Prostate cancer: What comes after diagnosis?
Prostate cancer is the second most frequently occurring cancer in men and predominantly affects elderly men of above 65 years of age. On the word of statistics, the incidences of prostate cancer in India are lower than that in the Western countries. However, recent surveys depict an increasing rate of prostate cancer prevalence in the Urban population.
Strategy to be followed by the proper diagnosis of prostate cancer is as follows:
Staging is a standard approach used to investigate the severity and duration of prostate cancer. Staging provides information about the extent of primary tumor, distance from lymph nodes, and presence of distant metastasis ( a spread of disease to other parts of the body). Staging is of two types, clinical staging, and pathological staging. Clinical staging is done by physical evaluation, lab tests, biopsy and imaging tests by doctors and pathologic staging is done following examination after surgery. There are four stages of prostate cancer, I, II, III, and IV based on increasing order of severity and location of the tumor.
Treatment Options: A perfect treatment plan for the management of prostate cancer may involve a combination of watching closely with or without surgery.
Watching closely with no treatment: As the disease progression is relatively very slow, some men may never require any treatment. Although they will be under keen observation and monitoring by their doctors, i.e., watchful waiting and active surveillance.
Surgery: Surgery may be opted to ascertain complete removal of cancer. Different types of prostate surgeries are; radical retropubic prostatectomy, radical perineal prostatectomy, laparoscopic radical prostatectomy, robotic-assisted laparoscopic radical prostatectomy, transurethral resection of the prostate, and cryosurgery.
Chemotherapy and medications: Medications like docetaxel, mitoxantrone with prednisone may be used for bone metastases.
Radiation: High-energy x-rays are used in radiation therapy to shrink cancerous cells. There are two types of radiation therapy which are used to treat prostate cancer, external beam radiation (three-dimensional conformal therapy and intensity modulated radiation therapy) and brachytherapy (short-term and permanent).
Hormone therapy: This therapy is used against cancerous cells which have spread to other parts of
the body and which recurred after treatment. This therapy cannot cure cancer completely, but it shrinks cancer cells and makes them grow more slowly.
Strategy for treatment:
For localized disease (Stage I + II) involves surgery for prostate cancer involving removal of the prostate gland.
Locally advanced disease (Stage III) is treated with surgery, radiation (external beam or brachytherapy) and hormonal.
The metastatic disease (Stage IV) is treated with hormone therapy which ceases production of testosterone, medications to stop the body production of testosterone and surgery to remove the testicles (orchiectomy).
Along with medical treatment, it is also important to deal with the sensitive, emotional aspect of the disease and controlling patient’s anger, anxiety, frustration, and depression.
Proper open interaction with someone in the family or any close friend helps a lot in coping with the after-effects of prostate cancer.