Prostate Cancer
Specialized care for prostate cancer with active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy options.
Prostate Cancer
Solid Tumors
Overview
Prostate cancer is the most common non-skin malignancy in men worldwide, developing within the prostate gland—a walnut-sized gland located just below the bladder in men, responsible for producing seminal fluid. Most prostate cancers are adenocarcinomas, which grow slowly and initially remain confined to the prostate gland, where they may not cause significant harm. However, some types are highly aggressive, spreading rapidly beyond the prostate capsule to adjacent tissues, seminal vesicles, lymph nodes, and bones (particularly the spine and pelvis).
Symptoms are virtually non-existent in the early stages. As the tumor grows and obstructs the urethra, patients may experience urinary symptoms such as a weak or interrupted urine stream, difficulty starting urination, frequent urination (especially at night, known as nocturia), painful urination (dysuria), blood in the urine (hematuria) or semen, and erectile dysfunction. If the cancer spreads to the bones, it can cause persistent bone pain, pathological fractures, or spinal cord compression.
The development of prostate cancer is closely linked to androgens (male hormones like testosterone), which stimulate the growth of prostate cells. Understanding the clinical stage, Prostate-Specific Antigen (PSA) levels, and the Gleason score (which measures tumor aggressiveness based on histological appearance) is vital to choosing the appropriate treatment, which ranges from active surveillance for low-risk disease to aggressive multi-modal therapy for advanced stages.
When to Consult
After elevated PSA levels, abnormal digital rectal exam, or confirmed prostate cancer diagnosis.
What to Bring
PSA test results, prostate biopsy reports, imaging scans (MRI, CT), Gleason score, and urological history.
Risk Factors
Causes
Treatment Options
Active Surveillance and Watchful Waiting
For men diagnosed with low-risk, localized prostate cancer (low PSA, low Gleason score, small tumor volume), active surveillance is the preferred management strategy. Rather than immediate active treatment, the patient is closely monitored with regular PSA tests, digital rectal exams, mpMRI scans, and repeat biopsies. The goal is to defer invasive treatments like surgery or radiation, avoiding potential side effects like urinary incontinence and erectile dysfunction, while retaining the opportunity for curative therapy if the disease shows signs of progression. Watchful waiting is a less intensive form of monitoring, typically reserved for older patients or those with significant comorbidities, focusing on symptom management if the disease progresses rather than curative intent.
Radical Prostatectomy
Radical prostatectomy is a surgical procedure that involves the complete removal of the prostate gland, seminal vesicles, and surrounding tissue, often accompanied by pelvic lymph node dissection. It is a curative option for patients with localized or locally advanced disease. The surgery can be performed via open laparotomy, but it is most commonly done using Robot-Assisted Laparoscopic Prostatectomy (RALP). Robotic surgery offers superior visualization, precision, and faster recovery. Surgeons employ nerve-sparing techniques whenever possible to preserve the delicate neurovascular bundles adjacent to the prostate, which control erectile function and urinary continence. Post-surgical recovery involves temporary catheterization and pelvic floor rehabilitation.
External Beam Radiation and Brachytherapy
Radiation therapy is a highly effective curative treatment for localized and locally advanced prostate cancer, either as primary therapy or following surgery (adjuvant/salvage radiation). External Beam Radiation Therapy (EBRT) utilizes advanced techniques like Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) to deliver precise radiation doses to the prostate while minimizing exposure to the bladder and rectum. Stereotactic Body Radiotherapy (SBRT) delivers high-dose radiation in fewer sessions. Brachytherapy involves placing radioactive sources directly into the prostate gland, either permanently (low dose-rate seeds) or temporarily (high dose-rate). Radiation is often combined with short-term or long-term hormone therapy to enhance its effectiveness.
Androgen Deprivation Therapy (Hormone Therapy)
Because prostate cancer cells depend on male hormones (androgens) like testosterone to grow, reducing androgen levels or blocking their action is a cornerstone of treatment, particularly for advanced, metastatic, or recurrent disease. Androgen Deprivation Therapy (ADT) is achieved medically through LHRH agonists (e.g., Leuprolide, Goserelin) or LHRH antagonists (e.g., Degarelix) which suppress testosterone production by the testes. Oral anti-androgens (e.g., Bicalutamide) or next-generation androgen receptor inhibitors (e.g., Enzalutamide, Apalutamide, Darolutamide) and androgen synthesis inhibitors (e.g., Abiraterone acetate) are used to block hormone pathways. Surgical removal of the testes (bilateral orchiectomy) is a permanent option to lower testosterone.
Systemic Chemotherapy and Radiopharmaceuticals
For patients whose prostate cancer has progressed despite low testosterone levels (metastatic castration-resistant prostate cancer, or mCRPC), chemotherapy and radiopharmaceuticals are essential treatment options. Chemotherapy , typically using Docetaxel combined with prednisone, has been shown to prolong survival and reduce pain. Cabazitaxel is used as a second-line chemotherapy option. Radiopharmaceutical therapy represents a precision medicine approach; Radium-223 mimics calcium and targets bone metastases, delivering localized alpha radiation. Recently, Lutetium-177 PSMA (Lu-177 PSMA) therapy has emerged as a landmark treatment, delivering targeted beta radiation directly to cells expressing PSMA throughout the body, improving survival and quality of life.
Frequently Asked Questions
Q. What is the most effective treatment for Prostate Cancer?
The most effective treatment for Prostate Cancer depends on the stage, location, molecular profile of the tumor, and the patient's overall health. Dr. R. Srinath Bharadwaj provides personalized protocols including chemotherapy , immunotherapy , targeted therapy , or combination approaches.
Q. Where can I get expert treatment for Prostate Cancer in Hyderabad?
You can consult Dr. R. Srinath Bharadwaj, a leading Medical Oncologist, at the American Oncology Institute, Nallagandla, Hyderabad. Call +91 91213 36638 to schedule an appointment.
Q. What documents should I bring for a Prostate Cancer consultation?
Please bring all recent biopsy reports, imaging scans (CT, MRI, or PET-CT), tumor markers, blood test results, and any previous treatment or surgery details to help outline your care plan.