It can be confusing for many patients receiving a diagnosis of prostate cancer because they will have to make a range of decisions regarding their treatment. This confusion arises both from the sheer number of treatment options available and from the fact that various determinants that differ from patient to patient must be taken into account to select the right one. In the case of prostate cancer, treatment varies depending on the disease stage: whether it is localised or metastatic, or if the tumour is aggressive.
Prostate cancer originates in the glandular cells of the prostate gland, which is a small organ located beneath the bladder and surrounding the urethra in male individuals. The majority of prostate cancers are slow-growing adenocarcinomas that may not require effective treatment at any point in the lifetime of men with such cancers.
The Gleason score, which is given following a biopsy, grades the tumour from 6 to 10 based on the microscopic appearance of the cells. The higher the score of the cancer, the more aggressive the disease is and the more urgent it becomes for treatment to take place.
Localised prostate cancer is frequently asymptomatic, discovered incidentally during PSA screening or routine examination. Symptoms include:
Transrectal and transperineal ultrasound-guided biopsy helps confirm the diagnosis and provide pathological grading of the sample. To locate the highest-risk areas and improve biopsy targeting, MRI of the prostate has increasingly been used before biopsy. Bone scan and either CT or PSMA PET imaging complete the staging process to determine whether the cancer has spread beyond the prostate.
Active surveillance is important for men with low-risk organ-confined prostate cancer. This approach consists of regular monitoring of PSA, MRI, and biopsy as indicated, and treatment is administered only if there is evidence of progression.
Surgery entails radical prostatectomy, where the entire prostate is removed from the body and is a viable option for men presenting with localised prostate cancer and having an acceptable life expectancy. Robotic-assisted laparoscopic prostatectomy has become the most commonly performed surgical technique due to its reduced blood loss and rapid recovery time.
Radiation therapy is offered as a non-surgical option for localised or locally advanced prostate cancer and can be combined with androgen deprivation therapy. The main options for radiation therapy include external beam radiation therapy and brachytherapy, where radioactive seeds are placed inside the prostate gland.
The use of androgen deprivation therapy is one of the main approaches to treating patients with advanced and metastatic disease. Prostate cancer cells require androgens, especially testosterone, in order to expand. The total reduction of testosterone through medical castration with the help of LHRH agonists or antagonists works well for some time.
Abiraterone acetate is an inhibitor of CYP17A1, which yields the suppression of androgen production in the testicles as well as in the adrenal glands, and even in the tumour cells. The clinical use of abiraterone is registered for the treatment of both metastatic castration-resistant prostate cancer and metastatic hormone-sensitive prostate cancer together with androgen deprivation therapy, where clinical trials indicated a considerable improvement in overall survival.
Zybiraa 250mg is the abiraterone acetate formulation to be prescribed with prednisolone at a minimal dose. The course of treatment is always conducted by an oncologist. The medicine must be taken daily on an empty stomach.
Every treatment method has its particular side effects. Androgen deprivation therapy brings along hot flushes, a decrease in libido, erectile dysfunction, tiredness, possible osteoporosis risk and mood alterations. Surgery carries hazards of urinary incontinence and erectile dysfunction, which may occur in a temporary way depending on the surgical method and the particular anatomy. Radiation therapy brings urinary, bowel, and sexual side effects that develop slowly over the months. Abiraterone-based therapy may lead to high pressure, decreased potassium levels, fluid retention, and high liver enzymes.
The psychological aspects of prostate cancer diagnosis are numerous and are frequently disregarded. Changes in sexual functioning, urinary control skills, body image and perception of masculinity are to be employed in the therapy. Availability of oncology counselling, support groups specifically for prostate cancer patients and involvement of partners in therapy are increasing the chances of successful treatment.
Post-treatment check-ups include frequent PSA tests, the most important marker for diagnosing recurrence. How often and for how long monitoring will take place depends on the type of treatment and the first classification of the illness. Regular monitoring of bone density is important for patients undergoing prolonged hormonal deprivation treatment, alongside advice on nutrition and physical activity to prevent osteoporosis.
Prostate cancer is not a single disease with one solution. Any treatment is most effective when it corresponds to the stage of the disease, grade of aggressiveness, and individual characteristics of patients. In the case of early diagnosis, making a decision regarding monitoring, surgery, or radiotherapy, it is important to analyse the consequences of all treatments.
Disclaimer: This article is for general informational purposes only and should not be considered medical advice. Always consult a qualified urologist or oncologist for diagnosis, staging, treatment planning, and guidance specific to your condition.