As Urologists we commonly find prostate cancer as an incidental finding. Either the patient had a PSA blood test which was found to be high or abnormalities were identified during a prostate examination.
Symptoms such as poor urine flow, incomplete bladder emptying, frequency and urgency identified by patients and brought to medical attention are usually more associated with prostate enlargement and not directly related to prostate cancer per se.
In a minority of cases, patients present with advanced prostate cancer. Those patients can have bone pain, neurological symptoms such as leg weakness, inability to pass urine and kidney blockage, feeling generally unwell often with back pain. These symptoms are related to prostate cancer spread to other parts of the body.
The diagnosis of prostate cancer is usually confirmed by Clinical examination, PSA blood test, Multiparametric MRI scan and Prostate biopsy. Those results will be discussed in a Multidisciplinary Team meeting (MDT) for assurance purposes and also to generate a treatment plan that is tailored to your condition.
There are number of treatments available for prostate cancer. The options on offer are dependent upon whether the prostate cancer is localised or advanced.
Localised prostate cancer:
Robotic Radical prostatectomy:
This is a good treatment option for localised prostate cancer. It involves removal of the entire prostate and sometimes with the adjacent lymph nodes using the da Vinci robot.
The aim of the operation is to physically remove the cancerous prostate with a view of curing the prostate cancer. In most situations, by removing the prostate, the patient finds both the benefit of treating the prostate cancer and the underlying prostate enlargement hence an improvement of the urinary symptoms such as urine flow.
The cancer outcome after surgery is generally good and the patient usually does not require hormone treatment with surgery, unlike radiation therapy, therefore, there are commonly less general side effects. Main side effects for surgery are related to genital urinary functions after the operation. In many occasions it is a transient effect which will recover with time and rehabilitation. We are happy to discuss with you in more detail in our clinic.
Radiation therapy is also used for treatment of localised prostate cancer. Instead of the physical removal of the prostate, the Oncologist often uses a combination of hormone treatment and radiation to treat the cancer. It is a good treatment option for localised prostate cancer, especially for patients who do not wish to have surgery.
The side effects can be from the transient hormone treatment which often consist of hot flushes, tiredness, weakness, breast swelling and lack of sex drive. Side effects from the radiation mainly effect genital urinary and bowel functions. We are happy to refer you to see one of the Oncologists to discuss this in more detail.
Active surveillance is a good option for patients diagnosed with low risk prostate cancer. Sometimes it is also suitable for selected patients with an intermediate risk of prostate cancer.
Active surveillance involves regular PSA blood testing, clinical examinations, sometimes with interval MRI scans and repeat biopsy. The principal aim of the treatment is to defer active treatment while the cancer is dormant, moving towards actively treating the cancer should it be identified as becoming more aggressive with curative intended treatments i.e. Robotic Radical Prostatectomy or Radiation therapy. The major benefit of active surveillance is to avoid over treatment and the side effects. We are happy to discuss with you in more detail in our clinic.
Advance prostate cancer:
Advanced prostate cancer is usually associated with development of cancers deposited outside the prostate. The common places for deposits are bone and lymph nodes. For this group of patient while the prognosis is not as good as localised prostate cancer, there are many treatments available to control the disease. The use of a combination of treatments including hormone, chemotherapy and newer drugs, in different sequences can often give good control of patient symptoms, tempering progression of the cancer.