Urology

Prostate Cancer

Prostate Cancer Feb 14, 2020

What is prostate cancer?

Prostate is a walnut sized gland present in males only. It is involved in formation of semen. This gland has a tendency to enlarge over period of time under the influence of male hormones. This enlargement is non-cancerous in majority of patients but can be cancerous in some. Most men show symptoms of prostate growth after the age of 50 years.

What are the symptoms of prostate cancer?

Prostate cancer in its initial stages may not have any symptoms. If there are symptoms, they may be essentially same as non-cancerous or benign enlargement. The symptoms may include frequent urination during day and night time, slow urinary flow, urgent urination with or without urinary leakage, straining to pass urine or even urinary retention or blockage. Advanced stages of prostate cancer can present with bone pain.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed based on the clinical history of patient, examination and a blood test called serum PSA.

Could you elaborate on the diagnosis of this disease?

When a patient presents to us for the first time, we take a detailed history of the symptoms. All the symptoms that I mentioned above are enquired into in a detailed manner using a scoring system. Thereafter, the patient is examined. A thorough physical checkup is carried out. This is followed by specific checkup of prostate called digital rectal examination. If we find a hard nodule on examination of prostate, then we suspect cancer and investigate further.

What is serum PSA test?

This is a blood test. PSA stands for prostate specific antigen. This is a protein produced specifically by prostate gland and secreted into semen. It escapes into blood whenever there are prostate problems. So the blood levels can rise if prostate is diseased. Any prostate problem can give rise to a high serum PSA. However, if there is no other reason for this rise, then prostate cancer is suspected. It is now done as a routine for screening men for prostate cancer especially in the age groups of 50 to 75 years.

Do all men with high serum PSA have prostate cancer?

Absolutely not. A high serum PSA has to be interpreted keeping the history of patient and examination findings in the mind. The interpretation of a high serum PSA should be left to the treating urologist. Many a times further investigations like percent free PSA, multiparameteric MRI or even PSMA PET scan may be performed by your treating urologist to make a diagnosis. An ultrasound-guided biopsy of the prostate may be necessary to reach a final conclusion. This entails obtaining a small piece of prostate with a needle and examining the same under microscope.

How is the treatment of prostate cancer done?

The treatment of prostate cancer depends on the stage at which this disease is diagnosed. At early stage, the cancer is still confined inside the prostate gland. If detected at this point, the gland can be completely removed by performing robotic surgery. Those not fit for surgery are treated by alternative methods like radiation and/or hormonal therapy.

If detected at late stage, meaning the disease has already spread beyond the gland, and then the treatment becomes palliative only by hormone therapy. Some aggressive tumors may require additional chemotherapy as well.

What is robotic surgery?

The treatment of prostate cancer has undergone a sea change since introduction of Robotic surgery from early 2000s. The procedure is called Robotic Assisted Radical Prostatectomy. The robot is essentially an equipment to control special instruments used to perform the operation. The robot is controlled by the surgeon sitting on a console. The surgeon gets a 3-D view of the operative field via special camera inserted into the abdomen of the patient. By controlling the movement of the instruments using a robot, the surgeon does the prostate removal. The robotic surgery is essentially an advanced form of laparoscopic or key-hole surgery. It requires general anesthesia.

What are the advantages of robotic surgery over the conventional surgery?

Robotic surgery is especially useful in operations of deeply situated structures like prostate which are difficult to access even on open surgery. The robotic instruments are specially designed to mimic the movements of human wrist. Thus, the surgeon gets to move the instruments as if his own hand is inside the abdomen. There is much better control during surgery, no tremors, minimal blood loss, better access to the target organs, better suturing and far better visualization compared to conventional surgery.

All these finally transform into better outcomes of surgery, faster recovery and lesser complications. Since no major cuts on the body are involved, the return to work is quicker. With the use of magnification and 3 dimensional visualization, there are better chances of preservation of the sphincter (the muscle that controls the urine from flowing out). This results in lesser chances of urine leakage post prostate surgery when compared to conventional surgery.

What are the other applications of robotic surgery?

Robotic surgery is especially useful in operations requiring intricate suturing (e.g. pyeloplasty) or where only a portion of organ needs to be removed (e.g. partial nephrectomy). However, all simple and complex operations of other organs can also be done in a better way using a robot.