Prostate Cancer

Prostate cancer is the second most common cancer in men after lung cancer. It usually affects men over the age of fifty years. It is estimated that approximately 1 in 5 men will be diagnosed with prostate cancer during their lifetime, however only 1 in 33 will die of this disease.

Prostate cancer usually does not give rise to any symptoms till it is in advanced stages. Hence in many countries men over the age of fifty, who go for routine health check-ups are also advised to get checked for this cancer. A clinical test in the doctors surgery called digital rectal examination or DRE can pick up some of these cancers.

Prostate is a reproductive gland found in males and is an androgen (or testosterone) dependent sex gland that provides the bulk of seminal fluid during ejaculation. The prostatic fluid is excreted in the semen and helps nourish the sperms and keep it in the fluid state in the vagina.

Unlike other cancers the natural history of prostate cancer is different. Some prostate cancer are indolent and slow growing and may take years before they manifest or become sinister; whereas another group are more aggressive - like any other cancers and require urgent treatment.

"Women with breast cancer almost universally die from it within 10 years if they don't get treated, It's quite different with prostate cancer. Many, if not most, men will live over 10 years with prostate cancer." - Harmon Eyre

The cancer can be picked up early by doing a blood test called - Prostate Specific Antigen (PSA). Prostate Specific Antigen is specific to prostate gland and is found only in seminal fluid or blood. Interestingly PSA was first used in forensic investigation to confirm if a stain on an undergarment was semen or not. Its presence meant that the fluid that stained the garment was seminal in origin.

If the cancer is picked up during a routine periodic check, a biopsy of the gland is advised to determine the aggressiveness of the tumour. The decision on how to treat the cancer is usually a decision that is taken by the treating Urologist. He determines by various tests the stage of the disease and decides on the line of treatment that is suitable for the patient.

If the cancer is still in its early stages and the patient is relatively young and in good health, they are usually advised to undergo a ‘Radical Prostatectomy'. However if the patient has early disease but is in poor health - hormonal manipulation and radiotherapy may be a better option to avoid the risks of surgery.

Cancer that have gone beyond the confines of the prostate gland and spread to other areas of the body are more advanced and may require treatment with hormones or removal of testis . This can help to slow or stop the spread of the disease.

Over the last couple of decades much research involving the prostate cancer has taken place and the disease is better understood. We however still have not been able to answer the question about which cancers requires urgent treatment and which do not require treatment. The research in genetics and proteomics may help us answer this important question in the near future.