Prostate cancer is one of the most common cancers among men, globally. However, it is also one of the cancers with a high survival rate, if detected early. Speaking to Kavita Bajeli-Datt, Dr Vimal Dassi explains the symptoms, preventive measures, and treatment available to cure this illness. He is the director of the Department of Urology, Uro-oncology, Robotics and Kidney Transplant, Max Healthcare, Vaishali and Noida, Uttar Pradesh.
How common is prostate cancer in India and among which age group?
Prostate cancer is the second most common cancer and the sixth leading cancer that causes death among men, worldwide. In 2020, there were an estimated 1.4 million new prostate cancer cases, causing 3,75,000 deaths. Nine among 1,00,00 men has prostrate cancer in India, which shows an increasing trend every year. However, the incidence rate of prostate cancer in Indian males is lower than in the western populations. Prostate cancer has a wide variation in incidence, disease characteristics, and mortality, within India. For example, the incidence rate is higher among the urban population. Also, this cancer is primarily a disease of the elderly, with more than three-quarters of cases occurring among men above the age of 65.
How to detect prostate cancer?
There won’t be any particular symptoms in the early stages of this cancer. As the disease progresses, patients may get symptoms, indistinguishable from benign prostatic disease (a condition in which the prostate gland is enlarged). These lower urinary tract symptoms include increased frequency of urination, nocturia (increased frequency of urination at night), poor urinary stream, and strain to pass urine. Further, there will be symptoms like blood in urine or semen, erectile dysfunction (trouble getting an erection), pain in the hips, spine, ribs, or other areas; weakness or numbness of legs or feet; and loss of bladder or bowel control.
How to diagnose prostate cancer?
Prostate screening includes a physical examination, which is Digital Rectal Examination (DRE). During a DRE, the doctor inserts a gloved, lubricated finger into the rectum to examine the prostate. If any abnormalities are found in the texture, shape or size of the gland, patients may need to take further tests. This includes a blood test, Prostate-Specific Antigen (PSA) test. PSA higher than usual level may indicate prostate infection, inflammation, enlargement or cancer. Based on PSA and DRE findings, a decision is taken to proceed with an MRI and prostate biopsy. Further investigations can help to determine how advanced the cancer is. For example, Positron Emission Tomography (PET)/ Computed Tomography (CT) scans may be used to see how far the cancer has spread, and a bone scan can help to detect bone metastases.
How can we prevent prostate cancer?
Screening is a vital tool to diagnose and prevent prostate cancer. It includes PSA examination after 60 years of age, especially in those who have a familial history of prostate cancer. A healthy lifestyle with daily exercise, mindful eating habits and restricting alcohol consumption and smoking is necessary to prevent prostate cancer. It is said that familial history, obesity and smoking are factors that might increase the chance of this cancer. However, the direct causation between these factors and cancer is inconclusive. The exact role of diet in prostate cancer is also unclear. However, there is evidence that choosing a healthy diet low in fat and full of nutrients may lower the risk, though research results have been mixed.
What is the life expectancy of someone who has had prostate cancer?
Prostate cancer survival depends on its stage. Life expectancy is very high if the disease had been detected early. The five-year survival rate is almost 100% in early-stage disease. Nearly 80% will survive their cancer for ten years or more. Generally, prostate cancer has a high survival rate – one of the highest among all cancers. It is often a slow-moving disease.
What are the available treatment options?
The earlier the treatment, the better the result and life expectancy. Treatment options range from surgical removal of cancer (radical prostatectomy) to hormonal/ chemotherapy/ radiotherapy as per stage of disease and response to therapy. In the case of low-risk localised disease, patients are kept under active surveillance and regular follow-up. Here, prostate removal surgery is the treatment of choice. In those with an advanced stage of high-risk cancer, palliative medicine, including hormonal therapy in the form of injections or bilateral orchiectomy (removal of both sites), is done.
Can prostate cancer be completely cured?
Early-stage or localised prostate cancer can be cured entirely after radical prostatectomy. Advanced diseases can be controlled with hormonal/ chemotherapy/ radiotherapy. However, a cure cannot be achieved for advanced illnesses. Even after complete removal, it requires strict follow-up to look for any recurrence or relapse and appropriate management. A few patients may develop urinary incontinence (leakage of urine) after surgery, for which they require frequent visits to the hospital. Follow-up requires a blood test to monitor PSA level and body imaging to look for any progression or recurrence. A typical follow-up after curative treatment is three months in the first two years, followed by a half-yearly or yearly follow-up.
What are the innovations in surgical management of prostate cancer?
Robotic surgery for prostate cancer is an innovative technology that has significantly improved the outcome of prostate cancer surgery. The surgery is associated with enhanced agility, 3D visualisation, and better magnification. It has reduced the risk of infection and bleeding. There will be minimal scar after the surgery and early recovery with less postoperative pain is also assured. This innovation has taken radical prostatectomy to a new level. Advancements like single port robotic prostatectomy (through a single small incision) are ongoing efforts to improve the results further.