Prostate is an accessory gland of male reproductive system situated in the pelvis beneath the urinary bladder and anterior to the rectum. It is about the size of a walnut in young males. Its size increases with age, with most rapid increase occurring after puberty (under the inﬂuence of androgenic hormones, especially testosterone) until the age of 30 years, approximately. It provides the passage for urethra through its center and contributes about 25% to the volume of the ejaculate. It also provides a passage for the ejaculatory ducts of the seminal vesicles (a pair of glands situated behind the prostate), which drain their secretions (that make-up most of the semen volume) into the prostatic urethra.
It consists of mainly 3 zones: a transition zone (surrounding the urethra and constituting about 10% of the prostate); a central zone (surrounding the ejaculatory ducts and constituting around 25% of the prostate); and a peripheral zone (incompletely covering the other two zones and constituting bulk of the prostate).
Adenocarcinoma (affecting secretory cells of the prostate) is the most commonly encountered (more than 95% of all cases) prostate cancer.
Prostate Cancer Infographics
Most common risk factors for prostate cancer are advanced age, race and ethnicity, being obese or overweight, dietary factors and family history.
Most common symptoms with which it presents are weak or interrupted flow of urine, increased frequency of urination, painful or burning urination, trouble starting urination, blood in urine or semen, etc.
Digital rectal examination, transrectal ultrasound, PSA, and biopsy help in confirmation of diagnosis, whereas, imaging tests (CT/MRI/PSMA PET) are required to stage the disease.
T Staging (T1 and T2)
T staging describes the locoregional extent of the tumor. It may be T1 to T4 depending on extent of tumor involvement of prostate gland and infiltration of surrounding structures.
T Staging (T3 and T4)
N and M Staging
N is the nodal staging that may be N0 or N1 depending on the involvement of regional lymph nodes by tumor. And M is the metastatic staging that can be M0 or M1 depending on the presence of distant tumor spread.
Localised and Locally Advanced Disease
Localised and locally advanced prostate cancer may be classified into very low or low risk, intermediate risk and high or very high risk. Treatment is done accordinglyy, as described in the infographic below.
Treatment for hormone sensitive metastatic prostate cancer depends on site and number of metastases. High volume and low volume disease is treated as discussed below.
Castrate Resistant Prostate Cancer (CRPC)
Disease progression while on androgen deprivation therapy or hormonal therapy is called as castrate or hormone resistant prostate cancer. Treatment for the same depends on whether it is localised or metastatic CRPC, as discussed below.
Prostate Cancer Videos
Meet Mr. Poppy – Prostate Cancer patient
Watch the video below where CancerBro meets Mr Poppy, who has recently been diagnosed with prostate cancer.
Risk factors for prostate cancer are explained below.
Symptoms and Signs
Symptoms and signs with which prostate cancer presents commonly.
Prostate Cancer Natural History
Understand the natural history of prostate cancer, how it progresses after being detected, and what is it’s usual course.
Investigations for Diagnosis and Staging
Following video explains the investigations that are required to confirm the diagnosis and stage the disease.
Anatomy of Prostate
It is important to know the anatomy of prostate and surrounding structures to understand the staging in a better way.
TNM staging is explained below in an easy to understand manner.
Observation vs Active Surveillance
The video below describes the difference between Observation and Active Surveillance and which one is preferred for early stage prostate cancer patients.
Localised and Locally Advanced Disease Treatment
Here we will discuss the treatment for cancer that is localised to prostate or invaded locoregionally to nearby structures.
Androgen Deprivation Therapy
Androgen hormones are main driving force for prostate cancer cells to grow. Here we discuss various modalities (medical and surgical) to deprive the cancer cells off androgens.
Castrate Resistant Prostate Cancer Treatment
Here we discuss the various treatment modalities for prostate cancer that has progressed on hormonal therapy.