The recent revelation of former US President
Joe Biden’s aggressive prostate cancer
diagnosis has once again brought the spotlight to one of the most common cancers affecting older men. While prostate cancer is often treatable, Biden’s case highlights the complexities of diagnosis and the importance of timely screening, even for those who undergo regular health checkups. Experts now question whether warning signs might have been missed and whether current screening guidelines need to be re-evaluated.
Prostate cancer, which affects over 300,000 men annually in the US is no longer rare in India either. Rising incidence in younger age groups, especially men in their early 50s, signals a shift in disease patterns that warrants urgent attention.
Firstpost spoke with Dr Sajjan Rajpurohit, Senior Director – Medical Oncology, BLK-Max Super Speciality Hospital to discuss various aspects such as detection, awareness, prevention and management of prostate cancer.
What is Prostate Cancer?
Dr Rajpurohit: Prostate cancer develops when cells within the prostate gland begin to grow uncontrollably. This small gland, located beneath the bladder and in front of the rectum, is responsible for producing seminal fluid. It’s a common malignancy; it’s estimated that 1 in 8 men will be diagnosed with prostate cancer in their lifetime. In India, the incidence rate is also on the rise, attributed to increased awareness and improved diagnostic capabilities.
Early signs and symptoms
**Dr Rajpurohit:**In its initial stages, prostate cancer often presents no symptoms, making early detection challenging without screening. However, as the disease progresses, men may experience:
*Frequent urination, particularly at night
*Difficulty starting or stopping urination
*Weak or interrupted urine flow
*Painful urination or ejaculation
*Blood in urine or semen
*Persistent pain in the back, hips, or pelvis
Men must be aware of these symptoms and consult a healthcare professional if they arise.
How is it diagnosed?
Dr Rajpurohit: Diagnosis typically involves a combination of tests:
PSA Test: The Prostate-Specific Antigen (PSA) test measures PSA levels in the blood. Elevated levels can indicate prostate cancer or other prostate conditions.
Digital Rectal Exam (DRE): A doctor performs a DRE to manually examine the prostate gland through the rectal wall, checking for any abnormalities.
MRI: Magnetic Resonance Imaging (MRI) provides detailed images of the prostate and surrounding tissues, helping to pinpoint suspicious areas.
Biopsy: If initial tests suggest cancer, a biopsy is performed to confirm the diagnosis. This procedure involves taking small tissue samples from the prostate for microscopic examination.
Major risk factors
Dr Rajpurohit: Several factors can increase a man’s risk of developing prostate cancer:
Age: The risk increases significantly after age 50.
Genetics: A family history of prostate cancer, especially in close relatives, can elevate risk.
Lifestyle: Diets rich in red meat and dairy products, along with obesity, may contribute to increased risk.
Ethnicity: Prostate cancer is notably more common in African American men compared to men of other ethnicities.
Progression and treatment options
Dr Rajpurohit: If untreated, prostate cancer can advance from a localized disease to an advanced stage, potentially spreading to nearby tissues and distant organs, leading to severe complications like bone pain and fractures. This underscores the importance of early detection and treatment.
Treatment options vary based on the cancer’s stage:
Active Surveillance: For low-risk, localized cases, doctors might recommend monitoring without immediate intervention.
Surgery: Radical prostatectomy, the surgical removal of the prostate gland and some surrounding tissue, is often recommended for localized cancer.
Radiation Therapy: This method uses high-energy rays to target and destroy cancer cells, either as a primary treatment or post-surgery.
Hormone Therapy: This approach aims to lower male hormone levels that can fuel cancer growth, frequently used for advanced prostate cancer.
Chemotherapy: For advanced cases, chemotherapy may be employed to kill rapidly dividing cancer cells throughout the body.
Recent advancements, including targeted therapies and immunotherapy, are also showing considerable promise in improving patient outcomes.
Can it be cured?
Dr Rajpurohit: Prostate cancer can often be cured, particularly when caught early. Survival rates for localized prostate cancer are very high, with nearly 100% of men surviving five years after diagnosis. However, survival rates decline for advanced stages, reinforcing the critical importance of early detection and timely treatment.
Age and treatment decisions
Dr Rajpurohit: A patient’s age significantly influences treatment decisions. Older individuals may have different health considerations, potentially leading to a choice for less aggressive treatments, while younger patients might opt for curative approaches. A thorough discussion with a healthcare provider is essential to determine the most suitable strategy for individual circumstances.
Role of lifestyle in prevention and recurrence
Dr Rajpurohit: Lifestyle factors play a substantial role in both preventing prostate cancer and reducing its recurrence risk. Maintaining a healthy diet rich in fruits, vegetables and whole grains, combined with regular exercise and a healthy weight can help lower risk. Additionally, avoiding smoking and limiting alcohol consumption are vital preventive measures.
Importance of early detection
Dr Rajpurohit: Early detection is paramount for successful prostate cancer treatment outcomes. Men, especially those at higher risk due to age or family history, should be encouraged to discuss screening options with their healthcare providers. Regular screenings, including PSA tests and DREs, can help identify the disease in its most treatable stages.