Prostate Cancer

What is Prostate Cancer? The prostate gland is a walnut-shaped gland that present below the bladder. The prostate surrounds the urethra, the tube that carries urine out of your body. Cancer is the result of abnormal cell growth, which takes over the body’s normal cell function, making it harder for the body to work the way it should. Prostate cancer develops when abnormal cells form and grow in the prostate gland. Not all abnormal growths, also called tumors, are cancerous (malignant). Some tumors are not cancerous (benign).

Should I be Screened?

“Screening” means testing for a disease even if you have no symptoms. The choice to be screened for prostate cancer is a personal one, and it should be taken seriously.

It begins with a conversation with your health care team about your risk for the disease, including your personal and family history.

Then, a talk about the benefits and risks of testing. Generally, screening is recommended for those with no symptoms who are between the ages of 45 to 69.

Which tests are used to screen for prostate cancer?

A blood test called Prostate-Specific Antigen (PSA) measures this protein present in the prostate. Physicians should utilize PSA as the initial screening test for prostate cancer.
A healthy prostate is indicated by a low PSA score. A large increase in scores could indicate an issue, not always cancer.
One optional physical examination to check for issues with the prostate is the Digital Rectal Exam (DRE).
Prostate biopsy:
If the findings of the PSA and/or DRE testing raise concerns, biopsy tests are used.
In order to diagnose cancer, a biopsy involves taking a tissue sample from the prostate and examining it under a microscope to look for any cancerous cells.

Transrectal Ultrasound Guided Prostate Biopsy

Imaging and scans may may help your health care team learn more about your cancer. Some types are Magnetic resonance imaging (MRI), Computed tomography (CT) scan and Positron emission tomography (PSMA PET) scan.

PET SCAN

Risk factors include aging, obesity, family history, high-fat diets, smoking, and inflammation of the prostate. Diagnosis typically involves PSA blood tests, digital rectal exams (DRE), imaging studies, and biopsy. Dr. Vaddi uses advanced tools to detect the cancer’s stage and plan the most appropriate treatment.

What are the Signs and Symptoms of Prostate Cancer?

Early stages may cause no symptoms.

Intermediate stages may cause urinary problems like:

• trouble urinating or a weak urine flow

• frequent need to pass urine

• pain or burning Non-cancerous problems (like prostatitis and BPH) may also cause these symptoms.

High-risk stages cause urinary problems and may include:

• Dull pain in the pelvic area

• Blood in the urine

• Painful ejaculation

• Pain in hips, lower back or upper thighs

• Loss of appetite and/or weight loss

Why Does Prostate Cancer Occur?

Although the exact etiology of prostate cancer is unknown, scientists have discovered a number of factors that can raise a man’s risk of developing the disease.

• Age: Men are more likely to develop prostate cancer as they get older. Men over 55 are more likely to have damage to their prostate cells’ DNA, or genetic material.

• Ethnicity: The condition is more common in African American men. Prostate cancer will be identified in one out of every six African American men. Compared to non-Hispanic white men, Asian American and Hispanic/Latino men are less likely to develop prostate cancer.

GET TREATED

Early-stage prostate cancer is a cancer that has grown in the prostate, but not escaped beyond it to other parts of the body, like lymph nodes or bones.

Men with early-stage prostate cancer have a very good chance of survival. There are several options for treatment. Your treatment plan will consider:

• The stage and grade of the cancer (Gleason score and TNM stage) .

• Your risk category (whether the cancer is low-, intermediate- or high-risk

• Your age and health

• Your preferences about side effects and long-term effects of treatment

• Your treatment goals

• Results from other diagnostic tests

Active Monitoring

If your cancer is tiny and slow-growing, active surveillance is the best option. Every few months, your doctor will want you to get tests to screen for prostate cancer. A biopsy, an MRI, and a blood test to measure your PSA are typically helpful tests. In most cases, men under active observation can prevent gastrointestinal, sexual, and urine side effects.

Active surveillance

may be a treatment that helps you maintain your quality of life for as long as feasible.

There are certain males who never require any additional care. It’s time to discuss additional measures to eradicate the cancer, such surgery or radiation therapy, if the PSA increases and a biopsy reveals that the disease is spreading. We refer to that type of care as “definitive therapy.”

WATCHFUL AWAITING

One method of monitoring cancer without treating it is watchful waiting. Regular PSA tests, biopsies, or other

active surveillance methods are not used. Watchful waiting carries the chance that the cancer will develop and spread in between checkups. Men with early-stage prostate cancer who are older and more likely to pass away from other reasons may occasionally be treated with watchful waiting. It is also intended for males with other medical conditions that would make radiation or surgery difficult for them.

Radiation therapy and surgery are the two primary treatments for prostate cancer in its early stages. These treatments aim to permanently eradicate the malignancy. They treat the cancer with roughly the same level of success. You can discuss the best course of action with your physician.

SURGERY

The surgical excision of the prostate, seminal vesicles, and surrounding tissue is known as a radical prostatectomy. The pelvic lymph nodes that flow from the prostate are frequently also removed. Anesthesia and a brief hospital stay are required for this surgery. Four forms of radical prostatectomy surgery exist: • Laparoscopic Radical Prostatectomy with Robotic Assistance (RALP). Five tiny incisions (cuts) are created in the lower abdomen during this procedure, which gives the surgeon access to remove the prostate by guiding equipment and a tiny camera. One of the most popular procedures for treating prostate cancer nowadays is RALP surgery.

Laparoscopic Radical Prostatectomy. This surgery uses a video camera and small surgical tools that fit through cuts in the belly to remove the prostate. This surgery has mostly been replaced with robotic assisted laparoscopic surgery.

Laparoscopic Radical Prostatectomy

Robot Assisted Radical Prostatectomy Specimen

OPEN RADICAL PROSTATECTOMY.

Hormone Therapy

Hormone therapy is a treatment that can help lower testosterone, or hormone, levels. This therapy is also called androgen deprivation therapy (ADT). Testosterone, an important male sex hormone, is the main fuel for prostate cancer cells, so reducing its levels may slow the growth of those cells. Hormone therapy may help slow prostate cancer growth when prostate cancer has metastasized (spread) away from the prostate or returned after other treatments. Some treatments may be used to shrink or control a local tumor that has not spread. There are several types of hormone therapy for prostate cancer treatment, including medications and surgery. You may be prescribed a variety of therapies over time.

Hormone Therapy with Medications There are different types of hormone therapies available as injections or as pills. Some of these therapies help limit the body from producing luteinizing hormone-releasing hormone (LHRH, also called gonadotrophin releasing hormone, or GnRH). LHRH triggers the body to make testosterone.

Other therapies help limit prostate cells from being affected by testosterone by inhibiting hormone receptors. A blood test is sometimes done to check testosterone levels after treatment is started. You may also have tests to monitor your bone density during treatment. With LHRH treatment there is no need for surgery to remove the testicles. Candidates for this treatment include those who cannot or do not wish to have surgery to remove their testicles. There are different types of medical hormone therapy you may be prescribed to lower your body’s production of testosterone or inhibit testosterone. After your testosterone levels drop to a very low level, you are at “castration level.” Once testosterone levels drop, prostate cancer cells may decrease in growth and/or proliferation.

Radical prostrotectamy

Types of Medications

• LHRH/GnRH drugs (androgen deprivation therapy – ADT): LHRH/GnRH are drugs that lower testosterone levels. They may be used whether or not the cancer has spread. There are two types, agonists and antagonists. Agonists (analogs) cause the body to produce a burst of testosterone (called a “flare”). Agonists are longer acting than natural LHRH. After the initial flare, the drug tricks your brain into thinking it does not need to produce LHRH/GnRH because it has enough. As a result, the testicles are not stimulated to produce testosterone. LHRH or GnRH agonists are given as shots or as small pellets placed under the skin. Based on the drug used, they could be given once every one, three or six months. Antagonists also lower testosterone. Instead of flooding the pituitary gland with LHRH, they help limit LHRH from binding to receptors. There is no testosterone flare with an LHRH/GnRH antagonist because the body does not get the signal to produce testosterone. Antagonists may be taken by mouth or injected (shot) under the skin, in the buttocks or abdomen. The shot is given in the health care provider’s office. You will likely stay in the office for a short period of time after the shot to ensure you do not have an allergic reaction. After treatment has started, a blood test makes sure testosterone levels have dropped. You may also have tests to monitor bone density.

• Antiandrogen drugs: Antiandrogen drugs are taken as pills by mouth. These treatments work by inhibiting the androgen receptors in the prostate cancer cells. Normally, testosterone would bind with these receptors to fuel growth of prostate cancer cells. With the receptors inhibited, there is less testosterone to “feed” the prostate. Using certain antiandrogens a few weeks before, or during, LHRH therapy may reduce flareups. Antiandrogens may also be used after surgery or castration when hormone therapy stops working.

• CAB (combined androgen reducing treatment, with antiandrogens): This method blends castration (by surgery or with the drugs described above) and antiandrogen drugs. The treatment reduces
production of testosterone and can help limit it from binding to cancer cells. Surgery or taking oral drugs may be ways to lower the testosterone made by your testicles. The rest of the testosterone is made by the adrenal glands. Antiandrogen therapy limits testosterone made by the adrenal glands.

• Androgen synthesis inhibitors: These drugs help limit other parts of your body (and the cancer itself) from making more testosterone and its metabolites. Those newly diagnosed with metastatic hormone sensitive prostate cancer (mHSPC) or people with metastatic castration-resistant prostate cancer (mCRPC) may be candidates for this therapy.

Hormone Therapy with Surgery

Surgery to remove the testicles for hormone therapy is called orchiectomy or castration. When the testicles are removed, it limits the body from making the hormones that fuel prostate cancer. It is rarely used as a treatment choice in the United States. People who choose this therapy want a onetime surgical treatment. They must be willing to have their testicles permanently removed and must be healthy enough to have surgery. This surgery allows the patient to go home the same day. The surgeon makes a small cut in the scrotum (sac that holds the testicles). The testicles are detached from blood vessels and removed. The vas deferens (tube that carries sperm to the prostate before ejaculation) is detached. Then the sac is sewn up. There are potential benefits to undergoing orchiectomy to treat advanced prostate cancer. It is simple and has few risks. It only needs to be performed once. It is effective right away. Testosterone levels drop dramatically.

Bone-Targeted Therapy

Bone-targeted therapy may help with prostate cancer that has spread to the bones as they may get “skeletalrelated events” (SREs). SREs include fractures, pain and other problems. These drugs may slow the cancer, reduce SREs and help prevent pain and weakness from cancer growing in your bones. Side effects may include flu-like symptoms, bone or joint pain, nausea, diarrhea, and /or feeling weak or tired.

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