Prostate Cancer

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Prostate Cancer

Introduction

Prostate cancer is the commonest cancer that affects men. 

How is prostate cancer diagnosed?

Most men with prostate cancer have no symptoms. Prostate cancer causes symptoms only when it is advanced. In such cases is may cause low back pain, blockage or difficulty with urination. Prostate cancer is however not the commonest cause of difficulty in urination. A non-cancerous enlargement of the prostate, also known as benign prostatic hyperplasia, often causes difficulty with urination.

Blood test: PSA

PSA test is a blood test that is used to identify patient at risk of prostate cancer. Patients with high PSA have a higher risk of prostate cancer. Your doctor will help you to interpret the PSA test. PSA count can sometimes be high in non-cancerous conditions. You should therefore not worry before making a consultation with a urologist.

Finger test called Digital Rectal Exam (DRE): Your doctor will use his index finger to feel for the consistency of your prostate.

Prostate biopsy:  Prostate biopsy is done by inserting an ultrasound guided biopsy probe into the anus and then taking small pieces of the prostate for pathology examination. This is the surest test for making a diagnosis of the prostate. Prostate biopsy is done under local anesthesia or general anesthesia depending on the preference of the patient. It is a short procedure that normally does not require admission.  Your doctor may consider admission in case of individuals who are using blood thinners like warfarin. 

What are the risks of prostate biopsy?

Prostate biopsy is generally a safe procedure with rare but non-trivial complications, which include: 

Infection of the prostate can occur after biopsy. The signs of infection include fever, nausea, chills, severe pain in the area of the anus and painful urination.  You doctor will give you antibiotic before and after biopsy to reduce the chance of getting infection after biopsy.  If you develop these symptoms after biopsy, contact your doctor for appropriate advice.

Bleeding: Passage of blood in the stool and urine is not unusual after prostate biopsy and usually stops without any treatment. Heavy bleeding after prostate biopsy is extremely rare.

Blood in semen: Some patients report blood staining of semen after prostate biopsy. In some occasions this may persist for 4-6 weeks and will also abate spontaneously.

What happens after prostate biopsy?

The samples of prostate taken during biopsy are sent to a pathologist who determines the presence or absence of prostate cancer as well as the aggressiveness of cancer. 

Your doctor needs the pathology results to appropriately advice you about treatment options

What are the options of treatment for a prostate cancer?

Treatment of prostate cancer depends on the degree of advancement of the disease. Your urologist will discuss with you and assist you to make appropriate options based on your individual circumstances. 

Treatment options include: 

Watchful waiting involves doing nothing unless the prostate cancer causes symptoms.

Active surveillance:  Involves routine follow up with blood test (PSA) and biopsy of the prostate annually. 

Radical Prostatectomy: Surgical removal of the prostate with the aim of total cure from prostate cancer. Prostate cancer surgery is done for patients with cancer which has not spread to the rest of the body and who can also  withstand prolonged surgery.

External Beam Radiotherapry: Surgical removal of the prostate with the aim of total cure from prostate cancer. Radiotherapy is done for individuals with cancer, which has not spread to the rest of the body.

Brachytherarapy: is a form of radiotherapy where small beads of radioactive materials are inserted into the prostate to kill cancer cells. This form of treatment is best suited for individual who have prostate cancer which has not spread to the rest of the body. This treatment option is best suited for men with small prostate. It is not an optimal option for patient as well as difficulty in urination.

Hormone treatment: Prostate cancer cell depend on male hormones such as testosterone for growth. Removal of the testicles stops the production of testosterone and slows prostate cancer. Your doctor will advise you to consider removal of testicles in case you have advanced prostate cancer.

Chemotherapy:  Chemotherapy is used in advanced prostate cancer that fails to respond to hormone treatment.

What to expect during prostate cancer surgery?

Prostate cancer surgery can be done using difference approaches including open prostatectomy, laparoscopic and robotic surgery. 

What are the risks and complications of prostate cancer surgery?

The main risk of prostate cancer surgery include:

  • Bleeding: which may require blood transfusion. 
  • Incontinence:  Some men lose the ability to hold back urine in the bladder after prostate cancer surgery. 
  • Impotence: Some men develop erectile dysfunction after prostatectomy

What are the risks and complications of radiotherapy for prostate cancer?

The risk of radiotherapy for prostate cancer include:

  • Impotence
  • Bleeding and diarrhea may occur as long term complication of radiotherapy.