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Cancer of the prostate is the most common cancer of the males worldwide.
It mostly affects the individuals after the age of 45 years. There is a hereditary predilection; it is more common if first degree male relatives are affected. These include real brothers or fathers. Also it is more common in the African American race group.
What is the Prostate ?
Prostate is an organ of the male genitalia which is associated above with the urinary bladder and inferiorly with urethra (male urinary passage)which is urinary conduit.
It is responsible for forming approximately 80% of secretions of the semen
The prostate cancer tends to be asymptomatic in the initial stages where the cure is mostly feasible. It tends to cause very few disturbances or symptoms.
If at all the symptoms in urination do appear they appear very late in the course of disease.
The cancer spreads to the lymph nodes (glands present throughout the body for fighting infection and other diseases), bones and rarely to the other organs of the body.
Therefore, the disease needs to be optimally diagnosed in a time frame where we can treat it adequately.
For the same reason there are screening methods to detect individuals at high risk for the disease. These are physical examination along with digital rectal examination and Serum PSA determination which is a blood examination.
The screening of the individuals is recommended after the age of 50 years but should be done earlier if the index person has family history of the disease.
Digital rectal exam detects any nodules or hardness in the prostate which is suggestive of further action and diagnosis.
The Serum PSA helps identify the patients at risk if the levels are elevated.
The next step in the diagnosis flowchart is the prostate biopsy which is a procedure to obtain prostatic tissue from the suspicious areas to diagnose the cancer. The procedure was conventionally done blindly guided by the hardness of the tissues.
Nowadays the standard technique is guided by the Ultrasound or better still an MRI TRUS fusion biopsy if needed in case the MRI suggests suspicious areas.
The biopsy confirms or refutes the presence of the cancer and also helps stratify the disease into grades. The grading which is known as the Gleason’s Grading helps classify the disease into milder and more aggressive forms.
How Prostate Cancer spreads and How to Treat ?
Staging literally means estimating the disease spread across the body.
A locally confined disease suggests that the disease is limited to the prostate without direct invasion into any of the surrounding organs. A disease spread across the body is known as metastasis .
A locally confined disease fares best with the treatment.
Treatment options are Surgery and Radiation Therapy
The surgery is Robot assisted Radical prostatectomy available at few centres across the country
The surgical robot is used to assist in the precise surgery.
It is an advanced form of laparoscopic surgery where the robot is docked and helps in the crucial tissue handling, greater degree of freedom in surgery, lesser loss of blood, and faster recovery from the surgery.
The patient is admitted a day prior to the operation. The surgery lasts for about 4 to 5 hours and hospital stay of the patient in the hospital is about 4 to 5 days
The patient goes home on a catheter which can be taken out after 10 to 14 days
Radiation therapy is delivered by the Radiation Oncologists and has evolved over the past decades to reduce the fall of doses to the surrounding organs like bladder , rectum and gut. The side effects of the radiation therapy include bleeding in the urine, stools and late side effects like radiation cystitis or proctitis. It is beneficial to personalize the treatment for all the patients including Hormonal therapy or Radiation therapy as the patient merits.