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Prostate cancer is one of the most common cancers affecting men. Most often men are affected after the age of 60 however in rare cases even younger men can be affected especially if there is a family history of prostate cancer. Today we have excellent cancer markers to detect this cancer earlier and also we have excellent treatment options to cure this cancer, therefore all men above the age of 50 should be more aware of this cancer.
Prostate is a reproductive organ and therefore is functional and useful when the man is in the reproductive stage of his life. However after he crosses the age of 50 this gland becomes redundant and then the chance of cancer also increases. It has been observed that sexually active men have lesser chance of cancer, and therefore I recommend sexual activity three times per week for all married men for their entire life. Also intake of antiandrogen drugs like finasteride can reduce the chance of cancer, however they have their own side effects. However these drugs can be used in individuals with chance of prostate cancer development, as in those men with family history of prostate cancer.
Like all cancers this cancer is also silent in the initial stages and therefore we rely on cancer markers for its early detection. PSA or prostate specific antigen is an excellent cancer marker for this cancer. It is a simple and inexpensive blood tests and can point towards the possibility of prostate cancer. However if the PSA is elevated it does not confirm prostate cancer. It can also be elevated in prostatic infection and obstruction or stagnation of urine. Therefore to confirm the presence of cancer the uro- oncosurgeon depends of biopsy of the prostate. This is performed painlessly via the transrectal route and is the only method to confirm the presence of prostate cancer.
Stage of the cancer means assessment of the extent of spread of the cancer. This is best performed nowadays with a PET CT scan called PSMA pet CT scan.
This scan can assess the entire body and demonstrate spread of the cancer wherever it has spread in the body. This gives the surgeon and the patient an accurate idea of the spread of the disease and also guidance regarding the best method to treat the patient.
When the cancer is located within the confines of the prostate gland we can cure the cancer. This is best achieved by radical prostate surgery. This surgery is performed nowadays with machine assisted surgery. This surgery is better than open surgery since the prostate is located deep down inside the lower abdomen of men and therefore accessing it via open surgery is often difficult but can be much better achieved by machine driven surgery like laparoscopy.
In the hands of an experienced uro-cancer surgeon, the surgery is performed in three to four hours, time and the patient can return home after three days. The patient is catheter free after two weeks and can resume normal life after three weeks of the surgery. Excellent Urinary continence is generally achieved within a short period of time, and the patient can lead a normal life.
These patients are generally followed up for ten to fifteen years after surgery. Each year twice they are checked for their PSA levels in the blood. If there is elevation of PSA levels after surgery, this indicates return of cancer. In these cases there is excellent antiandrogen therapy which is administered by our medical oncology colleagues and these patients are also assured of excellent quality of life for a very long time.
What is the best treatment for prostate cancer?
The best treatment for prostate cancer is complete curative laparoscopic resection of the cancer affected prostate along with removal of the draining lymph nodes. This surgery is relatively blood less and pain less and the patient can return to normal life after a period of one month.