Incidence of prostate cancer has increased significantly, or is it that we have better tools to diagnose them early? Well in the Indian scenario, we are now picking up prostate cancers much earlier as compared to what we were seeing ten years ago. With the advent of laparoscopy and robotics, Radical prostatectomy for prostate cancer has been revolutionized from a big incision and many blood transfusions to the fact that now we are discharging the patient in about 4 days,rarely requiring blood transfusion and a better social and sexual life post surgery.
- Laparoscopic Radical Prostatectomy:
Now being offered to even locally advanced prostate cancers and of course to localized prostate cancer too.
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PSA: blood serum test which when more than 4ng/ml, needs to be investigated further to rule out prostate cancer. It can be raised in cases of infection, trauma or a very big gland also. On the contrary highly differentiated Prostate Cancers may sometimes have normal PSA.
DRE: Digital Rectal examination is necessary for a complete assessment of prostate as it picks up hard a nodule or a nodular prostate which is suspicious of prostate cancer as compared to a smooth firm normal prostate . And on a DRE we are able to even assess the fixity of the prostate cancer to rectal mucosa of surrounding area.
TRUS: Trans Rectal Ultrasound is used to assess the prostate if PSA is high to localize the nodule or suspicious area in prostate (peripheral zone or transitional zone).
TRUS Guided Prostate Biopsy: Under adequate antibiotic coverage and Trans Rectal Ultrasound guidance, ( TRUS enables the urologist to take a precise biopsy from the suspicious area ), Prostate Biopsy is taken, as a day care procedure (12 core even up to 24 cores can be taken). Biopsy has a potential risk of retention of urine (post biopsy), hematuria ( blood in urine) or per rectal bleeding or sepsis with later abscess formation, All are easily treatable conservatively.
Treatment For Ca Prostate
Radical Prostatectomy: Involves removal of the prostate along with the seminal vesicle and Lymph nodes which can be achieved by:
Radical Prostatectomy is offered to patients with Localized Ca Prostate or in cases with locally advanced Ca prostate without any Lymph Nodes involvement.
Active Surveillence is a good option if the patient is old or has serious health problems or the cancer is slow growing. Active surveillance involves regular close monitoring of the progress of the cancer in form of periodical PSA levels and as and when required radiological investigation or even repeat prostate biopsy.
Hormonal Treatment involves Surgical Bilateral Orchiechtomy (testes removal) or monthly , 3 monthly or 6 monthly depot injections to suppress the formation of Testosterone which is formed in the testes. Normally these procedures are accompanied with oral tablets also. Hormonal treatment is a treatment option for locally advanced prostate cancers and advanced cancers with lymphnode or distant metastasis ( bone, liver, lungs or brain).
External Radiotherapy for localized prostate cancers or for the metastasis is another option for the patients not keen on surgery or for pain management in advanced metastasized cancers.