).

🔹 Key benefits:

✔ Non-invasive, outpatient procedure.

✔ Alternative to surgery with comparable cure rates.

🔹 Risks:

• Side effects may take months to develop.
• Requires multiple sessions over weeks (except for some modern techniques).

🔹 Who is it for?

• Advanced, recurrent, or metastatic prostate cancer.
• Often used alongside radiation therapy.

🔹 How does it work?

• Blocks testosterone production, which fuels prostate cancer growth.
• Can be achieved through medications (GnRH agonists/antagonists like Leuprolide, Degarelix) or surgical castration (orchiectomy).

🔹 Potential Side Effects & Management:

• Hot flashes, fatigue, mood changes – Can be managed with lifestyle changes or medications.
• Loss of libido & erectile dysfunction – Often reversible after stopping therapy.
• Osteoporosis – Regular bone health monitoring, calcium, and vitamin D supplements recommended.
• Weight gain & metabolic changes – Regular exercise and diet modifications can help.

🔹 Key benefits:

✔ Controls cancer growth, even in advanced stages.

✔ Can shrink tumors before radiation or surgery (neoadjuvant use).

🔹 Risks:

• Not curative on its own.
• Long-term use may increase risk of heart disease and diabetes.