Prostate cancer

Symptoms of prostate cancer

Early-stage prostate cancer can often cause only few symptoms or none at all. In fact, these symptoms may be similar to those caused by an enlarged prostate gland – also called benign prostatic hyperplasia. Typical symptoms for both prostate cancer and prostatic hyperplasia can include urinary incontinence or urinary retention. There is always reason to ask a specialist to examine all vague symptoms, as only more accurate examinations can help in finding out whether or not such symptoms are associated with prostate cancer.

Prostate cancer diagnostics

In order to find successful treatment, it is important to establish the most accurate diagnosis possible in an early stage. Diagnosing prostate cancer starts on the first visit to a urologist or a cancer specialist with thorough examinations. The physician also performs a rectal examination, which gives vital important about the state of the prostate, urinary organs and genitals. In addition to the rectal examination, the doctor can also perform an ultrasound of the prostate gland. If there is reason to suspect cancer in this stage, e.g. on the basis of high PSA levels or abnormal palpation findings, the urologist will prescribe further examinations, in order to make a diagnosis. Such tests include for example an STHLM3 test or Proclarix test and an MRI scan of the prostate. The cancer is ascertained, and its aggressiveness is assessed by the examination of a tissue sample.

The most representative samples of suspicious changes are based on a robot-assisted MRI-guided navigation biopsy. In order to treat prostate cancer efficiently, the extent of cancer has to be determined as precisely as possible. An MRI on the prostate is always needed prior to the final decision to select surgery or radiation therapy. The MRI shows if the cancer has spread outside of the prostate.

Prostate cancer treatment

Prostate cancer treatment is always designed individually according to the characteristics of the disease. The choice of treatment is influenced by other possible diseases, possible references to so-called high-risk prostate cancer, the results of prevalence studies and, of course, the patient’s own wishes. Local or locally advanced prostate cancer can be increasingly cured with radiation therapy. Depending on the characteristics of prostate cancer, radiation therapy can be tailored in many different ways. There are several different techniques to choose from in external radiotherapy, and radiotherapy can also be given as interstitial form or radiotherapy (HDR brachytherapy). In aggressive cancers, the best treatment outcome is most likely to be obtained by combining external beam radiotherapy with high-dose HDR brachytherapy.

Based on risk factors, radiotherapy can also be combined with cancer drugs. Most commonly, drug treatment is given in advanced prostate cancer, but also in high-risk local cancers as adjunctive therapy. New drugs are often also suitable for elderly patients, with other diseases, and for use as part of combination therapies. These new prostate cancer drugs are often both more effective and better tolerated than previous drugs, and can also be effective when previous drugs have already lost their effectiveness. New drugs can relieve symptoms, slow the progression of the disease, especially in the bones, and prolong life.

Treatment of advanced prostate cancer

The key to treating patients with advanced prostate cancer is an individualized treatment program. The front-line treatment of metastatic prostate cancer always includes medical treatments , most commonly hormone therapy and chemotherapy, or a combination. If cancer has metastasized to the bones, a medication to strenghten them is often administered. Radiotherapy can be included in treatment with special techniques, even if there are extensive metastases.

If remission of prostate cancer is achieved by means of medical treatment, we at the Docrates Cancer Center always consider adding localized radiation therapy. This has been shown to be effective in the treatment of advanced prostate cancer. Irradiating of the prostate may also prevent urinary retention later on.

Hormonal treatments and chemotherapy can remain effective for long periods but usually lose their efficacy over time. In these situations, the second-line treatment of radionuclide therapy with a radioactive substance (radium or samarium) that targets the bones has been found to be both an effective and safe treatment option when metastases exist only in bone structures. Solitary, or a small number of, bone metastases can also be effectively treated with external radiotherapy if necessary. In addition to radium and samarium, a new radioactive drug, 177-lutetium-PSMA, has now been discovered. This might be an additional option especially for elderly patients, for whom traditional chemotherapy may be challenging for example due to severe side effects.