A significant number of elderly males are diagnosed with prostate cancer due to increasing life expectancy and increasing use of PSA screening. The risk of prostate cancer is directly proportional to age and family history. It accounts as the second most frequent cancer diagnosis for men and the fifth leading cause of death worldwide. Many reports suggest about 20% of patients with prostate cancer report a family history.
This is majorly developed due to shared genes and/or exposures of similar nature to certain environmental carcinogens and lifestyle habits. Onlymyhealth editorial team spoke Dr. Kirti Chadha, Chief Scientific Officer, Sr Consultant Oncopathologist, MD, PDCC (Oncopath & Oncohemat), Metropolis Healthcare Ltd., Mumbai, to know about the advancements of diagnosis and treatment for prostate cancer in men in India.
What stages mean for prostate cancer?
Prostate cancer is unlikely to be a major threat to someone’s life. However, challenges remain in choosing the best treatments for individuals at all stages of the disease. The gland’s location on the neck of the urethra by the bladder might require whole-gland treatments like radical prostatectomy or radiation therapy. This often leave men with incontinence and erectile dysfunction. Thanks to developments in MRI, more targeted treatments to the prostate without damaging surrounding structures are evolving.
Loved by surgeons and patients alike for its ease of use and faster recovery times, the da Vinci surgical robot is less invasive than conventional procedures and lacks the awkwardness of laparoscopic (keyholes) surgery, hence has become the ubiquitous method for prostate removal. Robotic surgery is used in a range of surgical procedures, but its biggest impact has been in urology. Surgeons prefer to use the da Vinci robot because it offers improved visualization with hand and wrist flexibility. Recovery of continence is earlier in the robotic group, but after 12 months, there is no major difference between the two for urinary control and sexual function. Hence, it’s a matter of availability and patient clinician preference.
What tech brings to the table for prevention and treatment?
Machine learning (ML) and artificial intelligence (AI) are the new testing waters. The aim is to better recognize suspicious areas in a prostate MRI that should be biopsied. AI models are also coming up to help pathologists, who might not be prostate cancer experts, accurately assess prostate cancer grade. Cancer grade is the most important factor in determining the need for treatment versus active surveillance.
It is also critical to diagnose recurrence for which prostate-specific membrane antigen (PSMA) is used as found in large amounts & almost exclusively on prostate cells. By fusing a molecule that binds to PSMA to a compound used in PET scan imaging, scientists have been able to see tiny deposits of prostate cancer that are too small to be detected by regular imaging. The Food and Drug Administration (FDA) has approved two such compounds for use in PET imaging of men with prostate cancer.
Some aggressive cancers quickly spread (metastasize) outside of the prostate. Prostate cancer most commonly spreads to the bones and lymph nodes. It can also develop in the liver, brain, lungs and other organs. In such situations options include chemotherapy, androgen deprivation hormone therapy and immunotherapy.
The likelihood of Prostate cancer as per demographics
Differences in the incidence rates worldwide reflect differences in the use of diagnostic testing. Prostate cancer incidence and mortality rates are highly likely above the age of 65 years. Some plausible suggestion to reduce, if not remove the chances of disease are limiting high-fat foods, increasing the intake of vegetables and fruits and exercising. Regular screening after the age of 45 is also recommended.
Despite the high incidence rates, most prostate cancer cases are detected while the cancer is confined within the prostate. The 10-year survival rate is around 98%. Elevated levels of prostate-specific antigen (PSA > 4 ng/mL), a glycoprotein normally expressed by prostate tissue helps in diagnosis. However, men without cancer have also been found with elevated PSA. Therefore, a tissue biopsy is the standard of care to confirm cancer’s presence. During the examination, needles are inserted into the prostate gland in several places under the guidance of transrectal ultrasound (TRUS) imaging to collect samples of tissue.
Also read: 5 Warning Signs Of Advanced Prostate Cancer
What is Gleason score?
It is the most common scale used to evaluate the grade of prostate cancer cells. The scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer). The lower part of the range is less likely to be used. Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. Hence, 6 indicates a low-grade prostate cancer, 7 indicates medium and above 8 is considered a high-grade cancer.
Low-grade prostate cancer may need limited to no treatment. Instead, doctors may recommend active surveillance: regular follow-up blood tests, rectal exams and prostate biopsies. Only if tests induce cancer is progressing, treatments like surgery or radiation might be recommended. Although prostate cancer is commonly found, we are equipped with effective screening, diagnostic and treatment tools to combat it and ensure longer lifeline for patients.