Prostate cancer guide

23/10/2022

Icon editWhat is prostate cancer?

The prostate gland is the only unpaired sex gland in men. It is a muscular-glandular formation, in size and shape, resembling a walnut. The gland is located below the bladder and covers the urethra (the tube that empties urine from the bladder). The prostate produces a secret that makes up most of the sperm.

What is prostate cancer?The disease is considered the most common oncological disease, which is dominant among the male population's malignant diseases. According to statistical studies by the American Cancer Society, 1 man out of 8 will be diagnosed with prostate cancer during his life.

​​The negative feature of the cancer is slow but expressive malignant progression. If you compare this type of cancer to other forms, such as oesophagal or liver cancer, prostate malignancy grows very slowly, but even small tumours can metastasize. In the early stages, prostate cancer metastases and penetrates other body parts (spine, hips, pelvis, liver). Metastases are the biggest problem of prostate neoplasm.

Icon microscopeDiagnostic tests

There are no typical signs of prostate malignant tumours. For a long time, the disease may not show at all. However, the increase of the gland compresses the urethra, so one of the first signs may be symptoms associated with urine outflow. In the early stages, the following symptoms may be present:

  • blood in urine or sperm;
  • pain during urination;
  • frequent urges and difficulties in urination;
  • erectile dysfunction (impotence);
  • unreasonable weight loss;
  • bone pain.

Diagnostic testsThe first stage of diagnosing prostate cancer is screening, which includes:

  • Finger-rectal examination - is carried out by touching the prostate gland through the anus.
  • PSA (prostate-specific antigen) - a blood sample is taken from the vein, and the presence and amount of substance in the blood produced by the prostate are examined. The higher level indicates prostate disorders: inflammation, enlargement and even cancer.

After the screening, the doctor determines the need for additional examination:

  • Ultrasound scan - a probe is inserted into the rectum, which allows the doctor to receive an image of the gland.
  • MRI (magnetic resonance imaging) - gives a more detailed image of the prostate with a magnetic field.
  • Biopsy (prostate tissue sampling) - a tissue sample is removed with the help of a thin needle for further more accurate laboratory examination for the presence of cancer cells.
  • PET-CT (positron emission tomography) - with the help of a small number of radioactive materials, a special camera and a computer, the functions of organs and tissues are assessed. By identifying changes at the cellular level, this method can detect the early onset of the disease earlier than with other methods.
  • PSMA PET-CT (PSMA positron emission tomography) - computed tomography using a radioactive substance (68Ga-PSMA-11). This drug binds to prostate cancer cells, helping to localize them. As a result, the method allows you to determine the presence of a tumour or metastasis more accurately.
  • Bone scan (osteoscintigraphy) - is based on injecting a radiopharmaceutical drug-containing gamma radiation into the body. Its distribution is studied with the help of a gamma camera. One of the most popular methods in nuclear medicine - can detect functional pathologies of bones, not their structural changes.

Icon doctorTreatment methods

After the diagnosis is confirmed, the doctor faces the task to establish the stage. Stages of cancer are indicated by numerals, from I (cancer is limited only by gland) to IV (beyond the gland and extends to other parts of the body). Depending on the stage and individual characteristics of the patient, the treatment plan is different.

  • Radiation therapy (radiotherapy) - cancer cells are destroyed with the help of different types of rays and accelerators. It is successfully used in the early stages, combined with surgical treatment (before or after surgery) and for local exposure to single metastases.
  • Prostatectomy - the removal of the part or the entire gland through surgery. Standard treatment for prostate cancer.
  • Hormonal therapy - hormonal drugs reduce tumour growth.
  • Chemotherapy - using different forms of poisons or toxins that have a negative effect on the cells of the tumour. It is applicable in the most severe cases when the metastases to other organs.
  • Cryotherapy - a method of destroying cancer cells by cold. A probe is entered into the prostate gland through which cold gas (liquid nitrogen or argon) is inserted. Cancer tissues are frozen from -90C to -150C, and the cell dies.
  • Immunotherapy - uses drugs to stimulate the immune system to destroy cancer cells. It is dosed and often made individually for each patient.
  • Target therapy - targeted drug treatment that blocks the growth and spread of cancer cells at the molecular level. Focus on the disease with minimal impact on healthy tissues.

Icon plusNew treatment options

As mentioned above, prostate malignancy is one of the most common types of cancer. According to the American Cancer Society, about 20 million new cases and almost 10 million deaths from prostate cancer are recorded annually. And according to statistics published in A Cancer Journal for Clinicians, prostate cancer ranks fourth and composes 7.3% of the total number of new oncology cases.

Because of the widespread of prostate cancer, scientists worldwide are conducting research to improve treatment results. The most innovative methods in the treatment are the following:

  • Prostate removal by Da Vinci robot (Da Vinci® robotic prostatectomy) - operating using an automated complex, when the operation is performed not by a surgeon but by a robot. The doctor sits at the console and sees everything in 3D.
  • Lutetium-177 therapy (Lu-177 PSMA therapy) - the drug Lutetium - 177 is injected into the vein and binds at the cellular level to prostate cancer cells. At the same time, malignant cells are exposed to targeted radiation, leading to their death and reducing tumours and metastases.
  • Actinium-225 therapy (Ac-225 PSMA therapy) - the drug Actinium - 225, containing radionuclides, is administered intravenously, spreads with blood flow and is fixed on prostate cancer cells.
  • Radium-223 therapy (Ra-223 PSMA therapy) - a radioactive drug administered intravenously, selectively binds to cancer cells and emits radioactive particles to destroy them.
  • Proton therapy - is a type of radiotherapy in which a beam of protons with a given amount of radiation is directed precisely to the affected area, avoiding nearby organs.
  • Radio-guided surgery (PSMA-RGS surgery) - is a new method of detecting metastatic lesions in patients with recurrent prostate cancer to facilitate surgical removal.
  • High-intensity focused ultrasound (HIFU) - destroys cancer cells with focused ultrasound. It causes tissue necrosis and the death of cancer cells.
  • Brachytherapy (internal radiotherapy) - small granules containing radiation are injected directly into the affected organ. It works straight on the tumour and minimizes the impact on adjacent organs.
  • Radiosurgery (CyberKnife, GammaKnife) - unique radiosurgical systems for tumour removal without surgery. They allow removing the focus without removing the entire organ.

Icon chartStatistics and prognosis

Life expectancy for cancer depends on early detection and the spread in the body. The prognosis for cancer is estimated by a survival rate of five years. According to the International Center for Cancer Research, it consists of:

Statistics and prognosis

There are statistics for patients after radical prostatectomy (removal), regardless of the stage of the disease. For instance, the five-year survival rate is 99%, the ten-year survival rate is 98%, and the fifteen-year survival rate is 96%. It is one of the best survival statistics for all cancers.

References:

  1. World Health Organization: Cancer
  2. Web MD: Prostate cancer
  3. A Cancer Journal for Clinicians: Global Cancer Statistics 2020
  4. ESMO (European Society for Medical Oncology): Clinical Practice Guidelines
  5. National Cancer Institute: PSMA PET-CT Accurately Detects Prostate Cancer Spread, Trial Shows
  6. RadiologyInfo: Positron Emission Tomography - Computed Tomography (PET/CT)
  7. UCSF (Department of Radiology & Biomedical Imaging): Prostate-Specific Membrane Antigen (PSMA) PET Imaging for Prostate Cancer
  8. American Cancer Society: Key statistics for prostate cancer