Most often, prostate cancer diagnosis relies on screening tests, because the cancer typically does not produce symptoms in its early stages. In fact, about 40 percent of prostate cancer cases aren't detected until the cancer has spread beyond the prostate gland.

Screening tests are often part of a routine physical exam, especially in men over age 40. Surgical oncologists may also recommend screening tests because of symptoms pointing to a prostate problem. Screening tests include:

• Digital Rectal Exam (DRE) - The surgical oncologists gently inserts a gloved, lubricated finger into the patient's rectum and by pressing against the rectal wall can feel the back wall of the prostate gland. About 70 percent of cancerous tumors develop near the outer portion of the prostate and can be detected through a DRE.
• Prostate-Specific Antigen (PSA) Test - A sample of blood is analyzed for PSA, a substance produced in the prostate gland that helps liquefy semen. A small amount of PSA always circulates in the blood. High PSA levels, or levels that rise over time, could indicate prostate inflammation, enlargement, or cancer.
• Biopsy - Depending on the result of a digital rectal exam and/or PSA, the surgical oncologists may recommend a biopsy. Several small tissue samples from different areas of the prostate are removed - usually using a needle inserted through the rectum or perineum (located between the scrotum and anus). A surgical oncologists administers a local anesthetic to minimize any pain and discomfort. The tissue is then examined under a microscope for the presence of cancerous cells. A biopsy is usually done in the clinic as an outpatient procedure and generally does not require hospital admission.
• Chest X-ray - An X-ray can indicate if the cancer has spread to the lungs. Although less than 5 percent of prostate cancer spreads this far, lung cancer develops in about 25 percent of men with advanced prostate cancer.
• Ultrasound - This test is generally performed in conjunction with prostate biopsy. Sometimes, prostate cancer can appear different from normal prostate tissue. The best way to determine the presence of prostate cancer is the combination of digital rectal exam, PSA level, and biopsied tissue.
• Computed Tomography (CT) Scan - CT scans are most useful when combined with other tests. A CT scan can show abnormal lymph nodes in the pelvis and abdomen where prostate cancer tends to spread. But the test is not sensitive enough to identify microscopic or individual cancer cells in lymph nodes. CT scans, at this time, do not provide reliable enough information about the condition of the prostate or the stage of prostate cancer.
• Magnetic Resonance Imaging (MRI) - Magnetic resonance imaging does not require radiation. It produces a detailed, three-dimensional picture of the body that can detect the spread of cancer to lymph nodes and bone and is better suited for detecting cancer in soft tissues than a CT scan and some other imaging tests. During a specialized form of MRI, called endorectal coil MRI, part of the device is inserted into the rectum to discern details that may determine if the cancer has spread beyond the prostate.
• Bone Scan - Currently, this test is the most effective imaging procedure to determine the spread of cancer to bone. A low-grade radioactive drug is injected into a vein and is selectively taken up or absorbed by areas of new or rapid bone growth, possibly indicating cancer. The need for a bone scan test depends on a man's prostate cancer type and stage.
• Grading and Staging - If cancer cells are found, surgical oncologistss will determine how quickly the cancer is growing and whether it has spread beyond the prostate. Additional blood or imaging tests may be necessary to determine the extent of the cancer.

Tumour Board Evaluation

All cancer patients who come to DHRC start their treatment only after they have been discussed in the Tumor Board and given a Tumor Board Number. In the tumor board all our specialists (Surgical Oncologists, Medical Oncologists, Radiation Oncologists, Urologists, Oncopathologists, Radiologists and Microbiologists) evaluate and discuss the findings, and chart out the optimal plan of treatment for each patient based on established national and international guidelines and protocols.

Treatment approaches for prostate cancer range from prostate removal surgery, called prostatectomy, to non-surgical treatments such as radiation, Brachytherapy and hormone therapy. The choice of prostate cancer treatment depends on factors such as how fast the cancer is growing, how much it has spread, the age and overall health.

Men whose cancer is detected while confined to the prostate gland have an excellent chance for successful treatment with minimal or short-term side effects.

Oncologists at DHRC see several thousand men who have prostate cancer each year. That experience helps them to guide patients toward the most appropriate treatment approach. We take great care to ensure patients understand the benefits and risks associated with each treatment option.

DHRC offers all treatment options for prostate cancer, including surgery (prostatectomy), external beam radiation therapy, Brachytherapy and Hormone therapy.

Surgery

Surgery is the mainstay of prostate cancer treatment. As a single treatment method - meaning that no radiation, chemotherapy or additional treatment is anticipated - surgery is an effective way to treat cancer confined to the prostate gland.

Our Surgical Oncologists use great care and proven techniques to remove the prostate (radical prostatectomy) while making every effort to spare the muscles and nerve bundles that control urination and sexual function.

External Beam Radiation Therapy

At Dharamshila Hospital, we have the most advanced VMAT Radiation Technology to treat cancer patients.

Radiation therapy uses high-powered beams or other radiation to kill cancer cells. Cancer cells are generally more sensitive to the harmful effects of radiation compared to normal tissues. Radiation may be used to treat most stages of prostate cancer, with or without surgery, depending on each patient's overall health and cancer severity.

DHRC radiation oncologists have developed a method that uses special imaging devices to precisely track the internal movement of the prostate while daily radiation beam treatments are administered. Intensity modulated radiation therapy (IMRT) uses gold markers implanted in the prostate to allow radiologists to precisely guide radiation beams toward their intended target, reducing radiation exposure to the rectum and bladder. IMRT safely delivers more radiation to the prostate while sparing surrounding tissue, resulting in increased cure rates.

Radiation after Surgery

Radiation therapy is also commonly used after surgery to treat the prostate bed (the area formerly containing the prostate). Pathologists examine the removed prostate under a microscope to determine whether any cancer cells possibly may not have been completely removed via surgery. If suspected traces of cancer are thought to remain, additional radiation therapy may be administered at some point following surgery.

Post-surgical radiation treatments reduce the chances of recurrence. Treatment usually begins within two to three months following surgery and lasts for six to seven weeks. Radiation therapy may also be administered if the PSA level rises after surgery. At all times, the patient is considered to be a member of the treatment team and is involved in decision making.

Brachytherapy Radiation

Brachytherapy involves the implantation of rice-sized radioactive seeds into the prostate to destroy the cancer. In Permanent Prostate Brachytherapy, implanted seeds are left in place, but their radioactivity decreases over time.

Hormone Therapy

When advanced prostate cancer can't be treated through surgery or other means, hormone therapy is an option. Hormone therapy reduces the supply of male sex hormones that make prostate cancers grow faster. In most cases, hormone therapy is not a cure but may help control prostate cancer. This can be done by surgery (Removal of both testis) or injection Goserelin to be taken life long.

Expectant Management

Expectant Management may be an option for men over 70, those in poor health, or men whose cancer is small and slow growing. (Expectant management was formerly referred to as watchful waiting.)