Dr. H Sanjay Bhat, Consultant Urologist, Al Zahra Private Hopsital, Dubai

What is the Prostate Gland?

Walnut sized gland below the bladder Function is
to provide volume to semen Growth and function
dependent on male hormone testosterone Begins
to enlarge or undergo malignant change after 45
years of age

How common is Prostate Cancer?

After 50 it is one of the most common cancers in men
(may affect 1 in 7 men over all)
The incidence increases with age but in general 1 in
14 men aged 65 and 1 in 5 men aged over 75 can have
prostate cancer.
It is a slow growing disease and many elderly men
with prostate cancer may ultimately die of other age
related illness rather than prostate cancer.

What are the risk factors for Prostate Cancer?

1: It is more common in USA and Africa. Even second generation immigrants to these countries
have a higher risk implicating unknown environmental factors.
2: It is more common and aggressive in Black Americans, followed by whites, Asians and Indians
have a low incidence and the lowest incidence is seen in Japanese men.
3: If a male relative has the disease the chance is doubled.
4: It is more common in people using diets rich in red meat(beef,pork,sausages,bacon,ham) as
compared to vegetarian diets rich in green leafy and colored vegetables and fruits.

Myths about Prostate Cancer:

It has no relationship with increased or decreased sexual activity and ejaculation !!!!.
Previous vasectomy does not increase the risk!!!!

What are the symptoms of Prostate Cancer?

In early curable stages there may be no symptoms.
It can present as obstructive urinary symptoms such as hesitancy, poor stream, incomplete
feeling of bladder emptying or complete blockage of urine.
It can present with irritative urinary symptoms like burning sensation, frequent urination, feeling
of urgency to urinate or waking up frequently at night to pass urine.
When it spreads outside the prostate it can cause blockage of the tubes from the kidneys
resulting in kidney failure, constipation if it compresses the rectum.
back or bone pain due to spread to the bones.
Blood in urine or semen

When to screen for Prostate cancer?

1: At age 50 and once in 2-3 years at least thereafter. (Although this is an individual choice).
2: It is mandatory if a male relative has been diagnosed previously with prostate cancer.
3: African Americans after 45 years.
4: If symptoms are present.
You don’t have to wait for symptoms to visit the urologist after age 50 as you may miss the boat
with regard to cure

What are the stages of Prostate cancer?

Stage 1: Confined to less than half the gland. (Curable)
Stage 2: Involves more than half the gland but confined to its margins. (Curable)
Stage 3: Extends beyond the margins of the gland. ( Long term disease control is still possible)
Stage 4: Spread to distant organs like lymph glands, bone, liver,lungs.(Not curable but still better
survival than other cancers of similar stage)

How to detect Prostate cancer?

Physical examination
Blood tests
Radiology
Biopsy

Physical examination OR Digital rectal examination: The Urologist gently feels the consistency of the prostate using a well lubricated gloved finger through the anus.

Blood test:

PSA or prostate specific antigen

This is a substance produced by the prostate gland cells
and released into the blood circulation . It is usually
present normally in small quantities (< 4ng/ml although
this increases with normal ageing and the size of the
gland). In cancer prostate cancer higher levels are seen.

High psa levels warrant investigation

Serially increasing psa is worrying

psa testing is useful to follow-up prostate cancer after treatment.

How to confirm the diagnosis?

Once there is a strong suspicious on DRE and psa testing that a man may have prostate cancer one must proceed to confirm the diagnosis by Biopsy testing.

How do you the stage and plan treatment?

MRI SCAN/PET SCANS will help diagnose the stage of disease.

How to treat Prostate cancer?

Stage 1 and Stage 2 and selected cases of stage 3 diseases are treated with equal success by Radiation Therapy ,surgical excision or a combination of the two in selected

Radiation Therapy for Prostate cancer:

Usually for patients unfit for surgery or choosing this option. the results are comparable to surgery . Although rectal side effects like bloody and mucus diarrhea , erectile dysfunction and harmonal imbalances are reported.

The prolonged nature of the treatment and its availability in selected centers may also be a deciding factor. Ultimately the choice is left to the patient’s family.

Surgery for Prostate cancer:

Open and Laparoscopic/Robotic assisted laparoscopic Prostatectomy are usually the best option offered. Minimally invasive surgery provides additional advantages of Quick recovery and return to work by Avoiding prolonged treatment, although there is a risk of temporary urine leakage and erectile dysfunction.