Newton was a reputed dealer in air conditioners. When he was diagnosed with prostate cancer, though downcast, he sought immediate medical advice. His main goal was to complete his treatment and get back to doing all that he did before he was diagnosed with cancer. Newton was a man with determination and strength of mind who never gave up hope. Today, after therapy, he leads a normal life.
Prostate cancer develops in a man’s prostate, the walnut-sized gland just below the bladder. It’s the most common cancer in men after skin cancer. It often grows very slowly and may not cause significant harm. But some types are more aggressive and can spread quickly without treatment.
In the early stages, there may be no symptoms. Later, you can be troubled with frequent urination, difficulty starting or stopping micturition, a weak or interrupted urinary stream, painful or burning sensation during urination or ejaculation. Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.
As far as prostate cancer is concerned there are risk factors you can’t control: Growing older is the greatest risk factor for prostate cancer, particularly after the age of 50. After 70, studies suggest that most men have some form of prostate cancer, though there may be no outward symptoms. But there are risk factors you can control: Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. A diet too low in fruits and vegetables is not recommended either.
There are many myths about prostate cancer. Lay people often erroneously think that too much sex, a vasectomy and masturbation lead to prostate cancer. Researchers are still studying whether alcohol use plays a role in the development of prostate cancer. There are screening tests to detect prostate cancer early, but guidelines don’t call for routine testing in men at any age. The tests may find cancers that are so slow-growing that medical treatments would offer no benefit. And the treatments themselves can have serious side effects. The American Cancer Society advises men to talk to a doctor about screening tests, starting from the age of 50 for average-risk men who expect to live at least 10 more years.
Your doctor may initially do a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate. Then, a blood test can be used to measure “prostate-specific antigen” (PSA), a protein produced by prostate cells. An elevated level may indicate a higher chance that you have cancer, but you can have a high level and still be cancer-free. It is also possible to have a normal PSA and have prostate cancer
If PSA or DRE are abnormal, your doctor will order other tests, such as a biopsy. A needle is inserted either through the rectum wall or the skin between the rectum and scrotum. Multiple small tissue samples are removed and examined under a microscope and grading is done by a pathologist. A biopsy is the best way to detect cancer and predict whether it is slow-growing or aggressive.
The need for additional tests may arise to see if the cancer has spread beyond the prostate. These can include ultrasound, a CT scan, or an MRI scan. A radionuclide bone scan traces an injection of low-level radioactive material to help detect cancer that has spread to the bone.
The good news about prostate cancer is that it usually grows slowly. In 9 out of 10 cases found in the early stages, the 5-year relative survival rate is 100% for men with the disease confined to the prostate or nearby tissues, and many men live much longer.
With low-risk cancer, one option is to watch and wait. This is determined by your biopsy, PSA test, and pathologic score. For aggressive disease, external beam radiation to kill cancer cells can be used as a first treatment or after prostate cancer surgery. It can also help relieve bone pain from the spread of cancer. In brachytherapy, tiny radioactive pellets about the size of a grain of rice are inserted into the prostate. Both methods can impair erectile function. Fatigue, urinary problems, and diarrhoea are other possible side effects.
Removing the prostate (radical prostatectomy) is used to eliminate the cancer when it is confined to the prostate. New techniques use smaller incisions and seek to avoid damaging the nearby nerves. If lymph nodes are also cancerous, prostatectomy may not be the best option. Surgery may impair urinary and sexual functions, but both can improve over time. Hormone therapy may shrink or slow the growth of cancer, but unless it is used with another therapy it will not eliminate the cancer. Chemotherapy kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer that does not respond to hormone therapy.
The important thing is to pay no heed to reckless advice. I know of many patients who had “incipient” prostate cancer and are great proponents of herbal medicines. They advise all and sundry against “allopathic” treatment citing their own apparent “cure”. This is not surprising, as initial stage prostate cancer requires no treatment at all. However, it is reckless to advise everyone “herbal medicines” which area likely to lead to disastrous consequences. But then isn’t it true that “fools rush in where angels fear to tread?”
(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa, column writer and music aficionado)
