Prostate Cancer

WHAT IS PROSTATE?
Prostate gland is a walnut shaped gland found only in men. This gland is located just below the bladder and surrounds the urethra (a tube that allows urine to pass out of the body). It is a reproductive gland that produces some of the nutrients that the sperms need. Secretions from the prostate make up a large part of semen.

WHAT IS PROSTATE CANCER ?
The body is made up of many types of cells. In normal course, cells grow, divide, and produce more cells to keep the body healthy. However, at times, this process may not function properly and cells may become abnormal, forming more cells, in an uncontrolled manner. These extra cells form a mass of tissue, called a growth or a 'tumour'. Tumours can be benign, which means non cancerous, or malignant, which means cancerous. Prostate cancer occurs when a malignant tumour forms in the tissue of the prostate. Prostate cancer develops most frequently in men over fifty years of age.

WHAT ARE THE SYMPTOMS OF PROSTATE CANCER?
Most early prostate cancers cause no symptoms and are only found on routine annual physical examination. The doctor may suspect prostate cancer if you have symptoms, like slowing or weakening of the urinary stream or the need to urinate more often, difficulty in urinating and erectile dysfunction.

HOW IS PROSTATE CANCER DIAGNOSED?
If the symptoms suggest prostate cancer, your doctor will ask you for a detailed medical history and will do a physical examination before conducting any of the following tests.

Prostate Specific Antigen Test (PSA)
It is a blood test used to screen for prostate cancer. When the PSA level is high, it may indicate prostate cancer.

Transrectal Ultrasound (TRUS) and Biopsy
An ultrasound uses sound waves to create an image of the prostate on a video screen. The area in the gland, which is suspected to be cancerous is identified on the image. Then by using a biopsy needle a sample of tissue from the cancerous area is obtained and examined under a microscope. Once the cancer has been confirmed, your doctor will conduct the following tests to ascertain its extent and spread.

Blood Tests
A Complete Blood Count (CBC) determines whether the blood has the correct number of various types of blood cells. Abnormal test results may suggest spread of cancer.

Imaging Tests

Radionuclide Bone Scan : The bone scan is a test that shows whether the cancer has spread from the prostate gland to bones.

Computer Tomography (CT) : It is used to detect spread of cancer to internal organs like liver and lymph nodes.

Magnetic Resonance Imaging (MRI) : It can show abnormal spread of tumour to lymph nodes or internal organs.

HOW IS PROSTATE CANCER TREATED ?
Depending on the extent and type of the tumour, your doctor has more than one treatment option to consider. Several factors are taken into account while choosing between these options, including both, the potential benefits and risks. The options may include :

Surgery

Radical Prostatectomy : The surgeon will remove the entire prostate gland plus some tissues around it. This operation is usually done if the cancer has not spread beyond the gland.

Orchiectomy : When the cancer spreads beyond the prostate, removal of the testes (called as orchiectomy) may also be done to decrease testosterone levels and to control cancer growth. Medicines are also available which achieve the same benefit as orchiectomy.

Radiation Therapy
Radiation can also be used in place of surgery to treat prostate cancer limited to the gland. This therapy uses high energy rays (such as X-rays) or practicles (such as electrons or protons) to kill cancer cells. If the disease is at an advanced stage, radiation will help in reducing the size of the tumour or to provide relief from pain.

Hormone Therapy (Androgen deprivation)
This treatment is used when prostate cancer has spread beyond the prostate or has recurred after treatment. It can also be used in combination with radiation therapy for advanced stage disease. This therapy can be done through hormones or orchiectomy (removal of testicles).

Chemotherapy
It is an option, when prostate cancer has spread outside the prostate gland and hormone therapy has failed. It uses anticancer drugs which can be injected or can be taken orally.

Expectant management (Watchful waiting or Observation)
Sometimes the strategy with prostate cancer might be to "wait and watch" with on immediate active treatment.


SIDE EFFECTS OF PROSTATE CANCER TREATMENT
The most common side effect of surgery is loss of urinary control and erectile dysfunction (an inability to get an erection of the penis). Medications can help restore some degree of potency. With hormone therapy, the side effects are related to loss of testosterone (the male hormone). These are hot flashes, weight gain, loss of libido, enlargement of the breasts, impotence and osteoporosis.Side effects or radiation may include diarrhoea, impotence and bleeding through the rectum. With medication, symptoms tend to improve over a period of time.

PAIN MANAGEMENT
The management of pain is an integral part of cancer therapy. Medication are the cornerstone of cancer pain treatment, and their use is aimed at providing the greatest pain relief possible with the fewest number of side effects and the most ease of administration. Your doctor will prescribe a medication that ensures maximum pain relief. Sometimes, your doctor might recommend some interventional procedures like surgery and / or injections.

FOLLOW UP CARE
In Cancer treatment, follow up care is an essential element of the overall treatment plan. Regular checkups will be advised to detect any recurrence or change in the condition.

CANCER CARE AT ARTEMIS
At Artemis Health Institute state-of-the-art facilities are available for cancer diagnosis, treatment, follow up care and rehabilitation. These include imaging technologies such as a PET Scan, DWIBS and 3TMRI for diagnosing cancer. The hospital is also equipped with state-of-the-art radiation therapy such as Image Guided Radiation Therapy (IGRT) and Brachytherapy.

Prostate

Cervix

Head and neck

Breast

Gallbladder

Uterus

Vagina

In temporary brachytherapy, the radioactive material is placed inside or near a tumour for a specific amount of time and then withdrawn. In temporary brachytherapy, a delivery device, such as a catheter, needle or applicator is placed into the tumour using fluoroscopy, ultrasound or CT to help position them. The physician may insert the radioactive material at the same time remotely through the delivery device, and later remove the material and delivery device. Temporary brachytherapy can be administered at a high-dose rate (HDR).
AHI has HDR Brachytherapy from Nucletron, Model Microselectron HDR.X.

Diseases:-
The oncologists at AHI are equipped to treat various kinds of cancers, including but not limited to:

• Larynx
• Colorectal Cancer
• Hodgkin's Disease
• Leukaemia
• Prostate Cancer
• Oesophagus Cancer
• Oral Cancer
• Thyroid Cancer

Special Care Units / Diagnostic Equipment / Facilities

• Diffusion Weighted Whole Body Imaging with Background Body Signal (DWIBS)
• 3 Tesla MRI (Magnetic Resonance Imaging)
• Mammography System
• PET Scan
• Advanced CT Scan (64-slice CT)
• PET-CT Fusion Technology
• Dual Head Gamma Camera
• Brachytherapy
• Image Guided Radiation Therapy (IGRT) - the first in North India

Team of Specialists:

• Dr Ranga Rao Consultant- Medical OncologyView Profile

• Dr. Deep Goel, Gastrointestinal Surgeon Consultant- Surgical OncologyView Profile

• Dr Subodh Pandey Consultant- Radiation OncologistView Profile