Cancer Information
  • Home
  • Common Types of Cancers
  • Prostate Cancer

    Diagnosis and Treatment of Prostate Cancer


    • Digital rectal examination (DRE)   - A physician performs this physical examination to determine the consistency of prostate. Healthy prostate tissue is soft while malignant tissue is firm, hard, and often asymmetrical or stony. It is an initial evaluation only as nearly one-third of patients diagnosed with prostate cancer have a normal DRE.

    • Transrectal ultrasound (TRUS)

    • Prostate specific antigen (PSA) and Prostatic acid phosphatase (PAP)Tests - 

    1. Free and total  PSA - Malignant prostate cells produce more bound PSA; therefore, a low level of free PSA in relation to total PSA might indicate a cancerous prostate, and a high level of free PSA compared to total PSA might indicate a normal prostate, BPH, or prostatitis. A PSA of 4 ng/mL or lower is considered normal; 4 -10 ng/mL, slightly elevated; 10 - 20, moderately elevated; and 20 - 35, highly elevated. Most men with slightly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal PSA levels. A highly elevated level may indicate the presence of cancer. A false positive result occurs when the PSA level is elevated and there is no cancer. A false negative result occurs when the PSA level is normal and there is cancer. Because of this, a biopsy is usually performed to confirm or rule out cancer when the PSA level is high.

    2. Prostatic acid phosphatase (PAP) test Prostatic acid phosphatase is an enzyme produced by prostate tissue. The level of PAP increases as prostate disease progresses.

    • Tumor Biopsy -  If a tumor is found, a TRUS guided biopsy is usually performed to determine the type of cancer, its location, and stage of development. Pathologist gives Gleason score to the tissue depending on differentiation of the tumor. Gleason scores of 2 to 4 indicate that the cells are well differentiated, meaning the tissue is not too abnormal; 5 to 7 moderately differentiated; 8 to 10 poorly differentiated. Higher scores suggest aggressive tumors that likely require aggressive treatment.

    • Computed tomography (CT scan) - Computer-assisted tomography (CAT scan or CT scan) is used to determine the involvement of pelvic lymph nodes.

    • Bone scan -  A bone scan is a nuclear imaging procedure that is used to detect metastasis to bones. It is not used in patients with small cancers and low PSA levels.


    Medical Treatment  

    Treatment for prostate cancer depends on the stage of the disease and the patient's age and overall health. Elderly patients with minor symptoms, early stage cancer, or coexisting illness may be treated conservatively. Watchful waiting is a reasonable course of action for patients who are elderly, in poor health, or with early stage cancer. Untreated prostate cancer may take years to become problematic. Patient stays under careful observation of physician who monitors his signs and symptoms periodically investigates him. 

    Hormone Therapy  

    Hormone therapy for prostate cancer involves the use of antiandrogens to block production of testosterone, which prostate cancer cells use to grow. Drugs used for hormone therapy include leuprolid acetate (Viadur), goserelin acetate implant (Zoladex), bicalutamide (Casodex), and flutamide (Eulexin). This prostate cancer treatment suppresses androgen (e.g., testosterone, estrogen) production, causing the tumor to shrink or stop growing and reducing symptoms (e.g., pain, urinary retention, urinary frequency). Hormone therapy may often have undesirable side effects for which patient is carefully monitored.

    Treatment for Bone Metastases - Zoledronic acid (Zometa) is a bisphosphonate prescribed to treat hypercalcemia (excess calcium in the blood) in prostate cancer patients who have bone metastases (secondary tumors in bone).

     Radiation Therapy

    Two types of radiation therapy are used to treat prostate cancer: brachytherapy and external radiation therapy (XRT).

    This treatment involves implanting tiny, radioactive capsules into the cancerous prostate gland. The capsule emit radiation that kills the malignant tumor. Men with small tumors confined to the prostate (stage T1 or T2) are candidates for brachytherapy.

    External Radiation Treatment (XRT)
    External Radiation Treatment is recommended when the tumor has spread through the prostate capsule to surrounding tissues. XRT usually is given on an outpatient basis for 7 to 8 weeks.

    79% of stage T1, 66% of stage T2, 55% of stage T3, and 22% of stage T4 prostate cancer patients survived 10 years after External Radiation Treatment.

    Surgery - Good candidates for surgery to treat prostate cancer have one or more of the following characteristics: Good health ; No spread of cancer to bone ;Tumor confined to the prostate gland (stage T1 and T2); Under the age of 70 ;Expected to live another 10 years or longer ;

    Depending on the extent of the disease, there are several surgical options for prostate cancer-

    • Cryosurgery -  This is a minimally invasive outpatient procedure and it destroys cancer cells by twice rapidly freezing and thawing cancerous tissue. It is recommended for patients who cannot tolerate surgery or radiation, have prostate-confined tumors (stage T3 or lower), do not respond to radiation (both external-beam and brachytherapy), and are elderly.

    • Laparoscopic Radical Prostatectomy -Laparoscopic radical prostatectomy causes less bleeding and less postoperative pain and results in a shorter hospital stay and recovery period.

    • Radical Prostatectomy -Radical prostatectomy is the surgical removal of the prostate gland and surrounding tissues, including the seminal vesicles and the pelvic lymph nodes.