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It affects mainly men around 70 years of age and is very rare before age 50.
Prevention, as is the universal truth for all cancers, remains the best approach against prostate cancer.
The prostate is a small, walnut-sized structure that makes up part of a man's genital system. It is found below the bladder and produces the seminal fluid that nourishes the sperm.
Prostate cancer starts when abnormal prostatic cells start to multiply in an anarchic manner, creating a mass or a tumour. Initially the growth is limited to the prostate gland, and later on some cancerous cells may spread via the blood or lymphatic vessels creating new masses in other organs called metastasis.
The speed of the cancer's development is linked to the type of abnormal cells involved. While some types of prostate cancer grow slowly and may need minimal or even a "wait and see" approach, other types are aggressive and disseminate quickly to other parts of the body, such as bones, liver and lungs, and will thus require prompt and resolute treatment.
Prostate cancer can cause minimal symptoms in its early stages. Most cases are discovered through routine screening, with a thorough clinical examination (which must include a digital rectal examination) and a PSA test (or Prostatic Specific Antigen test).
In more advanced stages, complaints mainly involve difficulties in urinating, reduced stream of urine, presence of blood in the urine or sperm, incontinence, erectile dysfunction and discomfort in the lower abdominal area.
Many treatment options are now available. The choice is based on how aggressive are the cancer cells, their location in the prostate and the development stage of the tumour. It's essential to seek advice from an experienced multidisciplinary team of physicians and surgeons.
Established treatments include the following, used alone or in combination:
- Different surgical approaches to remove the prostate and often the nearby lymph nodes;
- Radiotherapy, either from outside the body (external beam radiation) or inside (brachytherapy, which involves placing many grainsized radioactive seeds in the prostate temporarily or permanently);
- Hormone therapy: Because prostate cells need testosterone to grow, cutting the production of testosterone cause cancer to grow more slowly. Several medicines are used and in some cases, a surgery to remove the testicles (orchiectomy) may be proposed to lower testosterone more effectively that medicine;
- Chemotherapy, usually proposed in advanced forms. Two new treatments are currently being investigated and include the cryosurgery to freeze (and kill) the prostate tissue affected by the cancer and the highintensity focused ultrasound, which heats the abnormal tissue and destroys cancer cells.
These two latter treatments, although promising, need more studies to better appreciate the benefits risk in comparison with existing approaches.
Dr Gerard Lalande is managing director of CEOHealth, which provides medical referrals for expatriates and customised executive medical checkups in Thailand.
