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Prostate Health Month 2022: The second most common cause of cancer among men, prostate cancer is also a leading cause of death in men globally. With rising life expectancy in our country, the burden of prostate cancer is expected to grow significantly. Dr Mohan Keshavamurthy, Chairman - of Renal Sciences Specialty Council, Fortis Hospitals, India, explains how and why the risk of developing prostate cancer increases exponentially with age.
Prostate cancer can be treated successfully in many cases when diagnosed early, especially with the advent of the Nervi-Sparing Robotic Prostatectomy technique. In some cases, with mild disease, the progression of the disease is so gradual that patients even manage to survive several years with minimal medication.
Standard clinical guidelines advise men above the age of 45 to get a yearly Serum PSA Evaluation as there are no specific symptoms for prostate cancer. However, in case of a family history of prostate cancer, men above 40 should get a yearly Serum PSA Evaluation.
Management of elevated PSA will involve treating the gentleman with antibiotics. If the repeat PSA is still elevated or shows a rising trend beyond two weeks, then specific tests such as free PSA, PSA velocity and PSA density can be used to assess the probability of cancer. When indicated, a transrectal ultrasound or a TRUS biopsy is the diagnostic technique of choice. Cancer prostate, once diagnosed, has to be graded and staged.
Organ confined intimidate grade cancer is best treated when nerve spearing robotic radical prostatectomy to prevent the common complications of impotence and incontinence, which are more likely in other surgical treatment techniques. Higher-grade cancer or advanced cancer will need multimodality management.
Investigation modality for planning treatment
1. PSMA pet scan
2. MRI pelvis with pirad scoring
3. BK - MR Fusion Biopsy in indeterminate cases