Diagnosis and best treatment options for prostate cancer

A simple urologist or uro-oncologist will prescribe a test for prostate cancer – PSA test. They will usually do this first to check your PSA levels are under the lower limits.

The PSA test uses a radioactive dye that will help determine if there are any more cell changes in your prostate. So your urologist or uro-oncologist will need to biopsy your prostate to get cells to determine whether the cancer has spread.

In your 50s you can expect to be asked for a PSA test every six to 12 months.

How is prostate cancer treated?

After the PSA test, a PSA test needs to be repeated to ensure the cells don't increase again. If there are no significant changes in the PSA, then you can expect to have treatment every six months.

The treatment options depend on the type of cancer you have and what your specific needs are. This will depend on the stage and grade of cancer you have, your general health and other risk factors.

A PSA test will usually show that your prostate cancer is not currently growing. But when it is cancer, the cancer cells are dividing more rapidly than your normal cells. As a result, they can form masses or multiple tumours.

At this stage, you will have a stage of your cancer known as localised prostate cancer (Stage 0).

When cancer has spread to nearby lymph nodes, bones, and internal organs, it will be called advanced prostate cancer (Stage 1).

To fight advanced prostate cancer, you need to treat it with a combination of surgery (called radical prostatectomy), radiotherapy (high intensity focused radiotherapy, which uses high energy x-rays to destroy cancer cells) and chemotherapy (drugs that stop the spread of cancer).

Stage 4 prostate cancer is currently incurable, but may be curable with treatment.

Treatment usually lasts for several weeks to several months. If cancer is not causing symptoms, or the prostate cancer is low grade or localized, then you can usually make a full recovery and don't need treatment.

Which are the best treatments?

Radical prostatectomy

If prostate cancer is locally advanced or has spread to other parts of your body, a radical prostatectomy is the best treatment. This operation removes your prostate gland along with any lymph nodes in the pelvis or around your spine.

During the operation, your prostate will be reduced by as much as 80-90%. This is done with a radiotherapy to destroy any cancer cells that may be left.

Radiation will be given for several weeks following the operation.

However, if you don't want radiotherapy, you can choose to have the surgery and only have radiotherapy.

Radiotherapy

If prostate cancer is a low grade (Stage 0) cancer, then the only option to treat your cancer will be radiotherapy. This treatment is given to your prostate gland to kill any cancer cells that are left behind.

Your prostate is usually removed along with the cancer during your surgery. The radiotherapy will be given to the removed gland.

The PSA test will show if your cancer has spread, and then this will be treated with radiotherapy.

If prostate cancer is not advanced, then radiotherapy will not be given, so it is not a treatment option.

Chemotherapy

If your prostate cancer is not low grade (Stage 0) and is curable with radiation or surgery, then chemotherapy is the only option to treat the cancer.

Chemotherapy is given to the whole body to kill the cancer cells. The drugs used in chemotherapy are usually very harsh and can cause your blood pressure to drop so that you have to be given a large dose of steroids to reduce this.

Chemotherapy may also cause you to lose your hair and even your teeth. It will make you feel very ill and may cause you to have a lowered immune system and you may be susceptible to other infections.

If your cancer is not near your bones, the treatment is typically given to your prostate gland.

If your cancer is advanced, your doctor may choose to give you chemotherapy before your operation to reduce the size of your prostate and to reduce the amount of time you'll need to be on antibiotics after the surgery.

Chemotherapy usually lasts for a couple of months, but sometimes the course may need to be extended.

Vasectomy

There are many men who wish to have a vasectomy, in order to reduce their risk of prostate cancer. A vasectomy is when a doctor cuts or blocks the tubes that carry sperm from the testicles to the urethra.

Although a vasectomy may reduce your chances of prostate cancer, your doctor will only perform a vasectomy if you have a very low risk of getting it.

Low risk of getting prostate cancer is one in 10,000 to one in 10,000. The risk of having a vasectomy is higher in older men.

It may be possible to be sterilized using a technique called two-part contraception.

Part one is a male sterilization procedure where a doctor simply clips the vas deferens (the duct that carries sperm from the testicles) at the base.

Part two is a hormonal injection that blocks sperm from being produced in the testicles for at least one year after the vas deferens is clipped.

This hormonal injection is also given as a combined contraceptive.

Topical hormone therapy

The aim of this treatment is to reduce the amount of male hormones in your body. Hormones play a role in your body's growth and development. Male hormones help to shape and harden the bones in your body.

Men who have a high testosterone level have a greater risk of getting prostate cancer.

The aim of treatment is to reduce your level of testosterone to normal or close to normal.

Adenoidectomy

Adenoidectomy involves removing part or all of the oesophagus (the tube that connects the mouth and the stomach) or an area of the head (the tonsils).

Sometimes the lymph nodes on the inside of the oesophagus are also removed.

This operation is carried out to remove a known risk factor of prostate cancer.

If a man has any risk factors for prostate cancer such as a genetic mutation (such as a BRCA 1 gene mutation) or high levels of PSA (prostate specific antigen), then an operation called a lymph node dissection may be performed.

Lymph node dissection involves taking out a part of the lymph nodes that are near the prostate gland.

This procedure can be repeated if cancer is found in the same area or another lymph node is affected.

In more advanced cases, the whole prostate gland may be removed.

Steroid injection into the prostate

This procedure involves inserting a needle into the prostate gland to drain fluid into a collecting bag.

After several months, the prostate gland will return to normal. It may take several months to be sure.

Surgery

In men with the genetic mutation, prostate cancer is often treated by removal of the prostate gland with a small cut to allow the cancer to be removed. The whole prostate gland may be removed in cases of advanced cancer.

Lymph node dissection

It is not clear how often this procedure is performed to treat prostate cancer, although it is common.

When an abnormality is found in a lymph node, the first step is often a biopsy where a biopsy needle is inserted into the node to collect tissue. If cancer is found in the node, the operation may be delayed until the cancer has been completely removed.

Three different methods are used to remove lymph nodes from the chest, arm, or groin.

The most common method is to insert a hollow needle through the skin and insert a special scoop or tool that extracts the tissue. The needle may be tilted at one end to ease extraction.

A less common approach is to enter the node through the skin and insert a catheter through the large vein in the arm or groin.

This minimizes the risk of damage to the veins and arteries in the area.

During surgery, the patient may have an incision over the affected lymph node and may be given drugs to stop bleeding, similar to blood loss from a wound.

There are some serious risks to this procedure. These include the possibility of infection, damage to the spinal cord or nerves, or a collapsed lung.

This procedure is used when a patient's lymph nodes show evidence of cancer.

A lymph node is a swollen area that becomes more visible as cancer cells pass through the lymph system.

The goal of treatment is to reduce the amount of cancer cells in the lymph node.

Caesarian section

If cancer has spread to the lymph nodes, then chemotherapy or radiotherapy may be used.

Radiation treatment can be given either in conjunction with a course of radiotherapy or with radiotherapy alone.

This type of treatment can stop the spread of the cancer into the lymph nodes and prevent them from developing cancer themselves.

A chemotherapy injection may be given to reduce the number of cancer cells in the lymph nodes.

Outlook

There is no cure for prostate cancer, but the outlook for a man who develops the disease is generally good. The chance of survival depends on a range of factors, including the size of the tumour and its location.

For this reason, it is important for men to discuss the options with their doctors. The doctor can advise on the best options for their specific situation.