Written By: Dr Ashwin Mallya | Updated : June 10, 2014 6:40 PM IST
Mr K P Gupta (name changed on request), a retired 63-year-old executive from Delhi came to us with a complaint of having to strain during urination. During his routine annual blood tests, he was found to have a raised PSA value (prostate specific antigen). On asking for his family history, he told us that he had an uncle who suffered from prostate cancer. We advised an ultrasound which confirmed a 2 cm growth in the prostate gland which on biopsy turned out to be malignant. He underwent a surgery for removal of the prostate gland with the latest keyhole techniques and he is back to his normal active lifestyle within one month after the operation visiting his friends and going for walks in the evening which he cherishes. He has been advised to visit his doctor twice a year for follow up. In all likelihood he will go on to live his normal life span. So, as you can see, prostate cancer is not a death sentence. In this post, I shall try and explain more about it, its signs and symptoms and how it can be detected and treated
The prostate gland (shown in picture) is an accessory sexual organ situated underneath the urinary bladder, in front of the rectum and covers a part of the urethra (the pipe through which urine is excreted). Its secretions form a part of the male ejaculate and nourish the sperm and keep the semen liquid. It is the size of a walnut in a normal adult male and increases in size with age. The development and growth of the prostate gland is dependent upon the male sex hormone testosterone.
The main conditions that affect the prostate gland are infection (prostatitis), abnormal age related increase in size with age (also termed as BPH or benign hypertrophy of the prostate) and prostate cancer. Benign prostate hypertrophy (or BPH) is not cancer and does not cause cancer but can cause an increase in size of the gland leading to problems with urination and may require medications and in some cases even surgery. This article will mainly deal with Prostate cancer.
Prostate cancer is one of the leading causes of cancer in men above the age of 60. Most cases could be slow growing and may even go undetected and not cause any problem. Some could be aggressive and can spread to other parts of the body and are difficult to treat.
Symptoms of prostate cancer:
It usually presents with difficulty and pain during urination, blood in the urine along with sexual dysfunction. In many early cases there may be no symptoms and it may be detected incidentally on performing rectal exam, blood test, scan and biopsy. Advanced cases may present with bone pain in addition to the urinary symptoms.
Risk factors for prostate cancer:
Prostate cancer is very rare before the age of 40 but the risk increases with age and most cases are detected in the late 60s. Susceptibility to this cancer depends on various other factors:
Diagnosis of prostate cancer:
Prostate cancer is most often detected in the early stages by a combination of clinical exam (rectal exam) and Serum PSA (Prostate specific antigen), a tumor marker that is useful in this disease. Further confirmation involves a biopsy of the prostate from the rectal route (most often) under local anesthesia and ultrasound guidance. This is a fairly painless procedure done usually by a Urologist and involves taking pieces from the prostate which will be examined under the microscope. If the diagnosis is confirmed a MRI scan of the pelvic area may be performed to look at the extent of disease. A chest X ray, ultrasound of the abdomen and bone scan may be ordered if there is suspicion of spread to these regions.
Fortunately in most cases, cancer of the prostate is not very aggressive and can be detected at a fairly early stage and treated by various modalities. The Urologist will make the decision regarding the modality of treatment to be used based on a combination of factors which includes age, physical fitness, co-morbidities, clinical stage of disease, biopsy findings and PSA levels.
Treatment options for prostate cancer:
Read more about causes, symptoms, diagnosis and treatment of cancer.
The aforementioned treatments could be used singly or in combination depending on the clinical situation, patient factors and expertise available.
Regular follow-up as advised by the urologist with blood tests including PSA levels and imaging investigations will have to be adhered to prevent recurrence or progression of disease. Side effects of various modalities of treatment will have to be understood and may play a role in the decision-making process. With further advances in surgical techniques, hormonal, radiation and chemotherapy, adverse effects are minimised to a large extent. Leading a normal life with normal physical and sexual activity is possible with the available techniques in modern medicine.
Valuable information on prostate cancer can be found on www.pcf.org ( prostate cancer foundation) and www.cancer.gov
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