During the initial stages of prostate cancer, often there are no symptoms but in some cases, cancer can cause symptoms that may feel similar to those of BPH or Prostate Enlargement. 

However, one can always opt for screening to detect the symptoms or changes to indicate cancer as the levels of PSA in the blood are measured during the screening and high levels of the same may indicate the presence of cancer.  

The symptoms of prostate cancer can be as follow: 

1. Pain in the lower pelvic area, lower back, hips, or upper thighs
2. Bone pain or bone fracture
3. Frequent urge to urinate
4. Facing problems like trouble starting and maintaining urination, pain, burning sensations, weak urine flow while urinating
5. Blood in the urine or semen
6. Painful ejaculation
7. Trouble getting and maintaining an erection
8. Tiredness and loss of appetite and weight
   

Imaging Scans

• These tests are done to check whether the prostate cancer has begun to spread and to see where it is spreading. The doctor will suggest imaging scans in some cases based on the results of other tests; however, not everyone has to go through these.
  

There is a range of options for prostate cancer and factors like grade & stage of cancer, risk level, age, health, treatment goals etc. play a major role while deciding the right treatment for you. 

Treatment Choices For Low-Risk Prostate Cancer

1. For low-risk cancer and men who do not have symptoms, active surveillance is the best option. It is not an active treatment wherein prostate cancer is treated. In active surveillance, regular follow-up blood tests, rectal exams, and prostate biopsies are performed to monitor the progression of your cancer. During active surveillance, actions like therapy or surgery are taken only when the risk level is increasing, cancer is spreading to other parts, or growing dangerously.  
   
2. Another treatment is watchful waiting. In this treatment, prostate cancer is not actively treated but only monitored without any actions. This option is the right choice for people of advanced age, who have serious illnesses, or who cannot or don’t want to go through cancer treatments due to side effects & other such factors. 
   

‍Both these options come with no side effects, complications, or risks that are associated with other treatment options such as surgery and therapies. However, these options do have the risk of the cancer growing or spreading during the follow-up visits which may make it harder to treat over time. 

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Surgery

• The surgical options involve removing the tumor from the prostate gland. Patients whose tumor is still confined in the prostate gland and hasn’t spread are eligible for surgery. Surgical treatments are also sometimes used to treat advanced levels of prostate cancer in combination with other treatments. There are many options or types of surgical treatments and depending upon your requirements, the best-suited treatment will be recommended to you which may include removal of the tumor, removal of the prostate, or removal of surrounding tissues & a few lymph nodes with the prostate etc. The following are the types of surgery for prostate cancer/carcinoma prostate - 

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1. Robot-Assisted Laparoscopic Prostatectomy (RALP)

• This is a common surgery performed to treat prostate cancer. This surgery begins with making small incisions on your abdomen. A mechanical device or a robotic system assists the doctor. This device holds the laparoscopic surgical tools and camera and is then inserted inside through incisions. Then the doctor with the help of hand controls, guides the robot to move the instruments. During RALP, the prostate can be removed through tiny ports placed in your belly. This popular surgery has replaced Laparoscopic Radical Prostatectomy surgery nowadays. 
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2. Retropubic Open Radical Prostatectomy

• In this method, the entire prostate gland is removed. This surgery begins with the doctor making a long incision in the lower abdomen. The prostate gland is then accessed and removed from this incision. This procedure is much less used than the RALP surgery, however, could be required in certain cases. 

3. Pelvic Lymphadenectomy

• This surgical procedure is suggested to check whether cancer has spread to the lymph nodes in the pelvis, how many lymph nodes contain cancer, their size, and the amount of cancer that has spread. It is also performed to remove nodes if they contain cancer or if the cancer is spreading to them, to avoid the recurrence of cancer, and to remove cancer that is still in the lymph nodes after radiation therapy or chemotherapy. 
  

Like any other major surgery, the risks of infection and bleeding may occur. Some people may experience complications right after the surgery whereas some people may encounter those later. For surgery, the side-effects may be as follow: ‍

1. Erectile dysfunction (note - sexual desire is not lost post-surgery)
2. Urinary incontinence 
3. Urine leakage when coughing, laughing, sneezing, or exercising
4. Overactive bladder
5. Inability to control urine
6. Impotence
7. Shortening of the penis (the exact reason for this is not known.)
8. Inguinal Hernia
   

Please note that these risks and side effects are uncommon and will not occur in one patient. The utmost care and preventive measures are taken at Aashray Urology Institute to avoid the occurrence of risks and complications. 
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Radiation Therapy

• Radiation therapy or radiopharmaceutical therapy uses high-energy rays to kill cancer cells or slow down their growth. It can be used as a primary treatment for prostate cancer or in combination with other treatments depending upon your cancer. There are mainly two types of radiation therapies - External Beam Radiation Therapy and Brachytherapy (Internal Radiation). 
  

1. External Beam Radiation Therapy (EBRT)

• This procedure uses radiation externally or radiation present outside of your body on the prostate to treat cancer. This therapy is a good option for treating prostate cancer that hasn’t spread yet. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy can help slow cancer's growth and relieve symptoms, such as pain. This treatment is also suggested to avoid the recurrence of cancer after other treatments. 

1. There are two types of beams involved in radiation therapy - photon beams and proton beams. In the first type of EBRT. photon beams are used. Photon beams makeup traditional x-rays that carry low radiation charge and can scatter nearby health tissue which may cause side effects. However, with the help of the latest equipment, it is possible to receive EBRT treatment without causing damage to nearby healthy tissue. 
2. In the second type, proton beams are used in EBRT. proton beams have more charge and heavy mass and can target deep tissue. High-energy protons can travel deeper into body tissue than low-energy photons. With proton beams, radiation can be directed to the specific site. So, the radiation does not go beyond the tumor and does not cause any damage to nearby healthy tissue.
   

2. Brachytherapy

• In this procedure, radiation or radioactive material is placed directly into your prostate. This treatment is suggested when the cancer is still confined within the prostate. 
• There are two types of brachytherapy - low dose rate (LDR) brachytherapy and high dose rate (HDR) brachytherapy.
  

1. In the low dose rate brachytherapy or LDR, radiation is contained into rice-sized seeds which are then inserted into the prostate with the help of a thin needle. The seeds deliver a low dose of radiation over a long period of time to kill nearby cancer cells. In LDR, the seeds are left in the prostate even after treatment is finished.
2. In the high dose rate or HDR brachytherapy, a thin catheter is placed inside the prostate with the help of a hollow needle. As it’s high-dose radiation treatment, the catheter stays in your prostate for a short period of time and is removed once the treatment is done. 
   

What Are The Side-Effects Of Radiation Therapy ?

Radiation therapy is less invasive than surgery and be it external or internal, it is a good option for early-stage cancer. The main side effects of radiation therapy are as follow:

1. Urinary incontinence
2. Erectile dysfunction
3. Impotence 
4. Bowel problems 
5. Tiredness 
6. Increased risk of bladder and/or gastrointestinal cancer.
   

The types of focal therapy are as follow: 

High-intensity focused ultrasound (HIFU)

‍High-intensity focused ultrasound (HIFU) treatment involves heating the prostate with the help of ultrasound or high-energy sound waves to kill or destroy the cancer cells. 

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Focal Cryoablation

‍This procedure involves destroying the tumor by freezing it. It is done by using a needle-thin probe to circle the tumor with a special solution which then kills the cancer cells. 

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Irreversible Electroporation:

‍In this treatment, a “Nanoknife” is used to pass an electrical current through the tumor. The electricity creates very tiny openings (called pores) in the tumor's cells, leading to cell death.

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Focal therapy is a good option for those who have a small tumor that has not spread beyond the prostate. The term focal therapy is used for different treatments that kill small tumors within the prostate without damaging nearby healthy tissue and the prostate.

This is a treatment for advanced-stage cancer. It is used to treat cancer that has spread to the other parts of the body. Chemotherapy is a cancer treatment that uses drugs to kill the rapidly growing other non-carcinogenic as well as cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form, or both. This way drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).  

Dose to reduce the side effects this may cause. Often, chemotherapy is used with other treatments. It is not the main treatment for prostate cancer patients.

What Are The Side-Effects Of Chemotherapy?

To reduce the side effects of chemotherapy, dose and frequency are carefully controlled. The side effects of this treatment depend on the drug, the dose, and how long the treatment lasts. The most common side effects are as follow:

1. Fatigue  
2. Nausea  
3. Vomiting 
4. Diarrhea  
5. Hair loss  
6. A change in your sense of taste and touch is also possible
7. There is an increased risk of infections and anemia because of lower blood cell counts.