Prostate Cancer

Symptoms & Causes Diagnosis & Treatment Doctors

How is Prostate Cancer Diagnosed?

Prostate cancer diagnosis involves a multi-step process that includes clinical evaluations, laboratory tests, and advanced imaging techniques. Early and precise diagnosis is essential to developing an effective treatment plan for prostate cancer, helping to improve patient outcomes.

Digital Rectal Examination (DRE)

A Digital Rectal Examination (DRE) is a simple yet vital screening method. During the procedure, a healthcare professional inserts a lubricated, gloved finger into the rectum to palpate the prostate and check for abnormalities, such as irregularities in size, shape, or texture. This test is often the first step in the diagnostic process.

Prostate-Specific Antigen (PSA) Test

The PSA test measures the level of prostate-specific antigen in the blood, a protein produced by the prostate. Elevated PSA levels may indicate prostate cancer, although other benign conditions, such as Benign Prostatic Hyperplasia (BPH) or prostatitis, can also cause higher levels. If PSA levels are elevated, repeated tests or additional imaging may be needed to confirm the presence of cancer.

Multiparametric MRI (mpMRI)

Multiparametric MRI combines multiple imaging techniques to provide high-resolution images of the prostate, identifying suspicious tumours. mpMRI is essential for identifying areas that may require further biopsy, offering high accuracy in distinguishing cancerous tissue.

Biopsy Procedures

If initial tests like PSA or imaging suggest possible prostate cancer, a biopsy is necessary for confirmation. The types of prostate biopsies include:

Transrectal Ultrasound-Guided Biopsy (TRUS): Tissue samples are taken through the rectum using ultrasound for guidance.
Transperineal MRI Fusion Biopsy: This method combines MRI with a biopsy to precisely target areas suspected of harbouring cancer, offering enhanced accuracy and reducing the risk of infection.

Advanced Imaging for Staging

To determine the extent or stage of prostate cancer, advanced imaging is employed:

CT and MRI Scans: These detailed imaging techniques are essential for identifying cancer spread to the surrounding tissues.
Bone Scintigraphy: Used to detect metastasis to the bones, which is common in prostate cancer.
PSMA PET/CT Scans: A cutting-edge method using Gallium-68 that allows for high-sensitivity imaging to detect cancer spread, especially to lymph nodes and bones, making it crucial for precise staging and targeted treatment planning.

Prostate Cancer Treatment Options

Treatment for prostate cancer depends on the stage of the disease, the patient’s overall health, and their preferences.

At Subang Jaya Medical Centre (SJMC), we offer personalised treatment plans designed by a multidisciplinary team of specialists to ensure the best possible outcomes.

Active Surveillance and Watchful Waiting

For low-risk or slow-growing prostate cancer, immediate treatment may not be necessary. Instead, active surveillance is adopted, which involves regular monitoring with PSA tests, imaging, and periodic biopsies. Curative treatment is delayed until the cancer becomes more active or risky. The watchful waiting approach is especially beneficial for patients with other health conditions where aggressive treatments may not be ideal; hence, treatment is only offered when required.

Surgery

Surgical removal of the prostate, known as a radical prostatectomy, is a common treatment for localised prostate cancer.

Laparoscopic Prostatectomy: A minimally invasive procedure using small incisions and specialised instruments.
Robotic-Assisted Prostatectomy: This technique offers enhanced precision through robotic technology.
Open Prostatectomy: Involves a larger incision and is generally reserved for more complex cases.

In some cases, nearby lymph nodes may also be removed during surgery to assess the cancer’s spread.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells and shrink tumours. There are two primary options:

External Beam Radiation Therapy (EBRT): A non-invasive method where radiation is directed at the prostate from outside the body over several weeks.
Brachytherapy: This method involves implanting tiny radioactive seeds (low-dose rate) or inserting a radioactive source via catheter/needle (high-dose rate) into the prostate for localised treatment.

Advanced Radiation Technologies at SJMC:

Helical Tomotherapy: Combines 3D imaging with intensity-modulated radiation therapy (IMRT) to accurately target tumours while sparing healthy tissue.
Varian TrueBeam System: Utilises Volumetric Arc Therapy (VMAT) for precise radiation delivery, reducing treatment time and side effects.

Systemic Therapies

For advanced prostate cancer, hormone therapy known as androgen deprivation therapy is the backbone of treatment. It is also used for localised and locally advanced stages to improve outcomes and efficacy of radiotherapy. Novel hormonal therapies such as abiraterone, enzalutamide and apalutamide are also used in locally advanced, recurrent and metastatic disease.

Chemotherapy: Drugs like docetaxel (Taxotere) are often used when prostate cancer has spread or is resistant to hormonal treatment.

Prostate-Specific Membrane Antigen (PSMA) Therapy

Lutetium-177 PSMA therapy is a radiopharmaceutical treatment designed to target PSMA proteins on prostate cancer cells, delivering targeted radiation directly to the tumour. This treatment is particularly effective for metastatic prostate cancer.

Targeted Therapy

Targeted drugs, such as olaparib (Lynparza) and rucaparib (Rubraca), focus on specific genetic mutations in cancer cells. These therapies are most effective in patients with certain DNA alterations.

Immunotherapy

Immunotherapy enhances the body's immune response to fight cancer:

Immune Checkpoint Inhibitors: Medications like pembrolizumab (Keytruda) help the immune system recognise and destroy cancer cells.

Alternative Medicine

While no complementary or alternative treatments can cure prostate cancer, they may help manage side effects and improve overall well-being. Techniques such as meditation, art therapy, and relaxation exercises can help reduce stress and anxiety during treatment.

Always consult your healthcare team before starting any alternative therapies to ensure they are safe and effective.

Coping and Support

A prostate cancer diagnosis can be emotionally overwhelming. To cope, consider the following strategies:

Learn About Your Diagnosis: Understanding your condition allows for better decision-making and management.
Find a Support Network: Seek emotional support from family, friends, or support groups.
Take Care of yourself: Maintain a healthy lifestyle with balanced nutrition, exercise, and sufficient rest.
Communicate with Your Partner: Explore alternative ways to maintain intimacy if erectile dysfunction occurs.

What to Expect From Your Doctor

During your visit, expect your doctor to:

Evaluate your Symptoms: They will assess your symptoms, medical history, and risk factors.
Diagnostic Tests: Your doctor may recommend PSA testing, imaging studies, or a biopsy to confirm the diagnosis.
Treatment Plan: A detailed treatment plan will be provided, discussing the risks, benefits, and expected outcomes.
Follow-Up Support: Regular check-ups and follow-ups will help manage your treatment and recovery.

FAQs About Prostate Cancer Diagnosis and Treatment

Yes, options like hormone therapy, targeted therapy, and immunotherapy can treat prostate cancer, especially in advanced or metastatic cases.

Biopsy results typically take 1 to 2 weeks, depending on the laboratory’s processing times.

Yes, robotic-assisted surgery and targeted radiation are common minimally invasive treatments that offer reduced recovery times and fewer side effects.

Yes, side effects may include bowel irritation, urinary issues, and erectile dysfunction, but advanced techniques minimise these risks.

PSA levels are crucial in identifying potential prostate cancer. Elevated PSA levels suggest a need for further investigation, including imaging or biopsy.

PSMA PET/CT scans provide highly detailed images of cancer spread, allowing doctors to plan targeted treatments like surgery, radiation, or PSMA therapy. This ensures more effective and precise care.

Following surgery, temporary issues like urinary incontinence and erectile dysfunction are common. However, these typically improve over time with proper rehabilitation.

Reference: