Why prostate cancer treatment is sometimes a challenge?
Prostate cancer (PC) is one of the most common cancers among males. It occurs when normal cells of the prostate gland grow out of control. PC is a slow growing cancer and is usually restricted to the prostate gland at the time of diagnosis and responds best to treatment at this stage. However, some PCs are very aggressive and spread to other parts of the body making treatment options challenging.
Early PCs may cause no symptoms and go undetected. For this reason, even healthy males aged 50 years and above are recommended to get screened for PC, especially if a father, brother or an uncle has had the disease. Screening consists of a simple blood test to detect the prostate specific antigen (PSA), which is a protein made by the prostate. PSA is elevated if PC is present. However, since even non-cancer conditions can raise PSA levels, a tissue specimen (biopsy) taken directly from the gland confirms a diagnosis of PC.
Treatments for PCs varies on a case-to-case basis and is risk (low, moderate or high) dependent. PSA levels and results of a rectal examination are also of significance to identify risk.
Treatment options are based on worsening symptoms, type and stage of the cancer, possible treatment-related side effects, age at detection and overall general health. If the cancer is slow growing causing no symptoms, no treatment may be required right away. When the cancer is limited only to the gland, is very low risk and a person is >65 years of age monitoring PSA levels every 3-6 months, rectal exam every year, and 2–5-year biopsies may be needed (active surveillance).
Generally, a team of urology surgeons, radiation cancer specialists and medical oncologists decide the best overall treatment plan after collating the PSA level, biopsy report and MRI or PET -CT data, for each case. When a decision for surgery is made, generally for men below the age of 70 years, the entire prostate gland and surrounding tissue is removed (radical prostatectomy).
Nowadays, surgeons use small incisions to reach the gland with specialized tools including robotic arms. This type of operation provides swift recovery after surgery. In certain patients, radiotherapy may also be advised before or after surgery. In patients with localized prostate cancer >70 years of age or in advanced cancer prostate, external radiation, Cyberknife Robotic Radiosurgery and Brachytherapy are good options for achieving a cure.
If the disease progresses despite these primary treatment or has metastasized or spread to other parts of the body, then hormone therapy (HT) is advised. Since PCs are hormone dependent, anti-hormone therapies play a major role in extending overall survival.
HT stops the production of testosterone, which fuels the growth of PC cells. It is also well-known that some PCs may not even respond to HT, then chemotherapy may benefit such patients. Of late, treatments that help the immune system of the body to fight cancer (immunotherapy) has shown some promise in challenging and difficult to treat PC. Difficult to treat prostate cancers are stage 4 disease, polymetastatic or having a neuroendocrine component besides adenocarcinoma.