WHAT IS PROSTATE AND WHAT IS ITS FUNCTION?
The prostate is the gland in the lower abdomen, between the base of the penis and the rectum. It is a part of the male reproductive system. The prostate is responsible for producing seminal fluid (semen), which mixes with sperm produced by the testes.
CAUSES
There are no particular reasons for the development of prostate cancer.
Risk factors:
Age: Prostate cancer is diagnosed more in older individuals (of age greater than 65 years and above).
Family history: Individuals with a family history of cancer are at a higher risk of developing prostate cancer.
Genetic factors: A man with a genetic abnormality is at higher risk of developing prostate cancer
Race: Black males are more likely to develop prostate cancer than white males. Black males are likely to die twice compared to white males.
Diet and lifestyle: Eating food with higher fat might increase the risk of prostate cancer. Exercise will reduce the risk of dying because of prostate cancer.
Prostate size increases with age:
The prostate gland size increases with age, called benign prostatic hyperplasia, which is not cancerous. An enlarged prostate can cause the same symptoms as that prostate cancer.
TYPES OF PROSTATE CANCER
Early-stage prostate cancer: Cancer has not spread beyond the prostate and grows slowly.
Advanced-stage prostate cancer: Cancer has spread beyond the prostate and can metastasize to the bones, lymph nodes, liver, lungs, and other organs.
Regional metastatic prostate cancer does not spread beyond the prostate and nearby lymph nodes. In distant metastatic breast cancer, cancer spreads beyond the prostate and regional lymph nodes.
SYMPTOMS OF PROSTATE CANCER
Early stage-prostate cancer grows slowly and has no significant symptoms. Advanced cancer can show signs. Some of the symptoms of prostate cancer are:
Frequent urination
Trouble while urinating
Blood in urine
Pain in pelvis
Weight loss
Bone, hip, or back pain
The symptoms of benign prostatic hyperplasia and prostate cancer are similar, and it is difficult to differentiate between the indications based on symptoms. Benign prostatic hyperplasia is a much more common indication than prostate cancer.
DIAGNOSIS
Digital rectal exam: The doctor will physically examine the size and texture of the prostate. An irregular or hardened prostate can be a sign of cancer.
Prostate-specific antigen (PSA) test: This test measures the amount of PSA, a protein produced in the prostate critical for semen transport. The regular cells and prostate cells generated PSA; a high amount of PSA in the blood is a sign of prostate cancer.
Biopsy: Several tissue samples are collected from different parts of the prostate using a needle. After studying the biopsy sample, a Gleason score will be given by the pathologist, which represents the amount of prostate that is normal.
Genetic tests: Genetic testing is conducted to find abnormalities in genes. There are two types of genetic testing: germline and molecular biomarker testing.
Germline testing aims to look for inherited mutation. It is recommended for patients whose family has a history of cancer or having some other cancer. In germline testing, BRCA1, BRCA2, ATM, CHEK2, MLH1, MSH2, MSH6, PALB2, PMS2, and others genes are tested.
In biomarker testing, the molecular components of the blood or tissue are analyzed. It is crucial to determine the risk of cancer.
Imaging tests: Tests like ultrasound, MRI, CT, PET, or a combination of these are used to determine prostate cancer.
A CT scan uses x-rays to take pictures of the body, which are ideal for examining the lymph nodes adjacent to the prostate. A CT scan of the abdomen and pelvis will help determine the prostate cancer's spread.
MRI scans are used to get a detailed view of prostate cancer. It helps to determine if cancer has spread to lymph nodes or bones of the pelvis.
A PET scan helps highlight the cancerous cells in the body. Radioactive materials are injected into the body, which targets the cancer cells. In the scan, bright spots appear at the cancer site.
A bone scan checks if cancer has spread to your bones. Like PET scans, a radioactive tracer is used to determine the pictures of the bones.
TREATMENT
It is critical to diagnose prostate cancer in the early stages. In patients with early prostate cancer, cancer can be cured, and they can live without cancer for the rest of their lives.
In the advanced stages, treatment aims to reduce cancer growth and symptoms. Common treatment options include surgery, chemotherapy, radiation, and hormone therapy.
The treatment can be either systemic or local. In systemic therapy, cancers throughout the body are targeted. In local therapies, specific areas of the body are targeted.
Hormone therapy:
Hormone therapy is removed by adding, blocking, or eliminating hormones. Male hormones are androgens, and the primary hormone is testosterone. Androgen deprivation therapy (ADT) aims to stop the production of testosterone or block cancer cells from using it. Hormone therapy is a common therapy for advanced-stage prostate cancer.
Chemotherapy:
Docetaxel - Used along with hormone therapy for advanced prostate cancer
Cabazitaxel - Indicated if docetaxel is not effective
Mitoxantrone- Used to relieve pain and decrease the need for pain medications
Cisplatin and carboplatin- Chemotherapy agents made of platinum
Immunotherapy:
Provenge (Sipuleucel-T) and Keytruda (pembrolizumab) are the common immunotherapies for prostate cancer.
In Sipuleucel-T, the immune cells are charged to fight against cancer cells. The immune cells are collected from the body and are activated to target prostate cancer cells.
Pembrolizumab is a monoclonal antibody that helps the immune system detect and fight against cancer cells.
Bone targeted therapy
Denosumab, zoledronic acid and alendronate are used for treating bone loss and fractures.
Radiopharmaceuticals:
Lutetium-177 and radium-223 are the radiopharmaceuticals that are used for treating prostate cancer.
Lutetium-177 gets attached to the prostate cancer cells in the body and the cancer cells absorb the radiation and die.
Recently, Pluvicto (lutetium Lu 177 vipivotide tetraxetan) was recently approved for treating PSMA-positive metastatic castration-resistant prostate cancer.
Radium-223 is collected in the bone and will kill prostate cancer cells.
Surgery:
Cancer and the tissue surrounding the cancer are removed in surgery.
A positive margin is a situation when cancer cells are found in the margin of the removed tissue.
A negative margin is when the cancer is not found in the margin of the removed tissue. It is critical to have a negative margin to eradicate cancer.
Radiation therapy:
High energy radiation from X-rays and gamma rays kill cancer cells and shrink the tumors. Radiation can also be used to treat cancer instead of surgery. Sometimes, radiation therapy prevents cancer recurrence in patients who underwent surgery.
After the surgery or radiation therapy, sometimes there will be an increase in the PSA levels. In these kinds of patients, it is critical to provide treatment.
In non-metastatic prostate cancer, the PSA will rise, but metastases are not found.
In metastatic prostate cancer, cancer spreads to other body parts.
Androgen deprivation therapy (ADT):
Combined therapy is the standard way of treating prostate cancer. Adding one or two therapies to ADT can help to reduce cancer symptoms.
Chemotherapy, immunotherapy, and radiopharmaceuticals are the therapies indicated for treating recurrent cancer.