Some days ago, a lady brought her father for a check-up. Towards the end, it was obvious that besides other medical problems, the 80-year old man had symptoms related to his prostate. I asked the daughter to get a blood test done for her father’s PSA (prostate specific antigen). “What is it about?” asked the young lady. “It tells us about prostate cancer,” I replied. “Then, doctor, I would like to get one done on myself too because we have a very strong family history of cancer,” she stated with anxiety writ large on her face. I explained that she need not bother about the prostate as it was an exclusive province of males. If she desired, she could do tests for ovaries and other organs of the female reproductive system. She agreed.
God blessed us males with a gland called ‘prostate’. It is a walnut-sized object located between the bladder and the penis, and just in front of the rectum. The urethra (male urinary duct) runs through the center of the prostate, from the bladder to the penis, discharging urine. The prostate secretes a fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra and it’s expelled with sperm as semen. Alas, this ‘gift of God’ can at times turn out to be a curse, especially when affected by cancer.
Prostate cancer has become a major health problem in the industrialized world. Previously, it was thought that prevalence of prostate cancer in India is far lower than western countries. But, with the increased migration of rural population to the urban areas, changing life styles, increased awareness, and easy access to medical facilities, more cases of prostate cancer are being detected. Now we know we are not far behind western countries. More worrying is the fact that cancer registries in India indicate that we are going to face a major increase in prostate cancer incidences in the coming years.
There is a silver lining: the marked disparity between ‘prevalence’ and ‘incidence’ rates of prostate cancer, on the one hand, and ‘morbidity’ and ‘mortality’ rates, on the other, has led some to conclude that many prostate cancers are harmless and perhaps can better be left untreated. Nevertheless, if the present trends of increasing life expectancy continue, this disease will become a far greater public health problem in the future.
Another thing that is encouraging about prostate cancer is that it is mostly a very slow progressing disease. In fact, many men die of old age without ever knowing they had prostate cancer – it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor. On the other hand, advanced prostate cancer is like a volcano; difficult to treat, especially when it spreads to other parts of the body.
Luckily, nowadays, prostate cancer can be detected at an early stage, just by doing a PSA blood test. PSA is a ‘tumor marker’ produced exclusively by prostate cells in response to cancer. It is used to diagnose and evaluate the patient’s response to treatment as well as to monitor for recurrence (return of the cancer after treatment). To date PSA has been hailed as the great discovery of the century. If a man’s blood levels of PSA are high, there is need for further confirmatory tests like an invasive biopsy. If more and more prostate cancers are being cured today, it is because of early detection thanks to this magical test.
And there are more good tidings. A test using gold nanoparticles recently discovered by the NanoScience Technology Center in Florida, US, is said to outperform PSA as a screening test for prostate cancer. Pilot studies find it to be more accurate than the standard PSA test and – surprise of surprises – the test costs less than $1 and yields results in minutes. This simple test not only holds the promise of earlier detection of one of the deadliest cancers among men, but will also reduce the number of unnecessary and invasive biopsies stemming from the less-precise PSA test.
As we watch these medical miracles unfold, we can’t help but agree with Dava Sobel, who wrote the book ‘Galileo’s Daughter’: “Man’s quest for knowledge is an unending one. It is in the human nature to incessantly want to try new things, to explore, to experiment and to discover. To fail, fall down, and to rise, to try again and again, to conquer and to master. All that is in our genes! And that’s how we learn to roll over, to sit up, to crawl, to walk and to run.”
Socrates aptly said ages ago: “There is only one good: knowledge, and one evil: ignorance.”
(Dr Francisco Colaço is a senior-most consulting physician)
