FACING PROSTATE CANCER
NEWLY DIAGNOSED ?

BASICS OF PROSTATE CANCER

The prostate is a small gland, about the size of a walnut, situated in front of the rectum, behind the penis, and below the bladder. It encircles the urethra, the tube responsible for carrying urine and semen out through the penis. The primary role of the prostate is to produce seminal fluid, a component of semen that serves to safeguard, nourish, and facilitate the movement of sperm.

DEVELOPMENT AND SPREAD OF PROSTATE CANCER

Prostate cancer initiates when normal cells within the prostate gland undergo alterations and proliferate uncontrollably, resulting in the development of an abnormal mass referred to as a tumor. A cancerous tumor is classified as malignant, signifying its capacity to metastasize and spread to other areas of the body. In contrast, a benign tumor is non-cancerous and does not have the ability to spread to other parts of the body. Prostate cancer usually starts with genetic changes in prostate cells, leading to uncontrolled growth. environmental factors can influence its development.
Certain prostate cancers exhibit slow growth and may remain asymptomatic or non-problematic for extended periods, sometimes spanning years. Alternatively, prostate cancer cells can enter the bloodstream or lymphatic system, initiating a process known as metastasis, through which they travel to other regions of the body. While prostate cancer can potentially spread to various parts of the body, one of the primary destinations for prostate cancer cells is the nearby lymph nodes, which are small, bean-shaped organs situated in proximity to the prostate and responsible for combating infections.
Prostate cancer can also progress to more distant areas in the body, including the bones, lungs, and liver. Nevertheless, prostate cancer differs somewhat from other cancer types in that many tumors remain confined within the prostate and do not spread beyond it. Even if metastasis occurs, metastatic prostate cancer is frequently treatable, enabling individuals to enjoy good health and an extended life span following their diagnosis.

UNDERSTANDING YOUR DIAGNOSIS

Physicians employ various tests to detect and diagnose cancer, as well as to determine whether cancer has metastasized to different areas of the body from its initial site. Similar to many other cancer types, a definitive diagnosis of prostate cancer can only be established through a biopsy. Following the biopsy, imaging tests may be utilized to assess whether the cancer has spread to other regions of the body. Additionally, doctors may conduct tests to identify the most suitable treatment options. It's important to note that not every diagnostic test is suitable for every individual. Your doctor will take into account factors such as your age, overall medical condition, presenting signs and symptoms, and prior test results when determining the appropriateness of a specific diagnostic test for you.




PRELIMINARY TESTS

Prostate-specific antigen (PSA) blood test


PSA, or prostate-specific antigen, is a protein found in the blood that is produced by the prostate gland. While there is no universally defined "normal PSA" level for individuals of a specific age, elevated PSA levels are often associated with various prostate conditions, including prostate cancer, an enlarged prostate (known as benign prostatic hyperplasia or BPH), or prostate inflammation or infection.
Doctors typically assess multiple aspects of the PSA level, such as the absolute level, changes over time, and the relationship between PSA levels and prostate size, to determine whether a biopsy is necessary. There is also a version of the PSA test that measures a specific component called "free" PSA, which can sometimes aid in determining whether an elevated PSA level is due to a malignant condition like prostate cancer. It's worth noting that some prostate cancers do not significantly increase PSA levels, so a normal PSA test result does not guarantee the absence of prostate cancer.
The use of the PSA test for prostate cancer screening in asymptomatic individuals is a topic of debate. On one hand, PSA testing can be valuable in detecting early-stage prostate cancer, enabling timely treatment to prevent cancer progression. On the other hand, PSA screening may identify conditions that are not cancer, as well as slow-growing prostate cancers that might never pose a threat to a person's life or cause symptoms. Consequently, screening for prostate cancer may lead some individuals to undergo unnecessary surgeries and treatments, which can result in significant side effects. Due to this, patients and their doctors may contemplate active surveillance rather than immediate treatment when dealing with prostate cancer, closely monitoring the tumor's progression before making treatment decisions.

DIGITAL RECTAL EXAMINATION

In the digital rectal examination (DRE), a physician inserts a lubricated, gloved finger into the rectum to manually assess the surface of the prostate for any abnormalities or irregularities. However, this test is not highly precise, and it typically does not detect early-stage prostate cancer.

BIO MARKER TEST

A biomarker is a substance that is found in the blood, urine, or body tissues of a person with cancer. It is made by the tumor or by the body in response to the cancer. A biomarker may also be called a tumor marker. Biomarker tests are used to help predict the chance that someone will develop prostate cancer

MAKING A CANCER DIAGNOSIS

If PSA or DRE test results are abnormal, then the following tests can help the doctor figure out whether the cause may be cancer.

TRANSRECTAL ULTRASOUND (TRUS)

A common procedure involves a doctor inserting a probe into the rectum to generate an image of the prostate by utilizing sound waves that reflect off the prostate tissue. Typically, this procedure is performed simultaneously with a biopsy.

BIPOSY

1. A biopsy involves the extraction of a small tissue sample for microscopic examination. Typically, a surgeon employs transrectal ultrasound (TRUS) and a biopsy instrument to obtain tiny slivers of prostate tissue. Multiple biopsy samples are taken from various areas of the prostate to ensure a comprehensive examination. This procedure generally results in the removal of 12 to 14 tissue pieces and typically takes about 20 to 30 minutes to complete. It is usually performed in a hospital or doctor's office, without requiring an overnight stay. Local anesthesia is administered to numb the area before the procedure, and antibiotics are often given as a preventive measure against infection.
2. In a transrectal prostate biopsy, an ultrasound tool is inserted into the rectum, and a biopsy needle is passed through the rectum and into the prostate gland to collect tissue samples.
3. To reduce the risk of infection associated with transrectal prostate biopsies, some doctors opt for a transperineal prostate biopsy. This procedure also utilizes TRUS for guidance, but the biopsy needle is inserted through the skin of the perineum, the area between the scrotum and the anus, and into the prostate gland. By avoiding the rectum and passing the needle through the skin, this method lowers the risk of infection.
4. Afterward, a pathologist examines the sample(s) under a microscope. A pathologist is a medical professional with expertise in interpreting laboratory tests and assessing cells, tissues, and organs to diagnose diseases. It is advisable to request a review of the findings in the pathology report with your healthcare team.

5. The vast majority of prostate cancers, over 95%, belong to a category known as adenocarcinoma. There is a less common form of prostate cancer called neuroendocrine prostate cancer or small cell anaplastic cancer that tends to spread at an earlier stage but often does not lead to an elevation in PSA levels.

Magnetic resonance imaging (MRI) fusion biopsy

An MRI fusion biopsy is a method that merges a prostate MRI scan with transrectal ultrasound (TRUS). A prostate MRI scan is now a standard practice. Initially, the patient undergoes an MRI scan to pinpoint suspicious regions within the prostate requiring further assessment. Subsequently, an ultrasound of the prostate is conducted. Specialized computer software combines these images to generate a 3D representation, aiding in precise targeting of the biopsy site. Although it may not completely eliminate the need for repeat biopsies, an MRI fusion biopsy can enhance the identification of areas more likely to be cancerous compared to other techniques. It's essential for an MRI fusion biopsy to be carried out by a professional experienced in this procedure.

DETERMINING WHETHER THE CANCER HAS SPREAD

To determine whether cancer has metastasized beyond the prostate to other parts of the body, healthcare professionals may conduct the following imaging tests. Given that many prostate cancers have a relatively slow or non-aggressive rate of spread, some of these tests are typically reserved for cases where the PSA level is significantly elevated, as they may not be necessary when the PSA level is only slightly elevated.​

  • Whole-body bone scan
  • Computed tomography (CT or CAT) scan
  • Positron emission tomography (PET) or PET-CT scan
  • MRI SCAN ​

STAGES OF PROSTATE CANCER

Individuals diagnosed with prostate cancer are typically assigned a stage as part of their diagnosis. Staging is a method for characterizing the cancer’s location, its potential spread, and whether it has impacted other areas of the body. Doctors employ various diagnostic tests to ascertain the cancer’s stage, and this staging process may not be finalized until all necessary tests suitable treatment plan and can also offer insights into the prognosis. Prostate cancer is are completed. Understanding the stage of the cancer is crucial for guiding the choice of the most categorized into different stages to determine its extent and severity.

STAGE-I

In Stage I of prostate cancer, the disease is typically in its early phase, characterized by a slow growth rate. The tumor is too small to be detected through a digital rectal examination (DRE) or seen on imaging tests. Stage I cancer usually consists of cells that closely resemble healthy cells and affects less than half of one side of the prostate gland. PSA levels tend to be low in this stage.

STAGE IIA, IIB, and IIC

II 1. It may involve a tumor that is still too small to be detected by touch or seen on imaging tests. 2. Alternatively, it could be a slightly larger tumor that can be felt during a digital rectal examination (DRE). In Stage II, the cancer is confined within the prostate gland, without spreading to lymph nodes or distant organs. However, the cancer cells in this stage may exhibit less resemblance to healthy cells and might have an increased potential for growth and spread. PSA levels typically fall within the medium or low range in Stage II.

STAGE IIIA, IIIB, AND IIIC

In Stage III of prostate cancer, the disease has progressed beyond the outer layer of the prostate and invaded nearby tissues. It may have spread to structures like the seminal vesicles (glands that aid in semen production), the bladder, or the rectum. The cancer cells in this stage typically exhibit significant differences from healthy cells, and PSA levels are notably elevated.

STAGE IVA & IVB

Stage IV of prostate cancer signifies the most advanced stage of the disease. In this stage, the tumor has metastasized or spread to other areas of the body, including the bladder, rectum, bones, liver, lungs, or lymph nodes. This stage is commonly referred to as metastatic prostate cancer. It indicates that the cancer has moved beyond the prostate and is affecting distant organs and tissues.