Prostate Cancer: Symptoms, Types, and Key Investigations

Today, the male population recognizes prostate cancer as one of the most significant medical issues. Prostate cancer is the second-most common cause of cancer death in men. It affects 4% of men in undeveloped countries and 15% in developed countries. 
Prostate cancers tend to arise within the prostate's peripheral zone, and almost all of them are adenocarcinomas. Metastatic spread to pelvic lymph nodes occurs early, and metastases to bone, mainly the lumbar spine and pelvis, are common. Genetic factors are known to play an important role in prostate cancer. 

Prostate cancer symptoms: 
Bone pain 
Hematuria 
Hematospermia 
Erectile dysfunction 
Low back pain 
Loss of urinary bladder control 
Weight loss 
Anemia 
Ureter obstruction 
Measurement of PSA levels in a peripheral blood sample, together with DRE, is the cornerstone of diagnosis. Before a PSA test, men should be given careful counseling about the limitations of the test: namely, a normal level does not exclude prostate cancer. At the same time, a high value does not confirm the diagnosis but will open a discussion about biopsy and possible future treatments with potential side effects. Individuals suspected of having prostate cancer, based on an elevated PSA and abnormal DRE, should undergo transrectal ultrasound-guided prostate biopsies. On biopsy, about 40% of patients with a serum PSA of 4.0–10 ng/mL or higher will have prostate cancer, whereas 25% of patients with a PSA of less than 4 ng/mL may also have prostate cancer. Occasionally, patients undergoing TURP for benign hyperplasia may incidentally find a small tumor focus. Suppose the diagnosis of prostate cancer is confirmed. In that case, staging should be performed by pelvic MRI to assess the presence and extent of local involvement, and an isotopic bone scan should be done to monitor and treat prostate cancer. 
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Prostate cancer by different location: 
Benign prostatic hyperplasia 
Granulomatous Prostatitis 
Transitional cell carcinoma of the prostate 
Prostatic calculi
Chronic prostatitis 

Investigations: 
PSA (prostate-specific antigen) density 
PAS velocity 
Total PSA ratio 
Age-specific PSA
DRE test 
The prostate undergoes a Transrectal Ultrasonography (TRUS) guided biopsy procedure. 
MRI- abdomen/pelvis/MR Urography 
Serum alkaline phosphate 
Bone scan 

Stage of Prostate Cancer: Prostate carcinoma is classified based on the tumor node metastasis (TNM). 

T: primary tumor 
TX Primary tumors cannot be assessed. 
T0: No evidence of primary tumor 
T1: A clinically inapparent tumor, not palpable or visible by imaging. 
The T1a tumor is an incidental histological finding in 5% or less of the resected tissue. 
T1b tumor incidental histological findings in more than 5% of tissue resected 
A needle biopsy has identified a T1c tumor. 
T2 tumor confined within the prostate 
T2a tumor involves one-half of one lobe or less; 
T2b tumor involves more than half of one lobe but not both lobes. 
T2c The tumor involves both lobes. 
T3 The tumor extends through the prostatic capsule. 
The tumor extends extracapsularly, either unilaterally or bilaterally, causing microscopic involvement in the bladder neck. 
The T3b tumor invades the seminal vesicle(s). 
T4 The tumor either fixes itself or invades adjacent structures other than seminal vesicles, such as the external sphincter, rectum, levator muscles, and/or pelvic wall. 

N: regional lymph nodes 
NX Regional lymph nodes cannot be assessed. 
N0: There is no regional lymph node metastasis. 
N1 Regional lymph node metastasis 

M: distant metastasis 
MX Distant metastasis cannot be assessed. 
M0 No distant metastasis. 
M1 Distant metastasis 
M1a Non-regional lymph node(s) 
M1b Bone(s) 
M1c Other site(s) 

Castration-refractory prostate cancer (CRPC, or HRPC) is an advanced prostate cancer. 
There are mainly two types of CRPC out there: metastatic CRPC and non-metastatic CRPC. 

Treatment of prostate cancer depends on the stage of the disease: radical prostatectomy, cryosurgery, hormonal therapy, radiotherapy, chemotherapy, and immunotherapy are effective treatments for prostate cancer. To prevent and cure cancer, plan your chemotherapy in Kolkata at the best price possible. 

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