Prostate cancer

About Prostate cancer

p cancer Prostate cancer forms in tissues of the prostate (a gland in the male reproductive system) and 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. It usually presents with difficulty and pain during urination, blood in the urine along with sexual dysfunction. Advanced cases may present with bone pain in addition to the urinary symptoms. 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.

Risk factors

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:

Men who consume a diet rich in red meat and high fat dairy products and do not consume vegetables and fruits are more susceptible.
Men in the West, especially African-Americans are more susceptible than Asians
Obese men are more susceptible to it as compared to non-obese
A person is more susceptible to suffer from prostate cancer if he has a family history (if his brother or father suffered from the same). Genetic basis for prostate cancer has been identified and certain gene mutations can cause it.
There are some data linking prostate cancer to chronic prostatitis, sexually transmitted infections, smoking and alcohol consumption.

Symptoms

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.

Diagnosis

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

The common treatment options of prostate cancer include –

Active Surveillance (wait and watch): No active treatment is done and the patient is followed up at regular intervals to see the progression of disease. This modality is used in elderly patients with short life expectancy and early disease.
Surgery: The operation performed to remove the cancerous tissue is called Radical prostatectomy. Depending on the extent, patient factors and expertise available it can performed via a fairly long cut in the abdomen, laparoscopically (key hole surgery) or even with Robotic surgical methods which is available at a few centres in India as well. The surgery has good success rates in expert hands but may have long term side effects like sexual dysfunction, urinary incontinence and narrowing of the urethra. Sometimes removal of the testes (orchidectomy) is advised in advanced disease to minimize the effects of testosterone on the growth and spread of cancer.
Radiotherapy: Can be administered as a primary modality via needles implanted into the prostate under ultrasound guidance or as an external beam. Radiation can be administered after surgery if the resection of cancer tissue has not been complete.
Hormone therapy: Medications that suppress testosterone levels are used as primary treatment and in advanced cases of prostate cancer.
Chemotherapy: In advanced cases, when the disease is not controlled with hormonal treatment the patient may be a candidate for chemotherapy wherein strong medications are used to kill the cancer cells and prevent spread.
Other local ablation treatments like Cryotherapy, Radiofrequency, High intensity focused ultrasound (HIFU) are used to treat early cancers or when the patient is not fit for a major surgery.

Prevention

Simple modifications in food habits, including adopting a diet rich in cereals, fish and green leafy vegetables, can drastically reduce chances of prostate cancer, considered to be one of the most common cancers among men. You can prevent prostate cancer with some of these simple lifestyle changes:

1. Avoid red meat

Julka said men with higher consumption of fatty products have been found to be more prone to getting prostate cancer. He suggests low-fat diet that restricts red meat, oils and dairy products such as milk and cheese. (Read: Top 10 food habits to prevent cancer)

2. Drink green tea

Studies of men who drink green tea or take green tea extract as a supplement have also found reduced risk of prostate cancer.

3. Modify your diet

Vineet Talwar, consultant oncologist, Rajeev Gandhi Cancer Hospital, said: ‘While age is a factor that nobody can control, certain dietary modifications throughout your life can certainly help you cut the risk of getting afflicted with the disease.’ Choosing a healthy diet is imperative in reducing the risk of this global killer’, he added. According to Sudhir Khanna, consultant urologist, Sir Ganga Ram Hospital, ‘Eating a big bowl of cereal, substituting cow’s milk with soy, including fish in the diet and eating several servings of spinach and other leafy greens per week may cut the risk of prostate cancer.’

4. Go green

Consumption of fats from plants is generally preferable to that from animals. For instance, cook with olive oil rather than butter or sprinkle nuts and seeds rather than cheese.

‘An increased amount of fruits and vegetables that are full of vitamins and minerals can add several benefits to your diets. So will a diet that includes tofu – a product made from soy beans – which again has been linked to reduced prostate cancer risks,’ Talwar told IANS.

5. Avoid sugar and starch

Sugary candy and soda as well as starchy foods such as white bread and white rice are all high-glycaemic carbs, which spark inflammation. One recent study found that men who ate the most sweet, starchy food were 64 per cent more likely to develop advanced prostate cancer.

Alternative remedies

For cancer treatment, Dr Chauhan recommends the following Ayurvedic holistic methods:

• Abstinence from root cause: The first step is avoiding a harmful diet or lifestyle that aggravates the root cause, tridosha imbalance.

• Eliminating aggravated doshas: They are eliminated by flushing them out of the body through panchakarma, involving purifying therapies to enhance metabolic processes. Panchakarma includes five techniques: Vamana – emetics, Virecana – laxatives, Basti – medicated enema, Nasya – nasal administrations, Rakta moksana – blood-letting

• Treating jataragni: Jataragni controls digestion and nourishment. It helps the formation of nutritive fluid (ahara rasa), physical elements (doshas), tissues (dhatus) and waste (malas). Treatment maintains healthy jataragni functioning.

• Rejuvenation: Rasayana medicines maintain enzymes and metabolism in peak condition, and enhance the generation of new cells and tissues. Rasayanas prevent and alleviate conditions associated with cancer, and increase ojas to boost immunity and strengthen cells and body.

• Satvavajaya chikitsa: Ayurveda considers mind and body as one entity. Cancer weakens the mind. Spiritual counselling and cultivating a positive, balanced mind are integral to Ayurvedic treatment. ‘By bringing our internal, physical and psychological systems into balance, we remove the cause of disease, cure its symptoms, and allow the damage to heal itself,’ explains Dr Chauhan.

Read to know in detail about alternative therapies to treat cancer

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