Prostate Cancer

Prostate cancer is one of the most controversial cancers in both diagnosis and treatment.

If you’re cursed with a cancer - this is the one to ask for!!

Prostate cancer is more aggressive in a black person than a white person

This is the second commonest cancer that affect men after lung cancer

The risk of developing prostate cancer increases after the age of 50 years. Majority of prostate cancer are diagnosed in men over 65 years.

There are over 2 million American men currently living with prostate cancer.

Charles B. Huggins in 1941 was awarded a Nobel prize for understanding that prostate cancer was dependent on testosterone for its growth and spread and this could be reversed by giving estrogens, the so called ‘Chemical Castration’.

Prostate Specific Antigen - a marker to diagnose prostate cancer was first used in forensic investigation to determine if a stain on the undergarment was due to semen or not.

The use of ‘robotics in surgery’ is most commonly deployed for removing a malignant prostate cancer from the pelvis.

Prostate cancer is a relatively slow-growing cancer. For all stages of the cancer the average 5-year survival rate is 98% and the 10-year survival rate is 84%. Remember - Most people die with this cancer and not of it.

About Prostate Cancer

Prostate cancer is the second most common cancer in men after lung cancer. It usually affects men over the age of fifty years. It is estimated that approximately 1 in 5 men will be diagnosed with prostate cancer during their lifetime, however only 1 in 33 will die of this disease.

Prostate cancer usually does not give rise to any symptoms till it is in advanced stages. Hence in many countries men over the age of fifty, who go for routine health check-ups are also advised to get checked for this cancer. A clinical test in the doctors surgery called digital rectal examination or DRE can pick up some of these cancers.

Prostate is a reproductive gland found in males and is an androgen (or testosterone) dependent sex gland that provides the bulk of seminal fluid during ejaculation. The prostatic fluid is excreted in the semen and helps nourish the sperms and keep it in the fluid state in the vagina.

Unlike other cancers the natural history of prostate cancer is different. Some prostate cancer are indolent and slow growing and may take years before they manifest or become sinister; whereas another group are more aggressive - like any other cancers and require urgent treatment.

"Women with breast cancer almost universally die from it within 10 years if they don't get treated, It's quite different with prostate cancer. Many, if not most, men will live over 10 years with prostate cancer." - Harmon Eyre

The cancer can be picked up early by doing a blood test called - Prostate Specific Antigen (PSA). Prostate Specific Antigen is specific to prostate gland and is found only in seminal fluid or blood. Interestingly PSA was first used in forensic investigation to confirm if a stain on an undergarment was semen or not. Its presence meant that the fluid that stained the garment was seminal in origin.

If the cancer is picked up during a routine periodic check, a biopsy of the gland is advised to determine the aggressiveness of the tumour. The decision on how to treat the cancer is usually a decision that is taken by the treating Urologist. He determines by various tests the stage of the disease and decides on the line of treatment that is suitable for the patient.

If the cancer is still in its early stages and the patient is relatively young and in good health, they are usually advised to undergo a ‘Radical Prostatectomy'. However if the patient has early disease but is in poor health - hormonal manipulation and radiotherapy may be a better option to avoid the risks of surgery.

Cancer that have gone beyond the confines of the prostate gland and spread to other areas of the body are more advanced and may require treatment with hormones or removal of testis . This can help to slow or stop the spread of the disease.

Over the last couple of decades much research involving the prostate cancer has taken place and the disease is better understood. We however still have not been able to answer the question about which cancers requires urgent treatment and which do not require treatment. The research in genetics and proteomics may help us answer this important question in the near future.




Experts Debate Over Standard Prostate Cancer Test

The most commonly used prostate cancer screening procedure, PSA, is at the center of a growing debate after its discoverer said it had become a "hugely expensive public health disaster."

In a commentary in The New York Times, Richard Ablin of the University of Arizona said the screening tool he discovered four decades ago now costs too much and is ineffective.

The American Cancer Society, which does not recommend the prostate specific antigen (PSA) test -- a standard screening for men since the 1990s -- has urged doctors to speak to their patients about its risks and its limits.

Prostate cancer, the second most common cancer in men worldwide after lung cancer, kills an estimated 254,000 men each year.

The new recommendations were based on preliminary results from two major studies -- one led in Europe and the other in the United States -- published last year in the New England Journal of Medicine journal.

The clinical trials found that the blood test could not be proved to save lives.

PSA does not allow to distinguish between aggressive cancers that require intervention and slow-developing tumors that, depending on the patient's age, likely will not be a primary cause of death, according to the American Cancer Society.

Furthermore, the test can also provide erroneous results.

As soon as they turn 50 years old, healthy men who bear no symptoms of cancer and are expected to live at least 10 more years should be informed by their doctors of the pros and cons of a PSA screening before deciding to undergo the test, the cancer society recommends.

"For them, the risks likely outweigh the benefits," it said in a statement.

According to Ablin, American men have a 16 percent chance of being diagnosed with prostate cancer but only a three percent chance of dying from it because most cancers develop slowly over time.

He deplored PSA screenings' annual cost of at least three billion dollars, much of that paid for by Medicare, the insurance program for the elderly, and the Veterans Administration.

"The test's popularity has led to a hugely expensive public health disaster," he wrote in his column.

"As I've been trying to make clear for many years now, PSA testing can't detect prostate cancer and, more important, it can't distinguish between the two types of prostate cancer -- the one that will kill you and the one that won't.

"Instead, the test simply reveals how much of the prostate antigen a man has in his blood," he added.

Levels of PSA, a protein produced only prostate cells, can jump when a prostate tumor grows in size. But they can also increase as the prostate enlarges naturally with a patient's age.