Prostate cancer is common among senior men and is still on a rise annually. One in 8 men have a chance of developing prostate cancer and the average age of diagnosis is 66 years old. Men should be aware and self-observe regularly for signs of prostate cancer to begin early treatment and mitigate the severity.

What are the signs of prostate cancer?

Early-stage prostate cancer patients tend to show no signs and diagnosis is discovered during health examination. Some may show concerning signs such as

• Bloody urine
• Urinary incontinence or interrupted stream of urine
• Frequent urination
• Painful urination
• Erectile dysfunction

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If prostate cancer spreads, what are the symptoms?

Prostate cancer patients who have metastatic disease to other organs may show the following symptoms:

• Loss of appetite
• Weight loss
• Symptoms at the site of metastasis such as bone pain, bone fracture or collapse. If the cancer spreads to pelvic lymph nodes, there might be some swelling in the feet.

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How is prostate cancer diagnosed?

Prostate cancer is diagnosed by

• Medical history, physical examination, digital rectal exam
• Prostate biopsy
• PSA (prostate-specific antigen) level in the blood
• Radiologic examination

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What is PSA?

Prostate-specific antigen (PSA) is the protein that is produced in the prostate in minimal amount. A patient with prostate cancer will produce higher PSA level than normal and will show up in a blood test. However, high amount of PSA does not indicate that a person has prostate cancer because other conditions may contribute to it. Likewise, some prostate cancer patients have normal PSA level, but still have prostate cancer as well.

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What radiologic examination can diagnose prostate cancer?

Radiologic examinations of prostate cancer include prostate MRI, bone scan, and computer tomography. Currently PET/CT has high accuracy and sensitivity to detect prostate cancer so it can be discovered quicker.

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How to Treat Prostate Cancer?

There are several treatment modalities for prostate cancer:

• Active surveillance
• Surgery which can be separated into three techniques: open surgery, laparoscopic surgery, and robotic surgery.
• Radiotherapy uses high radiation to destroy or stop tumor cell growth directly. There are two types. One is external beam radiation therapy which currently uses high intensity radiation and can be delivered directly to the location of the cancer. Furthermore, nearby tissue will receive minimal radiation so that cancer can be controlled effectively with fewer side effects. The other method is brachytherapy where radiation is directly applied to the prostate.
• Hormonal therapy has several methods, such as oral medication, anti-male hormone injections, or bilateral orchiectomy where both testicles are removed.
• Chemotherapy tends to be administered when the cancer has spread to other organs, and it is resistant to hormone treatment.

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Treatment of Prostate Cancer by Stage

Prostate cancer can be differentially treated based on the severity of cancer:

• Patients in the low severity group can practice active surveillance or receive surgery or radiotherapy only.
• Patients with moderate disease can no longer practice active surveillance. Suitable treatment is surgery or radiotherapy, and hormone therapy may be considered.
• Patients with severe disease should receive radiotherapy or surgery. All patients in this group should also receive hormone therapy. Patients in the high-risk group should consider receiving a combination of two hormones.
• Patients with metastatic disease should mainly receive chemotherapy.

Prostate cancer treatment depends on the severity of disease, benefits and side effects of treatment option, as well as overall physical and psychological health of the patient. Quality of life after treatment should also be considered. Thus, prostate cancer treatment should be under the discretion of a medical specialist to give the patient a good quality of life.