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What is prostate gland?

Prostate gland is a gland in the human body present only in men. It is situated at the bottom of the abdomen. The urine pipe (urethra) starts from the urinary bladder and goes through the prostate gland and then comes out of the body.

What are the medical issues that can happen in prostate gland?

Enlargement/ tightening of prostate cause ongoing urinary symptoms commonly called Lower Urinary Tract Symptoms (LUTS). This includes, difficulty in intiation, poor flow, incomplete emptying, intermittent flow, frequency of urination, getting up often in the night time. At time blood in the urine could be a presenting symptom of prostate cancer.

Can i have prostate cancer without symptoms?

Yes. Many a times, patients with early stage prostate cancer may not have symptoms. Awareness in the key for detecting these cancers.

Does elevated PSA mean I have cancer?

PSA blood test varies with age. If the age specific PSA is higher than normal then the suspicion increases especially at higher values. However PSA can be elevated due to other causes such as urinary infection, instrumentation, retention of urine etc. Hence the values need to be interpreted with caution by the doctor.

How is prostate biopsy done? Is it very painful?

Prostate biopsy is done using a ultrasound scan probe through the motion passage. The procedure is bit uncomfortable, The doctor will usually give you 2 local anaesthesia before taking biopsies, The biopsies are assessed by a pathologist who can confirm as whether prostate cancer is found or not

Is prostate cancer lethal? Will it kill me?

Prostate cancer, if found early can be treated effectively and can potentially be cured. Unlikely many other cancers, early prostate cancer especially low stage and low grade cancers can be cured. Even in advanced stage with spread disease, effective treatments are available to allow patients live for a long period of time for e.g. 5-10 years. The aim of this publication is to make people aware of prostate cancer so that the disease can be picked up at early stage where we can cure them.

Ok Doc! I have been told I have Prostate Cancer? What should I do now?

Well, it’s best to sit down with your doctor and have good discussion. There are multiple treatment options for prostate cancer, Hence your doctor, in discussion with other experts (UroOncologist, Medical Oncologist and Radiation Oncologist) and after a good discussion with yourself to understand your needs, will suggest the optimal treatment plan for you. Some patients may require more than one treatment (multimodal treatment). In such occasions, your doctor will suggest the optimal sequences which will sult your situation. for this decision making multiple factors such as grade , stage , fitness , presence of urinary symptoms , extent of the disease , other co morbidities etc will be taken into account.

Please tell me about the operations for prostate cancer...

Operations for prostate cancer can be either Radical prostatectomy or TURP. Radical Prostatectomy is done to remove the whole prostate with the cancer. Along with prostate seminal vesicles and vas and some amount of nerves around the prostate are removed inorder to give a complete clearance. Radical prostatectomy can be done by open or Robotic method. Both of them have the same results, However Robotic method has advantages as it is minimally invasive and therefore patients comfort is more and pain after operation is very less. TURP entails coring the prostate through in order to improve the flow of urine. In this process the outer shell of the prostate is still inside the body. This operation is done for symptom improvement rather than for cancer. After this operation, patents may still need to have another treatment such as Radiation or hormones or very rarely radical prostatectomy.

Please tell us about Radiation?

Radiation therapy is a method to treat prostate cancer, In this method, x-rays are shone on the prostate from outside. So this method generally does not involve operations. There are many methods of radiation. This includes IMRT, IGRT, Cyber knife, Proton Therapy etc. Another method to give radiation is to implant radioactive seeds in the prostate called Brachtherapy. Usually patients go the hospital every day! 5daysa week for about 4-6 weeks for their radiation treatment

What is Hormone therapy?

Prostate cancer thrives on the testosterone hormones produced by the testes. Hormone therapy, also called Androgen Deprivation Therapy, acts by stopping the male hormones in the body and thereby depriving cancer cells their nutrition. In this type of treatment is the comer stone for patients who have advanced widespread disease. This treatment is also used in patients who are undergoing radiotherapy on a short term basis

Can I prevent Prostate cancer?

Like many other cancers, the precise reason for this cancer is largely unknown. Smokers seem to have a higher chance of having this cancer. Being men and getting old are the tell-tale reason for prostate cancer, we can’t prevent prostate cancer. But being aware allows you to find this cancer at a early stage which in turns allows to have treatment which will cure.

What is the work of prostate gland?

Prostate helps in matures sperms. This step is required for successful pregnancy. As men grows old, prostate gland itself does not have any role. However the gland may enlarge and compress the urethra. This can cause Difficulty in urination.

If i have symptoms do i have prostate cancer?

Presence of urinary symptoms does not necessarily mean you have cancer. Majority of the men with urinary symptoms have only a benign (non-cancer) enlargement of the prostate.

How to detect prostate cancer?

Good clinical examination by an urologist or UroOncologist will raise the suspicion of cancer. Once suspected, the doctor will ask for blood test called Prostate Specific Antigen (PSA).

If PSA is higher or if examination shows some abnormality in the prostate what would happen next?

At this stage, your doctor will advise you for a scan (Multipara metric MRI) and then a biopsy of the prostate gland.

Are the tests mentioned above fool proof to find cancer? Is there a chance of missing cancer?

The combination of above mentioned tests usually picks up the vast majority of cancers, However in spite of the best efforts, sometimes small focus of cancer may get missed. Hence it is crucial that the patients be on close follow up with the doctor

My doctor mentioned about grade of the tumour. What does it mean?

Prostate cancer is usually graded using 2 grade devised by Dr Gleason. Hence it is called Gleason grade. In a prostate gland, many grade may be present, Hence we take the most prevailing grade + second most prevailing grade in that biopsy and give a Gleason score. This will help us understand the behaviour of the cancer. Higher the grade / score more aggressive are the behaviour of the cancer.

What treatments are available for prostate cancer?

In general treatment options could include operations (Radical prostatectomy, TURP) / Radiation therapy (External Beam Radiotherapy, Brach therapy), hormones therapy (to cut off the testosterone levels), chemotherapy and many new drugs

What are the side effects of radical prostatectomy?

Patients undergoing radical prostatectomy will experience urine leakage for a short while and impotence, Urine leakage (Stress incontinence) during coughing or sneezing is noticed immediately after the surgery. With adequate pelvic floor exercises, medications and motivation the vast majority of the patients will become dry. Impotence happens in al the patients. With treatment almost half the patients (who were sexually active before the operation) will notice recovery of the function almost a year after the surgery.

As regards TURP, the side effects are very minimal. Stress urinary incontinence happens rarely. Small proportion of men with TURP may develop a blockage stricture) and may require some more treatment

What are the side effects of radiation therapy?

Generally well tolerated, radiation side effects in the initial period of treatment is minimal, During the late part of the treatment and for a few weeks afterwards patients may experience urinary and rectal urgency. Rarely other side effects such a rectal bleeding etc can happen. In long term, patients with radiation experience a bit of rectal urgency and urinary urgency. A small proportion of patients will report! long term urge urinary incontinence. Impotence rates are very similar to surgery

Doctor, you mentioned about Multimodal therapy?

IN a single patient one or more methods may need to used to obtain best cancer control, The team of doctors will help you understand as what would be the ideal sequence-of treatment based on many factors which I discussed before.

So what should I do now Doc?

Well, Be aware that prostate cancer is common in men and is curable cancer. Have your periodic health check, Make sure your dad, uncle, brother and your friends have check-up done.