Understanding prostate cancer
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It’s Prostate Cancer Awareness month. This cancer is common yet, “unfortunately, most people don’t know that it is easily preventable,” says P.K. Julka, director of the Max Institute of Cancer Care in New Delhi.
Prostate cancer is the second most common cancer among men after lung cancer, according to the 2012 figures released by Globocan, a cancer surveillance database managed by the International Association of Cancer Registries. The latest figures will be available later this year.
Data from India’s national cancer registries, published in 2014, shows that incidence of certain cancers is on the rise—prostate cancer is the second leading cancer among men in Delhi, Kolkata, Pune and Thiruvananthapuram, the third leading cancer in Bengaluru and Mumbai, and is among the top 10 leading causes of cancers in the rest of the population.
There are many reasons for these high figures, says Hemant Tongaonkar, consultant (urologic and gynaecologic oncology), at Hinduja Healthcare Surgical in Mumbai. “Increasing life expectancy, more cases being diagnosed owing to greater awareness, better diagnostic techniques, changing lifestyles, dietary practices and socioeconomic patterns are contributing factors. Prostate cancer is likely to emerge as a leading cancer among Indian men in the next decade,” he says.
The prostate is a small gland, about the size of a walnut, located at the base of the bladder in men. It tends to become larger in older men, leading to a condition called benign prostatic hyperplasia (BPH), which could cause a problem while passing urine. The symptoms are usually mild and can be treated easily with medication. The condition is not life-threatening, but it should not be ignored because it could be an indication of a more serious condition.
“If left untreated, prostate enlargement can lead to bladder blockages and various kidney problems,” warns N.P. Gupta, chairman of the Medanta Kidney and Urology Institute in Gurgaon, near Delhi. “BPH is not a known risk factor for prostate cancer, although the two frequently coexist,” he adds.
In fact, in most cases, the cancer tends to be detected when BPH is investigated—this is what happened in the case of a 58-year-old Delhi-based businessman. The patient had complained of strain during urination. A blood test revealed a raised PSA (prostate specific antigen) value and an ultrasound confirmed a 2cm growth in the prostate gland, which turned out to be cancerous. He underwent surgery to remove the prostate gland, and was able to resume normal activities within a month of the operation.
Family history plays a role
There seems to be a clear genetic connect. Men who have a family history of prostate cancer (Agarwal’s uncle was diagnosed with it a few years ago) have a higher chance of getting it. This cancer usually begins by the age of 40, even though it may be diagnosed much later, for there are no early symptoms. “When symptoms do exist, they are usually urinary symptoms: frequent urination, weaker flow of urine, and urination multiple times during the night. In the advanced stage, severe backache or body pain, swelling of the feet, loss of appetite and weight, may be found,” says Dr Tongaonkar.
Men with a family history of prostate cancer need to be regular about their screenings. The PSA blood test and DRE (digital rectal examination) must begin at the age of 50 for those with no symptoms and no family history, and at 40 for those with a family history, says Dr Tongaonkar.
Reduce your risk
Besides family history and advancing age, there are other risk factors too. “Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. Smoking is also a risk factor,” says Prakash C. Shetty, a urologist at the Dr LH Hiranandani Hospital in Mumbai.
Data from 24 studies, published in 2010 in the American Journal Of Public Health, shows the link between smoking and prostate cancer incidence and mortality. “Being overweight or obese increases the risk of cancer that’s more likely to spread outside the prostate,” says Dr Julka.
Another aspect to keep in mind is that prostate cancer patients are at a higher risk of skeletal-related events (pathologic fracture, spinal cord compression) and osteoporosis. “So calcium and vitamin D supplementation and weight-bearing exercises like walking, jogging and climbing stairs are important to help maintain bone health,” adds Dr Julka.
Prostate cancer is diagnosed through needle biopsies from the prostate, and investigations like CT scan, bone scan, MRI or PSMA PET scan may be needed to decide on the optimum treatment, says Dr Tongaonkar. “Depending on the stage and age of the patient, radiotherapy, hormonal treatment and chemotherapy can be done,” adds Dr Shetty.
The good news is that the survival rate for prostate cancer is very high, especially if it’s diagnosed at an early stage. Even in its advanced stage, this cancer responds well to treatment options.