Understanding prostate cancer from diagnosis to treatment

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Understanding prostate cancer from diagnosis to treatment

As the life expectancy of men increases around the world, the incidence of prostate cancer will be on the rise.  This disease is primarily diagnosed in men past the age of 50.  Prostate cancer has an increased association with men who lead a sedentary lifestyle, consume a diet composed of processed food, processed meat, and alcohol and who may have had exposure to various kinds of pollutions and radiation.

Prostate cancer affects the prostate gland which is a walnut-shaped gland in men that produces the seminal fluid when a man ejaculates during intercourse.  Around the world, prostate cancer is one of the common cancers among men, including men in India.  It is predicted that by the Indian National Cancer Registry that the incidence of prostate cancer will increase by 220% by 2020. This is a huge increase in just the next two years.

To have a better understanding of prostate cancer, here is an overview of the disease from diagnosis to treatment:

Prostate cancer diagnosis

The first part of the diagnosis of prostate cancer is for a man to make an appointment with either his primary care physician or a urologist for a PSA blood test also known a prostate specific antigen. A PSA test is used to detect the presence in the blood of a protein produced by prostate cells.  If the level is elevated, it can be suggestive but not necessarily a diagnosis of prostate cancer.

There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a man’s PSA level over time may also be a sign of prostate cancer

If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum (transrectal biopsy). A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.

Staging the disease

Once a positive diagnosis for prostate cancer is confirmed on the biopsy, a urologist will then further test to determine the stage of the disease. 

A nuclear medicine technology-based bone scan may be used to see if the prostate cancer has spread to the bones.   The patient will be injected with a small amount of low-level radioactive material which settles in the damaged areas of bones in the body.  From this step, an image will be made to determine the extent of the disease and if it has spread to the bones or not. 

If the cancer has not spread or is localized, then treatment can be done.  The primary treatment used for best results are either surgery or radiation therapy. 

Treatment for prostate cancer

The exciting news for prostate cancer is the fact that technology is paving the way cancer diagnosis and treatment is being delivered offering new hope to patients.  This newer technology is less painful bringing more hope and peace of mind while saving more men’s lives in the process.  A couple of treatments proving to be very successful for prostate cancer are robot-assisted radical prostatectomy and CyberKnife robotic radiosurgery. 

Robot-assisted radical prostatectomy

A radical prostatectomy is a surgical procedure which involves the complete removal of the prostate gland along with lymph nodes.  There are several ways to do this which can include either open, lap or robotic assistance.  Of these options, the one with the best outcome is the robotic-assisted radical prostatectomy.

This procedure involves an actual surgeon who sits on a console guiding the robotic arm throughout the surgery.   Any man considering this procedure should do his research looking for an experienced skilled urologist in robotic surgery.  One such robot-assisted procedure is called da Vinci robot surgical system.  With this procedure, surgeons operate through just a few small incisions. The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human hand. As a result, da Vinci enables the surgeon to operate with enhanced vision, precision and control.

The surgeon is 100% in control of the da Vinci System at all times helping translate the surgeon’s hand movements into smaller, precise movements of tiny instruments inside your body.

This robotic procedure allows the patient a shorter recovery time, minimal blood loss, less post-operative pain, and a low likelihood of complications.

CyberKnife Robotic Radiosurgery for prostate cancer

Another procedure that may be recommended for men with prostate cancer is CyberKnife Robotic Radiosurgery. This is a system designed to treat tumors anywhere in the body, including the brain, spine, lung, liver, pancreas and prostate.

It delivers high doses of radiation with pin-point, sub-millimeter accuracy. Because the CyberKnife can deliver radiation beams from virtually any direction, the radiation beams are focused precisely on the tumor minimizing damage to the surrounding healthy tissue and nearby critical structures like the spinal cord or optic nerve.

Prior to treatment with the CyberKnife, the patient undergoes imaging procedures to determine the size, shape and location of the tumor. The process beings with a standard high-resolution CT scan, or for certain tumors other imaging techniques, such as MRI, angiography or PET, may also be used.

Following the scanning, the image data is then digitally transferred to the CyberKnife’s treatment planning workstation, where the treating physician identifies the exact size, shape and location of the tumor.

A qualified clinician then uses the CyberKnife software to generate a treatment plan to provide the desired radiation doses to the identified tumor location while avoiding damage to the surrounding healthy tissue. The patient does not need to be present during this step in the process.

During a CyberKnife procedure, a patient lies comfortably on the treatment table, which automatically positions the patient. Anesthesia is not required, as the procedure is painless and non-invasive.

The treatment generally lasts between 30 and 90 minutes and is typically completed in one to five visits

Follow-up imaging, generally performed with a combination of CT, MRI and/or PET scanning, is usually performed in the months following treatment to assess the tumor’s response to the delivered radiation.