Understanding prostate cancer

There are several procedures involved in diagnosing prostate cancer^{1c 6}:

Digital rectal exam (DRE)

The healthcare professional (HCP) checks the prostate gland of the patient for abnormal signs such as lumps or hard areas.

Prostate-specific antigen (PSA) blood test

PSA is a protein produced by the prostate. Elevated PSA levels are associated with prostate cancer, usually greater than 4 ng/ml at initial presentation in 80% of prostate cancer cases.

Medical imaging

Transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) are the primary imaging modalities used for initial prostate cancer detection and diagnosis.

Prostate-specific membrane antigen (PSMA) PET/CT scan

This is an imaging technique that uses a radiotracer specific to PSMA to enhance detection of PSMA-positive lesions and assess their location.

Biopsy

Involves the removal of a small tissue sample from the prostate for histological examination. It is the most definitive way to diagnose cancer and determine its Gleason score (a measure of aggressiveness).

Clinical staging

The tumor, node, metastasis (TNM) system is used to evaluate the stage and extent of prostate cancer. Its components include the size and extent of the tumor, the presence of involved lymph nodes, the PSA level, the Gleason score, and the presence of metastases.

The initial step in prostate cancer management involves assessing the necessity of treatment. Prostate cancer, especially in the case of low-grade tumors, often exhibits such slow growth that treatment may not be warranted. This is particularly applicable to elderly patients and those with concurrent medical conditions where their life expectancy could be reasonably limited to 10 years or less.^{1d 7 8}

However, when treatment is deemed necessary, several options are available, some of which include: 

Active surveillance

For low-risk, early-stage prostate cancer, some patients may choose active surveillance, which involves close monitoring of the cancer through regular PSA tests, DREs, and periodic biopsies.

Surgery

Radical prostatectomy is an option for localized prostate cancer. It is the surgical removal of the entire prostate gland.  

Radiation therapy 

This therapy uses high-energy x-rays to target and destroy cancer cells in the prostate. Radiation therapy can be employed as the primary treatment for localized prostate cancer or in combination with other therapies, such as surgery or hormone therapy, depending on the stage and characteristics of the cancer.

Androgen deprivation therapy (ADT)

This therapy reduces the level of male hormones like testosterone, which can fuel the growth of prostate cancer cells. It is usually used in combination with radiation or as a primary treatment for advanced or aggressive prostate cancer. 

Radioligand therapy

This therapy involves the use of radionuclides to precisely target the cancer cells that express a biomarker. RLT has emerged as a cutting-edge therapeutic option for the treatment of metastatic castration-resistant prostate cancer (mCRPC).