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Prostate cancer

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Dr Pavan Wakhare
Nephrologist

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Prostate cancer forms in tissues of the prostate, a gland in the male reproductive system, and is one of the leading causes of cancer in men above 60. Most cases could be slow-growing and may even go undetected and not cause any problems. However, some could be aggressive and spread to other parts of the body and are difficult to treat. It usually presents with difficulty and pain during urination, blood in the urine, along with sexual dysfunction. Advanced cases may present with bone pain in addition to the urinary symptoms. Prostate cancer is very rare before the age of 40, but the risk increases with age. Most cases are detected in the late 60s.

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Types

The different types of prostate cancers depend on the cells where cancer originates. Following are the various types of prostate cancers:


  • Acinar Adenocarcinomas: It is the most common type of prostate cancer. Such cancers develop in the cells of the prostate gland. 

  • Ductal Adenocarcinomas: Cancers developed in the cells of ducts of the prostate gland are called ductal adenocarcinomas. It spreads more rapidly as compared to acinar adenocarcinomas. 

  • Squamous Cell Cancer: There are flat cells that cover the prostate gland. Squamous cell cancer originates in these flat cells. They spread more rapidly than adenocarcinomas. 

  • Transitional Cell Cancers: It is also known as urothelial cancer. In this type, cancer develops in the cells of the tube, which carries urine from the bladder to the outside. In most of the cases, such cancers usually begin in the bladder and then slowly spread to the prostate. However, in some rare instances, it can also originate in the prostate gland. 

  • Small Cell Prostate Cancer: It is the rarest and one of the most aggressive types of prostate cancer. It falls under the category of neuroendocrine cancer.

Risk Factors

Prostate cancer is very rare before the age of 40, but the risk increases with age and most cases are detected in the late 60s. Susceptibility to this cancer depends on various other factors:


  • Men who consume a diet rich in red meat and high-fat dairy products and do not consume vegetables and fruits are more susceptible.

  • Men in the West, especially African-Americans, are more susceptible than Asians

  • Obese men are more susceptible to it as compared to non-obese

  • A person is more susceptible to prostate cancer if his brother or father suffered from the same. The genetic basis for prostate cancer has been identified, and certain gene mutations can cause it.

  • There are some data linking prostate cancer to chronic prostatitis, sexually transmitted infections, smoking and alcohol consumption.

Symptoms

It usually presents with difficulty and pain during urination, blood in the urine, along with sexual dysfunction. There may be no symptoms in many early cases, and it may be detected incidentally on performing a rectal exam, blood test, scan and biopsy. Advanced cases may present with bone pain in addition to the urinary symptoms.

Diagnosis

Prostate cancer is most often detected in the early stages by a combination of rectal exam and Serum prostate-specific antigen (serum PSA), a tumour marker that is useful in this disease.

Further confirmation generally involves a biopsy of the prostate from the rectal route under local anaesthesia and ultrasound guidance. This is a fairly painless procedure done usually by a Urologist and involves taking pieces from the prostate, which will be examined under the microscope.

If the diagnosis is confirmed, a magnetic resonance imaging (MRI) scan of the pelvic area may be performed to look at the extent of the disease. A chest X-ray, ultrasound of the abdomen and bone scan may be ordered if there is a suspicion of its spread to these regions.

Fortunately, in most cases, cancer of the prostate is not very aggressive and can be detected at a fairly early stage and treated by various modalities. The oncologist will decide the modality of treatment to be used based on a combination of factors which includes age, physical fitness, co-morbidities, clinical stage of disease, biopsy findings and PSA levels.

Treatment

The common treatment options of prostate cancer include -


  • Wait and watch: No active treatment is done, and the patient is followed up at regular intervals to see the progression of the disease. This modality is used in elderly patients with short life expectancy and early disease.

  • Surgery: The operation performed to remove the cancerous tissue is called Radical prostatectomy. Depending on the extent, patient factors and expertise available, it can be performed via a fairly long cut in the abdomen, keyhole surgery (laparoscopically) or even with Robotic surgical methods, which is available at a few centres in India as well. The surgery has good success rates in expert hands but may have long term side effects like sexual dysfunction, urinary incontinence and narrowing of the urethra. Sometimes orchidectomy (removal of the testes) is advised in advanced disease to minimize the effects of testosterone on the growth and spread of cancer.

  • Radiotherapy: Can be administered as a primary modality via needles implanted into the prostate under ultrasound guidance or as an external beam. Radiation can be administered after surgery if the resection of cancer tissue has not been complete.

  • Hormone therapy: Medications that suppress testosterone levels are used as primary treatment in advanced cases of prostate cancer.

  • Chemotherapy: In advanced cases, when the disease is not controlled with hormonal treatment, the patient may be a candidate for chemotherapy, wherein strong medications are used to kill the cancer cells and prevent spread.

  • Other local ablation treatments like Cryotherapy, Radiofrequency, High intensity focused ultrasound (HIFU) are used to treat early cancers or when the patient is not fit for a major surgery.

Prevention

Simple modifications in food habits, including adopting a diet rich in cereals, fish and green leafy vegetables, can drastically reduce the chances of prostate cancer, considered to be one of the most common cancers among men. You can prevent prostate cancer with some of these simple lifestyle changes:


  1. Avoid red meat


Men with higher consumption of fatty products are more prone to getting prostate cancer. He suggests a low-fat diet that restricts red meat, oils and dairy products such as milk and cheese. 

  1. Drink green tea


Studies of men who drink green tea or take green tea extract as a supplement have also reduced prostate cancer risk.

  1. Modify your diet


While age is a factor that nobody can control, certain dietary modifications throughout your life can certainly help you cut the risk of getting afflicted with the disease. Choosing a healthy diet is imperative in reducing the risk of this global killer. For example, eating a big bowl of cereal, substituting cow’s milk with soy, including fish in the diet and eating several servings of spinach and other leafy greens per week may cut the risk of prostate cancer.’ 

  1. Go green


Consumption of fats from plants is generally preferable to that from animals. For instance, cook with olive oil rather than butter or sprinkle nuts and seeds rather than cheese.

An increased amount of fruits and vegetables full of vitamins and minerals can add several benefits to your diets. So, will a diet that includes tofu – a product made from soybeans – has been linked to reduced prostate cancer risks.

  1. Avoid sugar and starch


Sugary candy and soda, as well as starchy foods such as white bread and white rice, are all high-glycaemic carbs, which spark inflammation. One recent study found that men who ate a high amount of sweet and starchy food were 64 per cent more likely to develop advanced prostate cancer.

Prognosis

Prostate cancer, if diagnosed early, is curable, and hence it has an excellent long term prognosis. Nearly 100% of the patients with prostate cancer have a five-year survival rate, ten years for 98% of the patient and 15 years for 95%. This statistic represents the survival rate in a large population; however, it may vary from person to person.

Alternative Remedies

For cancer treatment, the following Ayurvedic holistic methods are recommended:


  • Abstinence from root cause: The first step is avoiding a harmful diet or lifestyle that aggravates the root cause, tridosha imbalance.

  • Eliminating aggravated doshas: They are eliminated by flushing them out of the body through panchakarma, involving purifying therapies to enhance metabolic processes. Panchakarma includes five techniques: Vamana – emetics, Virecana – laxatives, Basti – medicated enema, Nasya – nasal administrations, Rakta moksana – blood-letting

  • Treating jataragni: Jataragni controls digestion and nourishment. It helps the formation of nutritive fluid (ahara rasa), physical elements (doshas), tissues (dhatus) and waste (malas). Treatment maintains healthy jataragni functioning.

  • Rejuvenation: Rasayana medicines maintain enzymes and metabolism in peak condition, and enhance the generation of new cells and tissues. Rasayanas prevent and alleviate conditions associated with cancer, and increase ojas to boost immunity and strengthen cells and the body.


• Satvavajaya chikitsa: Ayurveda considers mind and body as one entity. Cancer weakens the mind. Spiritual counselling and cultivating a positive, balanced mind are integral to Ayurvedic treatment. ‘By bringing our internal, physical and psychological systems into balance, we remove the cause of disease, cure its symptoms, and allow the damage to heal itself.

References

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