Prostate cancer is common in men over 50 years of age, with the risk of developing prostate cancer increasing with aging. Men with a first-degree relative, diagnosed with prostate cancer at a younger age will have an increased risk of developing the disease. The exact causes of prostate cancer are not known. Prostate cancer is comprised nearly always of adenocarcinoma cells that arise from glandular tissue. Prostate cancer more commonly metastasizes to lymph nodes in the pelvis and to the bones.

Prostate Cancer Treatment In Malaysia



 

Risk Factors

Age
Sixty percent of prostate cancer cases arise in men over 65 years of age.
Family history
Men with a first-degree relative, father or brother, diagnosed with prostate cancer at a younger age will have an increased risk of developing the disease. The risk of developing prostate cancer also increases with the number of relatives affected.
Genetic factors
Prostate cancer is, infrequently, directly attributed to identifiable genetic changes in the BRCA2 gene. BRCA2 gene mutation may increase risk of developing breast or ovarian cancer in affected female family members.
Lifestyle factors
Diets high in red meats and fatty foods and low in fruits and vegetables appear to be associated with a higher risk of developing prostate cancer. Obesity is also linked to a higher risk of the disease.

Symptoms & Signs

A patient with early prostate cancer is usually asymptomatic. Prostate cancer symptoms associated with enlargement of the prostate gland may include:

  • Frequent urination
  • Difficulty in starting or stopping the urine stream
  • A weak or interrupted urine stream
  • Urinary retention
  • Loss of control of urination
  • Painful urination
  • Blood in the urine or in the semen

Advanced prostate cancer symptoms may include:

  • Bone pain and bone fracture from minor trauma
  • Unexplained weight loss
  • Fatigue
  • Shortness of breath
  • Swelling of the legs related to obstruction of the lymph tissue by prostate cancer.

Screening and Diagnosis of Prostate Cancer

Talk to our oncologists at Onco Life Centre about when screening should begin based on your age and family history of the disease.

Prostate cancer screening consists of periodic laboratory testing, usually every one to two years, which includes a prostate specific antigen (PSA) test and digital rectal examination. However, the PSA is not sensitive enough to pick up all prostate cancers, and can also be raised even in people with prostate glands that are infected, inflamed, or enlarged but not cancerous.

An abnormal PSA and/or abnormal digital rectal examination are the indications for prostate biopsy. Prostate cancer is definitively diagnosed by removal of small cores of prostate tissue, which are then examined under the microscope by a pathologist. The prostate cancer present will be assigned a numerical score, which is referred to as the Gleason Score. This characterizes the appearance of the cancer cells and helps predict its likely level of aggressiveness.

The PSA level, Gleason score and the extent of involvement of the biopsy core will allow our Specialists at Onco Life Centre to formulate the best multidisciplinary treatment plan for you.

Stages of prostate cancer

Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA and radiologic studies. The American Joint Commission on Cancer (AJCC) TNM system for prostate cancer staging is as follows:

 
T1

Prostate cancers cannot be seen on imaging tests or felt on examination.

 
T2

Prostate cancers can felt on examination and can be visualized with on imaging studies.

 
T3

Prostate cancers have extended beyond the prostate gland to possibly involve the seminal vesicle or bladder neck.

 
T4

Prostate cancers have invaded adjacent tissues or organs.

 
N0

Means that there is no prostate cancer evident in the nearby nodes.

 
N1

Means that there is evidence of prostate cancer in the nearby nodes.

M0

Means that there is no evidence of spread of prostate cancer into distant tissues or organs.

M1

Means that there is spread of prostate cancer into distant lymph nodes or organs.

The PSA and Gleason score at presentation as well as the final cancer stage designation determine the prognosis of the affected individuals.

 

Treatment options for prostate cancer

Talk to our Oncologists at Onco Life Centre about your treatment options. The main treatments for prostate cancer are surgery, hormonal therapy, chemotherapy and radiation therapy. Often the best approach uses 2 or more of these treatment methods. It is important that you understand the goal of your treatment. If a cure is not possible, treatment is aimed at relieving symptoms such as pain.

Surgery

The removal of the entire prostate gland and the urethra that runs through the prostate and the attached seminal vesicles is referred to as a radical prostatectomy. Radical prostatectomy is an appropriate treatment optionn for men with clinically localized prostate cancer with a life expectancy of 10 or more years. Pelvic lymph node dissection may be recommended depending on the Gleason score, PSA, and radiologic findings.

Hormonal therapy

Prostate cancer is highly sensitive to and dependent on the level of the male hormone testosterone, which drives the growth of prostate cancer cells, except in poorly differentiated forms of prostate cancer.
Front-line hormonal therapy for advanced and metastatic prostate cancer is called androgen deprivation therapy (ADT).
While it is not a curative treatment in that setting, it can both reduce symptoms and slow down the growth of the prostate cancer to prolong life.
Medications that block testosterone production by the testes include LH-RH agonists, LH-RH antagonists. Medications that block the action of testosterone include the androgen receptor blockers and are usually considered in individuals who have failed first-line ADT.
Adrenal androgen synthesis inhibitors block testosterone production from the adrenal glands. More recently, new agents in this class of drugs have been developed and are also considered in individuals who have failed first-line ADT.

Chemotherapy

The use of chemotherapy in metastatic prostate cancer is able to relieve symptoms of prostate cancer, and can prolong life. It is usually used in the setting of castration-resistant prostate cancer.
Chemotherapy drugs may damage the DNA of the cancer cells or disrupt the cells ability to divide. These effects can cause cells to die. Active chemotherapy drugs for the treatment of prostate cancer today include taxane drugs. Although traditionally recommended for men with castrate-resistant prostate cancer, the NCCN has also recommended the use of taxane in combination with ADT and EBRT in men with high- and very-high-risk localized prostate cancer.

Radiation therapy

Radiation therapy is a potentially curative treatment that uses radiation to kill cancer cells. External beam therapy (EBRT) is appropriate for men who are candidates for radical prostatectomy but do not wish to undergo the surgery or who are not ideal surgical candidates.
The NCCN guidelines recommend that patients with high-risk and very-high-risk prostate cancer receive neoadjuvant/concomitant/adjuvant hormone therapy (androgen deprivation therapy [ADT]) for a total of two to three years.

Bone-targeted therapy

Several bone-targeted therapies have been approved for use by the US FDA, as both prostate cancer as well ADT can have a significant impact on bone health.

1) Bisphosphonates
These drugs encourage the death of the osteoclasts. In prostate cancer they impact the course of skeletal-related events including reducing pain in the bones, and delaying the progression of bone metastases associated problems including the appearance of fractures.

2) Monoclonal antibody therapy
This class of bone-targeted therapy inhibits a protein that tells the osteoclasts to remove bone. It does not require dose adjustments if kidney function deteriorates. In some studies, this agent appears to be more effective than bisphosphonates in delaying the initial onset of skeletal-related events in patients with bone metastases.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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