Cancer of the prostate gland is common in males above the age of 50 years. Currently we have four modalities of management. Choosing from among the four is done after considering a number of factors namely -

The person’s general medical condition and age

The stage of the disease he has

The results of the laboratory investigations: For example the blood level of PSA (Prostate Specific Antigen) which is an enzyme produced by the prostate.

Whether the patient is medically fit to face the side-effects if treatment is started in the early stages of prostate cancer

Once the above factors have been taken into account, one of the strategies is adopted:

I. Watchful waiting

This can better be read as ‘observation’. Patients with an early stage of the cancer are better managed by close observation of changing symptoms and disease progression rather than initiating treatments all of a sudden.

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II. Surgery

Surgery may be opted for if the patient is healthy (meaning medically fit for an operation). There are three options. Sometimes the gland as such need not be removed, only the pelvic lymph nodes are taken out. Lymph nodes are aggregates of tissue taking part in filtration of lymph and storage of lymphocytes (white blood cells). The process is called pelvic lymphadenectomy.

In certain cases the whole of the gland may be removed along with the lymph nodes. This is radical prostatectomy. In persons in whom a major surgery cannot be performed due to any reason (for example an advanced age), the surgeon my resort to removing a part of the affected tissue alone, which is the whole of the gland, is not removed. This is Transurethral Resection of the prostate (TURP).

Some of the side effects of surgery are: Impotence, leakage of urine and leakage of stools. It is however possible to retain functions like erection by nerve-sparing surgeries, which need not always work out!

Radical prostatectomy can now be done using a minimal surgical approach called laparoscopic radical prostatectomy. The patient enjoys an early post-op  recovery as there is minimal cut and less post-op pain.

Robotic Radical prostatectomy is the new thing in which the whole surgery to remove prostate is done using a robot controlled by a trained surgeon, the advantages are less blood loss, minimal scar, early discharge from the hospital, better continence and perhaps less chances of impotence. 

III. Radiation Therapy

Radiation therapy is a cancer treatment where high-energy x-rays or other types of radiation are used to kill cancer cells or prevent them from growing. There are two types of radiation therapy. 


In External radiation therapy, a machine outside the body is used to send radiation toward the cancer. The total dose of radiation therapy may be divided into several smaller, equal doses which are delivered over a period of time spanning over several days. In Internal radiation therapy, a radioactive substance may be placed directly into or near the cancer. The type of radiation therapy used depends on the type and stage of the cancer being treated.

However radiation therapy is associated with a number of side-effects:-

Urinary problems

Increased risk of bladder cancer and rectal cancer

Impotence

However there is seldom any risk of incontinence or risk to life – this is a possibility in a major surgery like radical prostatectomy.

IV. Hormone therapy

Hormone therapy fundamentally aims at preventing the testicle from producing the hormone called testosterone. Testosterone is responsible for the growth of prostate tissue and hence the tumour. A number of formulations are available for this purpose, the names of which need not be memorised! However for the sake of completion I would like to introduce Leutinizing hormone-releasing hormones agonists like leuprolide, anti-antrogens like flutamide. Don’t bother about the involved jargon! It is worth to know that hormone therapy has some side-effects too: decreased libido, weak bones, diarrhoea, nausea and sometimes intense itching but not anything life threatening. 

Apart from the above mentioned standard modalities we have other options to try out. Trials with these options are still on.

Cryosurgery: Extreme cold is used to freeze and destroy cancer tissues.

Chemotherapy: Using drugs to manipulate the cell cycle which is responsible for cell multiplication

Proton beam radiation therapy: As the name suggests this is the radiation therapy using proton beams targeted at tumour cells

High intensity focussed ultrasound: High energy sound waves are used to kill cancer cells.

Immunotherapy (Biologic therapy): Natural or lab generated substances are used to manipulate the body’s immune system.

Early diagnosis and initiation of treatment gifts a better prognosis for the cancer. It has however been found that prognosis is poorer in the developed countries when compared to the rest of the world.