Men's health month is observed in June and raises awareness around the medical issues that concern men. In India, prostate cancer is one of the top 10 most common cancers. It mostly affects males in their sixties and seventies. However, cancer reports among younger males aged 35–44 residing in metropolitan regions have recently increased. Looking at the rise in cases among younger men, there is a need to increase awareness regarding early signs, risk factors, detection and treatment options for prostate cancer.
While prostate cancer is widespread in the west, urologists in India are seeing a major upsurge in the disease these days. And, despite the availability of a wide range of current diagnostic tools, prostate cancer remains undetected due to the lack of particular symptoms that would raise clinical suspicion. As a result, the vast majority of cases are detected late.
Prostate cancer is a slow-growing malignancy that typically has no symptoms in the early stages. Urinary issues, such as trouble commencing urination, frequent urination, especially at night, difficulty emptying the bladder, painful or burning urination, are all symptoms of prostate cancer. Because all of these symptoms are thought to be a normal part of the ageing process, they are often ignored. So it is critical for males over the age of 40 to go for a prostate cancer screening at least once a year.
Factors that might increase the risk
Prostate cancer can be severe if it grows fast or spreads outside the prostate. It can be caused by a number of reasons but the following are some crucial ones to be aware of.
Genetic factors and Family history: Prostate cancer risk rises proportionately with the number and severity of linked family members who have been diagnosed with the disease.
Lifestyle: Smoking has been linked to an increase in cancer-related mortality, with smokers being twice as likely as non-smokers to die of prostate cancer. Alongside, it is also linked to heavy alcohol consumption (more than 15 g per day).
Obesity is a significant risk factor that promotes physical inactivity and dilutes PSA, resulting in a delayed prostate biopsy and, as a result, a late diagnosis. Physical inactivity is one of the modifiable risk factors, and men who exercise frequently have a much lower risk of prostate cancer.
Sexually transmitted infections: Human Papillomavirus (HPV 16/18) and other sexually transmitted infections can cause gene mutations, which can lead to prostate cancer.
Understanding the importance of early screening is most crucial now. While prostate cancer frequently has few warning signs or symptoms, early detection and screening are critical. Early detection, while the cancer is still limited to the prostate gland, offers the best chance of being successfully treated.
Treatment for prostate cancer should begin as soon as symptoms appear. With the discovery and availability of a blood test called Prostate Specific Antigen, early detection and treatment of prostate cancer became a reality (PSA). If the cancer has not gone beyond the prostate gland, surgical removal of the prostate and surrounding tissues (radical prostatectomy) is the primary treatment option.
DRE and the prostate-specific antigen (PSA) blood test are two of the most effective approaches to detect prostate cancer early. After the age of 45, those with a family history of prostate cancer should get regular check-ups, including DRE and PSA, regardless of symptoms.
Treating Prostate Cancer in Young Men
Patients with intermediate-risk of prostate cancer are counselled about a multi-modality approach like radiation and chemotherapy. With timely screenings, Radical Prostatectomy (RP) can be performed by open, laparoscopic, or robot-assisted approaches. The total surgical removal in the form of RP provides high chances of a cure for localized prostate cancer.
The most advanced minimally-invasive approach of robotic-assisted radical prostatectomy (RARP), using the da Vinci RAS technology, provides several advantages over traditional prostatectomy. The key benefits include possible preservation of potency and continence including, the potential for lesser blood loss and blood transfusions, as well as a shorter hospital stay.
The introduction of robotic-assisted surgery is a game-changer in the surgical approach to urological cancers, and most surgeons, particularly urologists, would agree that the benefits far outweigh the drawbacks.
Importance of a Follow-up Care
Even if the patient has completed the treatment, the doctors will still want to watch closely. It's very important to go to all of the follow-up appointments. The doctor visits will usually include PSA blood tests, possibly with Digital Rectal Exams (DREs) if the prostate hasn't been removed. These will probably begin within a few months of finishing treatment. Patient need to talk with the doctor about developing a survivorship care plan.
By Dr Yuvaraja TB, Head, Robotic Surgery and Consultant Uro-Oncologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai
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