Dr Thangarajan Rajkumar Director Research (Oncology), MedGenome
Prostate cancer is one of the most prevalent cancers in Western countries, and its incidence is gradually rising in India. It currently ranks among the top 10 cancers in Indian men and ranked 3rd in Delhi, Mumbai, and Bangalore, especially the urban regions. To comprehend the significance of prostate cancer, it is essential to explore the prostate gland’s role, risk factors, methods of detection, and treatment options.
The Prostate Gland and Its Functions
The prostate gland is a small, walnut-sized organ located just below the urinary bladder and in front of the rectum. It plays a vital role in male reproductive health. The urethra, the tube that carries urine from the bladder, passes through the prostate gland. Additionally, the prostate receives the ejaculatory tube formed by joining seminal vesicle tubes with the vas deferens, which transports mature sperm from the epididymis, a sperm storage organ situated behind the testis.
The prostate gland, together with the seminal vesicles, secretes fluid that nourishes and energizes sperm, primarily through fructose sugar. This fluid is alkaline, which helps neutralize the acidic environment of the vagina, aiding sperm in their journey. During ejaculation, the prostate gland prevents the discharge of urine and promotes the ejaculation of semen.
As men age, the prostate gland tends to enlarge, leading to a condition known as Benign Prostatic Hyperplasia (BPH). BPH is not cancerous, but an enlarged prostate can obstruct urine flow, causing complications.
Prostate Cancer Risk Factors
Prostate cancer typically affects men over the age of 60. Several risk factors contribute to the development of prostate cancer, including:
Smoking: Smoking has been linked to an increased risk of prostate cancer.
Alcohol: Excessive alcohol consumption may also elevate the risk.
Diet: Diets high in red meat and low in vegetables and fruits have been associated with a higher risk.
Ethnicity: Black African men are at a higher risk than other ethnic groups.
Family History: A family history of prostate cancer can increase the risk.
Prostate cancer can be classified based on its origin:
Sporadic: Occurs by chance.
Hereditary: Caused by a faulty gene inherited from either parent. Hereditary prostate cancer is more likely to occur at a younger age and can be associated with genes like BRCA1 and BRCA2.
Early Detection and Screening
Fortunately, prostate cancer can be detected early through clinical examinations and blood tests. Digital Rectal Examination (DRE) involves a doctor inserting a lubricated gloved finger into the rectum to feel the prostate for any abnormalities. Additionally, a blood test for Prostate Specific Antigen (PSA) can help in early detection.
For individuals with a family history or genetic predisposition to prostate cancer, screening should start as early as age 40. Regular screenings, every 6-12 months, are crucial for monitoring PSA levels. If PSA levels rise, further tests such as Trans-rectal Ultrasound (TRUS) and biopsy may be necessary to confirm the presence of cancer.
Treatment Options
The treatment of prostate cancer depends on the stage and extent of the disease:
Localized Cancer: When the cancer is confined to the prostate, treatment options include surgery (Robotic Radical Prostatectomy or Laparoscopic Radical Prostatectomy) or radical radiotherapy.
Advanced Cancer: If the cancer has spread beyond the prostate or has lymph node involvement, additional therapies like hormonal therapy (Androgen Deprivation Therapy or ADT) and radiotherapy may be necessary.
Hormonal Therapy in Prostate Cancer
Hormonal therapy is a common approach for managing prostate cancer. Prostate cancer cells rely on testosterone (and its derivative, Dihydrotestosterone or DHT) to grow. Hormonal therapy aims to lower testosterone levels. This can be achieved by medications that inhibit testosterone production by the testis or block the binding of DHT to its receptors. In some cases, drugs like Abiraterone prevent the formation of DHT in the adrenal gland. This combination of approaches is known as complete Androgen Blockade or Androgen Deprivation Therapy (ADT).
Personalized Medicine for Prostate Cancer
In recent years, personalized medicine has emerged as a promising approach for prostate cancer treatment. This involves tailoring treatments based on the tumor’s unique characteristics, including mutations and gene expression patterns.
One target for personalized treatment is Poly-ADP Ribose Polymerase (PARP), which is involved in DNA repair. PARP inhibitors can be effective in patients with HRR deficiency, a condition linked to certain genetic mutations, including those in BRCA1 and BRCA2.
Another personalized approach involves assessing the tumor’s mutational burden and using monoclonal antibodies to target the PD1-PDL1 immune checkpoint. Next-generation sequencing can identify mutations in other genes, allowing for targeted therapies.
In elderly individuals, the benefits and potential side effects of prostate cancer screening and treatment must be carefully weighed, especially if they have significant comorbid conditions.
In conclusion, understanding prostate cancer, its risk factors, detection methods, and treatment options is crucial for effectively managing this common disease. Regular screenings and personalized treatment approaches can significantly improve outcomes for patients and help them make informed decisions about their prostate cancer care.
