Articles on active surveillance of prostate cancer

Grave Misconceptions About Prostate Cancer

Dr. Anish Kumar Gupta, Andrologist
Prostate Cancer remains one of the least talked about cancers in general public at-least in India. Hence there remains a great deal of confusion surrounding this disease.Ask any group of men about prostate cancer – some might have few notions of their own unsubstantiated by medical information, other might change the topic and a couple may have few jokes ready too.Most men who have ever heard about a Prostate Specific Antigen (PSA) will say so, that the PSA is the benchmark for Cancer Prostate diagnosis for them and their physicians1. Prostate cancer is an old man’s disease.WRONG!The more likely you are to be diagnosed with prostate cancer (65% of cases are diagnosed in men who are 65 or older)35% men are diagnosed at an early ageAge Wise incidence:   < 40 Years:  1 in 10,000 men      40 – 50 Years: 1 in 40 to 60 men.      60 – 69 Years: 1 in 15 men.There are many risk factors to consider - Your race, family history, physical health  and lifestyle—even geographic location.2. If you don’t have any symptoms, you don’t have prostate cancer.WRONG!Prostate cancer is one of the most asymptomatic cancers in oncology, meaning not all men experience symptoms.Many times symptoms can be mistaken or attributed to something else.Signs of prostate cancer are often first detected by a doctor during a routine check-up. Common symptoms include a need to urinate frequently, difficulty starting or stopping urination, weak or interrupted flow of urination, painful or burning urination, difficulty having an erection, painful ejaculation, blood in the urine or semen, or frequent pain and stiffness in the lower back, hips or upper thighs. If you experience any of these symptoms, be sure to tell your doctor.3. Prostate cancer is a slow growing cancer I don’t need to worry about.The answer to this one is sometimes, yes. Sometimes, no. Aggressiveness can be commented upon ONLY AFTER BIOPSY keeping in mind patient’s age and health status. Patients need to understand the complexity of this disease and make treatment decisions that are right for them in consultation with a trusted Urologist.4. Prostate cancer doesn’t run in my family, so the odds aren’t great that I will get it? WRONG!While a family history of prostate cancer doubles a man’s odds of being diagnosed to 1 in 3. This compares to 1 in 8 women who will be diagnosed with breast cancer.Family history and genetics do, however, play a role in a man’s chances for developing prostate cancer. A man whose father or bother had prostate cancer is twice as likely to develop the disease. The risk is further increased if the cancer was diagnosed in a family member at a younger age (less than 55 years old), or if it affected three or more family members.5. The PSA test is cancer test.WRONG!The PSA tests measures levels of prostate-specific antigen in the prostate, not cancer. PSA is produced by the prostate in response to a number of problems that could be present in the prostate including an inflammation or infection (prostatitis), enlargement of the prostate gland (benign prostatic hyperplasia) or, possibly, cancer. Think of it as a first alert smoke alarm, instead of a fire alarm.  The PSA test may be the first step in the diagnostic process for cancer.  It has made detection of cancer in its early stages, when it is best treated, possible. Experts believe the PSA test saves the life of approximately 1 in 39 men who are tested. The flip side is also the fear of over detection of cancer, which may not affect the patient in his lifetime. This is supported by various Cancer Watchdog Organizations world over.This article is the first of a two part series. Watch out this space for more debunked myths such as-6. A High PSA level means that you have prostate cancer and a Low PSA means you do not have prostate cancer.7. Treatment for prostate cancer always causes impotence or incontinence.8. Sexual activity increases the risk of developing prostate cancer.9. You can pass your cancer to others.10. TURP / Endoscopic Procedure is Adequate treatment for Cancer Prostate 

Prostrate Cancer: Early Detection Can Help Your Chances

Dr. Sandeep Nayak, Surgical Oncologist
In India, prostrate is the second leading site of cancer among males in large cities like Delhi, Kolkata, Pune and Thiruvananthapuram, third leading site of cancer in cities like Bangalore and Mumbai and it is among the top ten leading sites of cancers in the rest of the country. Usually, prostate cancer is a very slow growing cancer and most people do not have major symptoms until the cancer reaches an advanced stage. Most men with prostate cancer die of other unrelated causes, and many never know that they have the disease.Factors that can increase the risk of prostate cancer include:Age: Risk of prostate cancer increases with age. Out of every 10 prostate cancers, 6 are detected in men above 60 years of age.Diet: Consumption of excess calcium through food (especially dairy foods) or supplements has been linked with higher risk of developing prostate cancer.Family history: Prostate cancer seems to run in families which suggest a genetic or inherited factor involved in its causation. Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome in which large bowel cancer is the most common feature, is caused by inherited gene changes that carry an increased risk for many cancers including prostate cancer.Screening and Early Detection    Early detection of cancer can often be done by testing the amount of prostate-specific antigen (PSA) in a man’s blood sample. Another way to find prostate cancer early is the digital rectal exam (DRE).If the results of either one of these tests are abnormal, further tests are performed to see if there is a cancer. The  prostate cancer found as a result of screening with the PSA test or DRE, will probably be at an earlier, more treatable stage than if no screening were done. However, neither the PSA test nor the DRE is 100% accurate.Treating Prostate CancerNowadays, robot-assisted radical prostatectomy has become the standard of care for prostate cancer throughout the world. In this approach, the laparoscopic surgery is done using a robotic interface (called the da Vinci system). The surgeon sits at a control panel in the operating room and moves robotic arms to operate through several small incisions in the patient’s abdomen.Robotic prostatectomy has advantages over the open approach in terms of less pain, blood loss, and recovery time. For the surgeon, the robotic system provides more maneuverability and more precision when moving the instruments than standard laparoscopic radical prostatectomy (LRP).

Let’s Not Leave the Men Out: Trends in Prostate Cancer Research

Ms. Samara Mahindra, Dietitian/Nutritionist
The risks of getting prostate cancer depend on a variety of factors. Scientists have been studying the various effects of prostate cancer. Scientists have found that certain foods when included in your diet can significantly lower your risk of developing cancer. Tomatoes and soybeans contain chemical compounds that can help in preventing prostate cancer.Tomatoes contain Lycopenes and soybeans contain Isoflavones. Based on this research some scientists are trying to create compounds synthetically that can be used as nutritional supplements, however supplements should be taken with caution. Other substances that could have beneficial chemical compounds include pomegranate, green tea, broccoli, turmeric, flaxseed, and soy.In the United States, there were 190,000 new prostate cancer cases accounting for 10% of all new cancer cases. The means of detecting prostate cancer are not perfect as many of the tests used for detection are still not very accurate. Prostate cancer is rare among men under the age of 40. As age increases the risk of getting prostate cancer also increases. Some researchers are also working on vaccines for prostate cancer. These vaccines cannot prevent prostate cancer but they can help in the treatment of it. This vaccine enables the patient’s immune system to recognise cancer cells earlier and thereby helps in destroying them. As scientists develop better techniques for the detection and treatment of prostate cancer, the mortality rate for this type of cancer will dramatically come down.

Prostate Cancer - Risk Factors, Signs And Treatment

Dr. Anish Kumar Gupta, Andrologist
What is Prostate Cancer?Cancer is a disease in which cells in the body grow out of control. When cancer starts in the prostate, it is called prostate cancer. What Is the Prostate?The prostate is a part of the male reproductive system, which includes the penis, prostate, and testicles. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). It produces fluid that makes up a part of semen. As a man ages, the prostate tends to increase in size. This can cause the urethra to narrow and decrease urine flow. This is called benign prostatic hyperplasia, and it is not the same as prostate cancer. Men may also have other prostate changes that are not cancer.What Are the Risk Factors?Research has found risk factors that increase your chances of getting prostate cancer. These risk factors include:Age: The older a man is, the greater his risk for getting prostate cancer.Family history: Certain genes (the functional and physical units of heredity passed from parent to offspring) that you inherited from your parents may affect your prostate cancer risk. Currently, no single gene is sure to raise or lower your risk of getting prostate cancer. However, a man with a father, brother, or son who has had prostate cancer is two to three times more likely to develop the disease himself.Race: Prostate cancer is more common in some racial and ethnic groups than in others, but medical experts do not know why. Researchers are trying to determine the causes of prostate cancer and whether it can be prevented. They do not yet agree on the factors that can influence a man’s risk of developing the disease, either positively or negatively.Some drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear. Regular use of multivitamins has not been proven to increase or decrease the risk of early or localized prostate cancer. Talk to your doctor about multivitamin use.What Are the Symptoms of Prostate Cancer?Different people have different symptoms for prostate cancer. Some men do not have symptoms at all.Some symptoms of prostate cancer are:Difficulty starting urination.Weak or interrupted flow of urine.Frequent urination, especially at night.Difficulty emptying the bladder completely.Pain or burning during urination. Blood in the urine or semen.Pain in the back, hips, or pelvis that doesn’t go away.Painful ejaculation. If you have any symptoms that worry you, be sure to see your doctor right away. Keep in mind that these symptoms may be caused by conditions other than prostate cancer.Should I get screened for Cancer Prostate ?Informed Decision Making - Most urologists support informed decision making. Informed decision making occurs when a man:Understands the nature and risk of prostate cancer.Understands the risks of, benefits of, and alternatives to screening.Participates in the decision to be screened or not at a level he desires.Makes a decision consistent with his preferences and values. We need better ways to screen for and treat prostate cancer. Until we make these discoveries, and even when we do, men and their families will turn to trusted health care professionals to help them make informed decisions.How Is Prostate Cancer Diagnosed?If your prostate specific antigen (PSA) test or digital rectal exam (DRE) is abnormal, doctors may do more tests to find or diagnose prostate cancer. Transrectal ultrasound: A probe the size of a finger is inserted into the rectum, and high-energy sound waves (ultrasound) are bounced off the prostate to create a picture of the prostate called a sonogram. This test may be used during a biopsy.Biopsy: A small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.Gleason score: This score is determined when the biopsy is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2–10. The lower the score, the less likely it is that the cancer will spread.Staging If prostate cancer is diagnosed, other tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. This process is called staging. Whether the cancer is only in the prostate, or has spread outside the prostate, determines your stage of prostate cancer. The stage of prostate cancer tells doctors what kind of treatment you need.How Is Prostate Cancer Treated?Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are:Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms.Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer. There are two types of radiation therapy—External radiation therapy. A machine outside the body directs radiation at the cancer cells or Internal radiation therapy (brachytherapy). Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells. Brachytherapy is not available in IndiaHormone therapy. Blocks cancer cells from getting the hormones they need to grow.Other therapies used in the treatment of prostate cancer that are still under investigation includeCryotherapy. Placing a special probe inside or near the prostate cancer to freeze and kill the cancer cells. Not available in India.Chemotherapy. Using special drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through your veins, or, sometimes, both.Biological therapy. Works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.High-intensity focused ultrasound. This therapy directs high-energy sound waves (ultrasound) at the cancer to kill cancer cells.Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor before you start any kind of complementary or alternative medicine.Which Treatment Is Right For Me?Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects.Sometimes people get an opinion from more than one cancer doctor. This is called a “second opinion.” Getting a second opinion may help you choose the treatment that is right for you.

How Cancer Scare Can Change Your Life

Dr. Sandeep Nayak, Surgical Oncologist
Coping with cancerReceiving a diagnosis of cancer is probably one of the worst things happening to anybody. But, it need not be that scary. You are not alone. When you are diagnosed with cancer you are facing a total new and unknown world. Whether this is your first time with cancer, or you’re experiencing a recurrence, it’s most important to remember that you are not alone. There are many like you who are going through this treatment and successfully so. Take Emotional HelpEveryone deals with a cancer diagnosis differently. You could approach the others suffering from cancer to understand what they go through and prepare yourself for the future steps. It is better to approach a group than an individual as they provide you a broader perspective. There are many help groups that are actively involved in such activities and help new patients to cope with their disease.  You will be vulnerable at this time and it is important to avoid, as far as possible to make any key decisions about your treatment, while you are in the state of shock. Most people report that they could not retain or remember what the doctor told them.Treatment of Cancer.Many don’t know that cancer can be treated and in many cases it can be cured. Your doctor would advise you a combination of surgery, chemotherapy (injections) and radiotherapy. Sometimes other forms of treatment are advised. It is important that you go through all the subjected treatment without skipping any. It may take a few months to complete all of it. Hope for Cure.While cancer may be one of the biggest challenges you will ever face, there are reasons to be hopeful. Treatments for cancer has become more sophisticated and health professionals continue to deepen the understanding of cancer.Cure is possible for many cancers today. And beside medical treatments you have many other resources to draw on as well for your healing, e.g. complimentary medicine, integrative medicine, alternative therapies, yoga. Your Cancer Mentor, friends, family, your spiritual community or and other follow patients and survivors also there for you, to support you throughout your healing journey.

Understanding Cancer Better

Dr. Sandeep Nayak, Surgical Oncologist
What is cancer?Cancer is the name given to a group of diseases that behave similarly. There is a wide range of cancers which are characterised by an uncontrolled division of body's cells without halting and thereby, spread into surrounding tissues pushing normal cells.Cancer can begin at any place in the human body, which is comprised trillions of cells. Regularly, human cells divide and shape into new cells as the body needs them. At the point when cells get senile or get harmed, they bite the dust, and new cells assume their position. When the organised procedure of cell growth fails, cancer begins. Cells turn out to be increasingly irregular in shape and size, and continue to survive even when they ought to die, and new cells are formed even when they are not required. These cells can multiply without any reason and may form what is called tumours. Cancerous tumours are harmful, which implies that they can spread into, or attack, adjacent tissues. Moreover, as these tumours develop, some cancer cells can escape and go to far off spots in the body through the blood or the lymph framework and shape new tumours a long way from the first tumours.Why worry about cancer?Cancers figure among the main causes of morbidity and mortality around the world, with roughly 14 million new cases and 8.2 million cancer-related deaths every year. In the next two decades, it is estimated that the incidence of cancer will increase by 70% throughout the world. Among men, the five most common cancers in 2012 were lung, prostate, colorectal, stomach, and liver cancer.In women, the five most common cancers are breast, colorectal, lung, cervix, and stomach cancer.Around 33% of cancer deaths can be prevented by behavioural and dietary changes. The risks include high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use.Read my blogs on early detection of cancer and cancer prevention to understand how to reduce your risk.

10 Symptoms of Cancer Which Nobody Should Ignore

Dr. Sandeep Nayak, Surgical Oncologist
Cancer is an unwanted growth of cells that destroys the healthy environment of the body. The fear associated with it is not because of the disease itself, but, because of the delayed diagnosis due to lack of clear symptoms. Here are a list of commonly ignored symptoms which could be warning signs of cancer. Cancers are PAINLESS when they start and so they get ignored by the patient and doctors alike. Anemia: Tiredness in cancer is usually due anemia (lack of blood) and deficiency of nutrition. The cancer eats up most of nutrients in its race to grow quickly. Also there bleeding from cancer tissue that makes one anemic.Blood while passing stool: very often this is due to piles or similar causes. However, cancer of colon and rectum also causes this. When anyone has blood in stool, it is advisable to do colonoscopy to look inside of colon. Cancer of colon can cause change in bowel habit (like alternating constipation and diarrhea)Blood in urine: This always require further tests.  Cancer of kidney or urinary bladder or prostate (among men) can cause blood in urine. The bad part is this bleeding can be infrequent. This infrequency makes patients ignore this symptom. Even one episode of blood in urine needs through examination.Bleeding in between periods (women): Any bleeding that does not follow the usual pattern of menstrual period is a warning sign. Cancer of uterus or cervix can present with this kind of symptoms. Patients with cervical cancer also have bleeding after having sexual intercourse. A patch or wound inside mouth: Oral or mouth cancers are common in India. These cancers start as a patch or wound and progress over months. If diagnosed early they can be treated effectively. Lump or swelling: Cancers of breast and limb begin as painless lumps or swellings and progress over months. Any newly appearing lumps or swellings should be completely investigated. Loss of weight without trying: A sudden weight loss when you are not dieting needs investigations. As cancer consumes most of the nutrition that you take, you tend to loose wt. Loss of appetite and bloating food: this could be because of obstruction to bowel or because of a cancer secreting its toxic substances. Thorough examination is needed to reach a diagnosis. Lymph node enlargement: Lymph nodes are present everywhere in the body and function as filters. Most of the times they enlarge due to infections. The cancer cells also get filtered in this nodes and are trapped. They grow in these nodes and the nodes enlarge as a result of this growth. Trouble swallowing or vomiting after taking food are both warning signs of a cancers in the digestive tract. These need to be evaluated with endoscopic tests to identify the cause. Some patients have only persistent heart-burns which is misdiagnosed as gastritis and treated only for months before correct diagnosis reveals itself. Pain is the last feature of cancer. Do not wait for it.

Lower Your Chances of Getting Prostate Cancer

Dr. Anish Kumar Gupta, Andrologist
To understand how to prevent prostate cancer, one must first understand what causes it. There are three major factors that influence one's risk for developing prostate cancer.Age: Prostate Cancer is common after 65 years of age. There is no average age for diagnosis in India but internationally it is proposed to be around 69 years. The incidence increases every year after that age.Race: All over the world, Asian men who live in Asia have the lowest risk; however when they migrate to the west, their risk increases. Family history: A man with a father or brother who developed prostate cancer has a 2 times risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.The factors above are difficult or cannot be changed, however, there are many things that men can do to reduce or delay their risk of developing prostate cancer.  All things listed below do not have a very high level of evidence at present, but our research associates world over are working hard to find probable environmental and contributory causes. Why is prostate cancer so common in the Western culture and much less so in Asia, and why when Asian men migrate to western countries the risk of prostate cancer increases over time? We believe the major risk factor is diet – foods that produce oxidative damage to DNA. What can you do about it to prevent or delay the onset of the disease?1. Eat lesser calories and exercise more to maintain healthy weight.2. Decrease the amount of fat from non-vegetarian diet and dairy products to a minimum.3. Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance.4. If you take a mixed diet: Eat more fish – they have "good fat" particularly omega-3 fatty acids. Avoid trans fatty acids (found in ghee / margarine).5. Other antioxidant foods, which may be included, are: Cauliflower, tomatoes cooked in olive oil, soy and green tea are also potential dietary components that may be helpful in moderate amounts.6. Avoid smoking for many reasons. Drink alcohol in moderation, if at all.7. Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer8. What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may “fuel the cancer”, and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.9. Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.10. All of these advises together will not take away the risk of having cancer prostate to zero, hence if there are risk factors present, one must talk to his Urologist about screening for Prostate Cancer, its various modalities and risks and benefits.