News

Prostate Cancer at alarming stage?

Dr. P.S.R.K Sastry

MBBS, MD (Gen Medicine), ECMO, Consultant Medical Oncology

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may spread from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction.

The main aim behind this is to educate the population about the risk factors and the advantage if the early detection of cancer so as to provide good quality life to the patients. Prostate cancer incidence is increasing in India by 1% every year, but good news is current survival rate in 97%. This gland is prone to become cancerous, as men grow older. It is typically diagnosed in men in their 60’s. Prostrate cancer is an uncommon cancer in the developing countries affecting 4-5 men per 100,000 population in India.

All cancers, including prostate Cancer are divided into 4 stages, depending on their size/extent and degree of spread beyond the confines of the organ of origin, which is prostate gland in this instance. Early prostate cancer (stage 1 and 2) means it is still localized to the prostate gland whereas stage 3 is locally advanced cancer and stage 4 disease means it has spread into distant organs like, bone, lungs or liver. Consequently men should undergo a digital rectal examination (DRE) and or a simple blood test, which measures a protein called prostate specific antigen (PSA). PSA is produced by the normal prostate gland but the normal blood level is quite low in younger aged men (under 50 year olds). It is typically under 2.5 ng/ml) in the 50-60’s but goes up to >2.5 to 4 ng in men in their 70’s and 5-6 ng in the 80’s. High PSA levels (>4.0ng) raises a flag for possible diagnosis of prostate cancer. A biopsy of the prostate gland is required in order to confirm a suspected diagnosis of prostate cancer. Prostate biopsy is typically done by an Urologist.

People who are at higher risk are:

· A close blood relative diagnosed with cancer at an early age

· More than one blood relative with the same type of cancer

· More than one type of cancer in the family

For localized prostate cancer (Stage 1 and 2) surgery (called Prostatectomy) or radiotherapy to prostate gland appears to be equally effective. For Stage 3 cancer hormonal therapy using androgen deprivation with drugs like Lupron injections and radiotherapy are commonly used. For metastatic (Stage 4) cancers the best initial therapy is hormone (androgen) deprivation which is quite effective but the benefit does not last more than 1-2 years.

Gone are the days when samples needed to be sent all the way either to the United States or Europe for certain specialized tests and it would be weeks before you got to know the result. Indian hospitals and standalone laboratories are coming up with testing facilities or are tying up with the best names globally nowadays to bring the most advanced diagnostic techniques within the reach of millions in the country, and that too at comparatively lower rates. It may cost up to a couple of lakhs for certain tests to be done abroad, which could be done well under one lakh in Indian laboratories.

Genetic testing is available in India for genes that cause cancer of breast, ovaries, colon, eyes (retinoblastoma), brain, sarcomas, thyroid, pancreas, kidneys, prostate and leukemias/ lymphomas, etc. Be it detecting the level of risk a patient is at for a particular disease, or helping zero in on the most effective cancer drug for a patient, or having a healthy disease-free embryo in a safer and faster manner during an in vitro fertilization process, there are diagnostic tests within your reach to make your life easier. This year the number has risen to 10 Lakh new cancer cases, 550,000 people die because of this disease every year and 10% of cancer in adults and 20% in children are hereditary.

The cause of prostate cancer is unknown, but the cancer is not thought to be related to benign prostatic hyperplasia (BPH). The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. As a matter of fact, some studies have suggested that among men over 80 years of age, 50%-80% of them may have prostate cancer! More than 80% of prostate cancers are diagnosed in men older than 65 years of age.

In the early stages, prostate cancer often causes no symptoms for many years. As a matter of fact, these cancers frequently are first detected by an abnormality on a blood test (the PSA, discussed below) or as a hard nodule (lump) in the prostate gland. Rarely, in more advanced cases, the cancer may enlarge and press on the urethra. As a result, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder.

These differences in diagnosis and death rates are, however, more likely to reflect a difference in factors such as environmental exposure, diet, lifestyle, and health-seeking behavior rather than any racial susceptibility to prostate cancer. Prostate cancer is more common among family members of individuals with prostate cancer. This risk may be two to three times greater than the risk for men without a family history of the disease. Testosterone, the male hormone produced by the testicles, directly stimulates the growth of both normal prostate tissue and prostate cancer cells. Not surprisingly, therefore, this hormone is thought to be involved in the development and growth of prostate cancer. Recent evidence has suggested that sexually transmitted infections are risk factors for developing prostate cancer.