Prostate cancer is the second most common cancer and sixth most common cause of death among men worldwide. Although statistics over the last few decades show a lower incidence among Asian men compared to African, African-American and Caucasian populations, it is certainly on the rise.
Significant advances have been made in the treatment of prostrate cancer over the last two decades with development of new drugs (cytotoxic drugs and antiandrogens and immunotherapeutic drugs) for better cancer control. In addition, refinements in surgery and radiotherapy aim at providing higher cancer cure and control rates with reduced complications and long-term morbidity.
Despite these advances, there are several misconceptions about prostate cancer. Better understanding will help to allay fears about this disease.
Early stage detection of prostate cancer can be tricky. Majority of prostate cancer cases are asymptomatic in early stages and become symptomatic only in advanced stages. Totally asymptomatic subjects have presented with complications like bone fractures due to metastatic cancer. So it is prudent to get evaluated based on the risk factors like a positive family history, diabetes, obesity etc.
Prostate cancer screening is done by checking Serum PSA levels regularly, in asymptomatic subjects. Although many urologists question this practice, it has been used quite extensively in the western countries, and it may be relevant in recent years due to the rising incidence of PCa in our country. Screening gives us an opportunity to diagnose the disease in the early stages and offer curative treatment with reduced morbidity.
PSA or Prostate-Specific Antigen is specific for prostatic diseases, but not for cancer. Increased PSA levels are not only seen in this type of cancer, but also in prostatitis, prostatic abscess, Benign Prostatic Enlargement and acute urinary retention.
Benign prostatic hyperplasia, which is non-cancerous enlargement of the prostate, is far more common than prostrate cancer. There is no definite correlation between the size of the gland and the risk of cancer. In fact, the majority of large prostate glands are benign.
Significant advances in treatment of this disease have been made. This has reduced the morbidity of both the disease and the treatment. In addition, improved cancer specific survival has been achieved. Hence, at whatever stage the cancer is diagnosed, treatment should be considered.
In India, a majority of prostate cancer cases (over 75 percent) are diagnosed in the advanced stages, after they have spread outside the prostate gland. Advanced cancers can lead to complications like bone fractures, kidney failure and swelling of limbs. Hence, it is imperative to treat prostate cancer at diagnosis regardless of the stage. Moreover, the chance of cure increases when the disease is localised to the prostate.
Unlike other cancers, prostate cancer, even in advanced stages, respond well to several modalities of treatment, with significant survival rates. With recent advances in hormonal therapy, the quality of life even in advanced prostate cancer can be good. Hence, treatment should be offered even in advanced prostate cancer.
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