Understanding Prostate Cancer: Symptoms, Diagnosis And The Newest Treatment Advances

Understanding Prostate Cancer: Symptoms, Diagnosis And The Newest Treatment Advances

Prostate cancer is one of the most common cancers affecting men worldwide. It originates in the prostate gland, a small, walnut-sized organ located below the bladder that plays a key role in the male reproductive system by producing seminal fluid. While many cases of prostate cancer grow slowly and remain confined to the gland, others can be aggressive and spread rapidly, making early detection and personalized treatment essential.

Dr Shyam Singh Bisht, Associate Director, Radiation Oncology, Cancer Care, Medanta, Gurugram explains everything you need to know:

Symptoms of Prostate Cancer

Symptoms of prostate cancer often mimic those of benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate commonly seen in older men. It is important to note that BPH is not a precursor to prostate cancer. The overlapping symptoms of BPH and prostate cancer involve bladder emptying (weak stream, straining, prolonged urination, delayed initiation of urination), bladder storage (frequency, nighttime urination, urgency), and post-urination issues (post-void dribbling, incomplete emptying). These are collectively referred to as lower urinary tract symptoms (LUTS). The IPSS scale is used to assess the severity of LUTS.

Not all cancer patients will have symptoms, and the severity of LUTS does not predict the extent of disease. In its early stages, prostate cancer often presents without symptoms, which is why regular screening is crucial especially for men over 50 or those with a family history. When symptoms do appear, they may include difficulty urinating, blood in the urine or semen, lower back pain, or unexplained weight loss.

Approach in Suspected Prostate Cancer

Patients presenting with BPH-like symptoms usually undergo a digital rectal examination (DRE), where the doctor assesses the prostate gland for consistency and abnormalities. A blood test (serum PSA) is also advised. If either is abnormal, a special MRI (multiparametric MRI) is recommended to evaluate the likelihood of prostate cancer using the PIRADS score.

If the PIRADS score indicates suspicion of clinically significant cancer, systematic biopsies are performed to determine the grade of cancer, known as the Gleason grade.

Following locoregional staging and metastatic evaluation usually via PSMA PET-CT prostate cancer is classified into localized, locally advanced, nodal, and metastatic stages (oligometastatic and polymetastatic).

Localized/locally advanced disease is confined to the prostate and further categorized into low-, intermediate-, and high-risk groups.

Nodal disease involves spread to pelvic lymph nodes.

Metastatic disease involves spread to bones, visceral organs, or non-regional lymph nodes.

Treatment depends heavily on stage, aggressiveness, and individual patient factors.

To determine the optimal treatment for a patient with prostate cancer, clinicians consider:

risk category (for prostate-confined disease), stage of spread, symptoms, age, and overall life expectancy.

Low to favourable intermediate-risk group: Active surveillance, radical prostatectomy, or radiation therapy (SBRT–CyberKnife or LINAC-based/brachytherapy). Hormone therapy is usually not required.

Unfavourable intermediate-risk group: Radical prostatectomy or radiation therapy (SBRT–CyberKnife or LINAC-based/brachytherapy) combined with short-course hormone therapy (4–6 months).

High-risk group: Radical prostatectomy with lymph node removal (followed by early salvage radiation if PSA recurs) or radiation therapy (IGRT/VMAT) with long-course hormone therapy (18–36 months).

Nodal and oligometastatic disease: Hormone therapy (ADT and secondary hormone agents) plus radiation therapy.

Polymetastatic disease: Hormone therapy with or without chemotherapy, and palliative radiation when needed.

While these methods are effective, they may cause side effects such as urinary incontinence, erectile dysfunction, fatigue, and emotional distress. This has increased interest in precise, less invasive therapies.

Recent years have seen remarkable progress in prostate cancer treatment. Some of the most promising advancements include:

Robotic-Assisted Radical Prostatectomy:

Surgeons operate via a console controlling robotic arms that offer enhanced precision, reduced blood loss, and faster recovery. Improved nerve preservation lowers the risk of long-term complications such as incontinence and sexual dysfunction.

Robotic Radiosurgery (CyberKnife-based SBRT):

This technique has transformed treatment for low- to intermediate-risk prostate cancer. Cure rates are comparable to surgery, with no risk of urinary incontinence. Treatment is completed in just five days, unlike conventional radiation therapy which requires 4–6 weeks.

Radioligand Therapy:

This targeted approach uses radioactive molecules that bind to prostate cancer cells, delivering radiation directly to the tumour while sparing healthy tissue. It is particularly effective for metastatic castration-resistant prostate cancer (mCRPC), where standard therapies often fail.

PARP Inhibitors:

Targeted drugs such as Olaparib show high effectiveness in prostate cancers with specific genetic mutations.

Immunotherapy and Genetic Profiling:

Though still in early stages for prostate cancer, immunotherapy is being explored for select patients with particular genetic profiles.

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Prostate cancer treatment is no longer one-size-fits-all. Advances in diagnostics, molecular biology, radiation technology, and minimally invasive surgery are allowing clinicians to tailor therapies to each patient's unique disease profile. Early detection remains the most powerful tool, but with the rise of personalized medicine, even advanced cases are increasingly being managed with better outcomes and fewer side effects.

As awareness grows and access to advanced therapies improves, the outlook for men with prostate cancer continues to evolve offering not just longer survival, but a better quality of life.

Source: News18
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