Prostate cancer is the second most diagnosed cancer in men. The incidence is highest in North America, Australia, and Northern Europe. The incidence, though less in India, has been increasing in recent years.
According to Dr V. Surya Prakash Consultant Urologist, Laparoscopic, Robotic & Transplant Surgeon, Yashoda Hospitals Hyderabad, the disease is usually asymptomatic in the early stage. Prostate-specific antigen is the tumour marker used for screening of prostate cancer. The disease also has a hereditary predisposition. Men with a family history of prostate cancer also need genetic testing and regular PSA testing to diagnose the disease at an early stage.
Men with high PSA are examined by a urologist. A digital rectal examination of the prostate is done in all men with high PSA. Men with high PSA and a clinically benign prostate are advised to undergo a Multiparametric MRI of the prostate. MRI can identify clinically significant prostate cancers.
The disease is diagnosed by a Transrectal ultrasound-guided prostate biopsy. Biopsy plays an important role in deciding the management. The low-grade and low-risk disease is very slow-growing and can be observed without any intervention by Active surveillance.
Men with intermediate and high-risk diseases need further imaging like MRI or PSMA PET Scan to know the extent of the spread of the disease. Cancer confined to the prostate on imaging is called localized prostate cancer and can be cured by radical prostatectomy or radiotherapy. Patient’s age, 10-year survival probability and associated co-morbidities are taken into consideration in deciding the treatment. Robotic radical prostatectomy is the best treatment modality with minimal side effects and is the first option for patients fit for surgery. Robotic surgery has a definite advantage over open or laparoscopic surgery in achieving the trifecta – Cancer control, urinary continence and sexual potency. Radiotherapy is also an alternative curative treatment modality.
Men with high-risk prostate cancer and locally advanced prostate cancer need multimodality treatment. Robotic prostatectomy with postop radiation and radiotherapy with hormonal therapy are the treatment modalities.
ALSO READ: Blood Cancer: Hepatitis B and C viruses can cause multiple myeloma, finds study
