Age is the most significant risk factor for prostate cancer, with the majority of cases occurring in men over 50, particularly after 65. The risk increases if there is family history of prostate cancer, especially if a close relative was diagnosed before 60, says Dr Jaspreet S Sandhu, urologic surgeon at Memorial Sloan Kettering Cancer Center, in an interview with Affan Abdul Kadar. Edited excerpts:
What factors can affect prostate health?
Prostate health can be influenced by several factors, some of which are beyond our control, such as age and genetics. Age is the most significant risk factor, with the majority of prostate cancer cases occurring in men over 50, particularly after 65. A family history of prostate cancer, especially if a close relative was diagnosed before 60, increases your risk. Ethnicity also plays a role, as African American men are more likely to develop prostate cancer and have more advanced stages when diagnosed. Unlike prostate cancer, benign prostatic hyperplasia (BPH) presents with symptoms like frequent urination or inability to urinate. BPH is a disease of aging with roughly 50% of men above the age of 50 having some element of BPH. It's important to talk to your doctor about your individual risk factors.
What is the role of one's lifestyle in triggering prostate cancer?
As for lifestyle's role in prostate cancer and BPH, while it's not the sole cause, it can impact your risk. A healthy lifestyle, including maintaining a healthy weight, exercising regularly, and eating a balanced diet, may lower the risk. Diets rich in plant-based foods and low in red and processed meats are encouraged. Obesity, though not directly linked to an increased risk of prostate cancer, has been associated with more aggressive forms of the disease. Exercise can actually benefit those that are being treated for prostate cancer. Smoking doesn't appear to directly cause prostate cancer, but it can also worsen health outcomes related to cancer. A healthy lifestyle can make a meaningful difference in overall prostate health. Finally, anabolic steroids such as those used by bodybuilders and exogenous testosterone may play a role in initiation or progression of prostate cancer.
In your experience of two decades, who are more prone to prostate ailments?
Certain groups of individuals are more prone to prostate ailments due to a combination of biological and environmental factors. Men over 50, particularly those above 65, are most prone to prostate ailments. Family history significantly increases risk, especially if relatives were diagnosed young. African American men are also at higher risk, often with more aggressive conditions. Lifestyle factors like obesity, poor diet, and inactivity can contribute but are manageable with proactive care and regular screenings.
How has the treatment for prostate cancer improved over the years – both in terms of patient-care and healthcare?
Early detection has significantly improved, thanks to better screening methods, allowing for more effective treatments and higher survival rates. Today, over 90% of prostate cancer patients survive at least 10 years post-diagnosis, a significant improvement from the past. This is largely due to advances in surgical techniques, radiation therapies, and targeted medical treatments. This has also led to an understanding that active surveillance for low-risk prostate cancer is appropriate and preferred in most men with low-risk prostate cancer.
Understanding the diverse nature of prostate cancer has led to more personalised treatment plans.
For localised tumours, options such as focal therapy or partial gland ablation target only the cancerous portion of the prostate, minimising damage to surrounding healthy tissue. In cases of aggressive cancer, a combination of treatments like hormone therapy, brachytherapy, external beam radiation therapy, and increasingly surgery is employed to effectively manage the disease. Surgical treatments, such as radical prostatectomies, have become more precise with the use of robotic and laparoscopic techniques, reducing complications and improving recovery times. Radiation therapy has also seen significant improvements, with techniques like Image-guided, intensity-modulated radiation therapy (IG-IMRT) and stereotactic radiosurgery offering highly targeted treatments with minimal damage to surrounding tissues.
What can patients coming in for prostate cancer treatment expect, or what should they keep in mind?
When it comes to prostate cancer treatment, patients can expect a comprehensive, personalised care plan that takes into account the unique nature of their condition. Prostate cancer varies greatly from person to person, and treatment approaches are tailored accordingly. Some patients may be diagnosed with slow-growing, localised tumours that require active surveillance, while others may need more aggressive interventions. The treatment process is not one-size-fits-all, and ongoing monitoring through blood tests, imaging, and regular check-ups is crucial to evaluate how the cancer is responding to treatment.
Any side effects of treatment that patients should be aware of or be mentally prepared for?
Patients undergoing prostate cancer treatment should be aware of potential side effects, although many can be managed with the right support and care. Surgery, such as radical prostatectomy, can lead to urinary incontinence and erectile dysfunction, which may improve with rehabilitation. Radiation therapy often causes fatigue, bladder and bowel irritation, and changes in urinary function, while hormone therapy can result in hot flashes, weight gain, and decreased bone density. However, advancements in precision medicine, such as image-guided radiation therapy (IG-IMRT), have minimised some of these side effects by targeting cancer cells more precisely.