CHENNAI : Prostate cancer (PCa) is the second most common cancer and sixth most common cause of death among men worldwide. Although statistics over the last few decades show a lower incidence among Asian men compared to African, African-American and Caucasian populations, it is certainly on the rise. Significant advances have been made in the treatment of PCa over the last two decades, with development of new drugs (cytotoxic drugs and antiandrogens and immunotherapeutic drugs) for better cancer control. In addition, refinements in surgery and radiotherapy aim at providing higher cancer cure and control rates with reduced complications and long-term morbidity.
In spite of these advances, there are several misconceptions about prostate cancer and better understanding will help to allay fears about this disease.
I do not have prostate cancer as I do not have any symptoms
Majority of PCa are asymptomatic in early stages and become symptomatic only in advanced stages. Totally asymptomatic subjects have presented with complications like bone fractures due to metastatic cancer. So it is prudent to get evaluated based on the risk factors like a positive family history, diabetes, obesity etc.
Screening is not required as prostate cancer is rare in India
PCa screening is done by checking Serum PSA levels regularly, in asymptomatic subjects. Although many urologists question this practice, it has been used quite extensively in Western countries, and may be relevant now due to the rising incidence of PCa in India. Screening gives us an opportunity to diagnose the disease in early stages and offer treatment with reduced morbidity.
A high PSA is certainly because of prostate cancer
Increased PSA levels are not only seen in PCa but also in prostatitis, prostatic abscess, Benign Prostatic Enlargement and acute urinary retention.
Risk of cancer is high in larger prostate glands
Benign prostatic hyperplasia, which is non-cancerous enlargement of the prostate, is far more common. There is no definite correlation between the size of the gland and the risk of cancer.
Treatment is complicated and associated with permanent disability & suffering
Significant advances in treatment of PCa have been made which have reduced the morbidity of both the disease and the treatment. Improved cancer specific survival has been achieved. Hence at whatever stage the cancer is diagnosed, treatment must be considered.
Mild prostate cancers do not need to be treated
In India, majority of PCa (more than 75%) are diagnosed in the advanced stages, after they have spread outside the prostate gland. Advanced cancers can lead to complications like bone fractures, kidney failure, swelling of limbs. Hence it is imperative to treat PCa at diagnosis regardless of the stage. Moreover, the chance of cure increases when the disease is localised to the prostate.
It is futile to treat advanced cancers as most men die soon regardless of treatment
Unlike other cancers, PCa, even in advanced stages, respond well to several modalities of treatment, with significant survival rates. With recent advances in hormonal therapy, the quality of life even in advanced PCa can be good.
(The writer is senior consultant, urologist, Kauvery Hospital,Bengaluru)