What is Prostate Cancer?

“An early diagnosis is essential. I would strongly recommend older men who suffer from lower urinary tract symptoms, to see their doctor. Especially if they have a first degree relative who suffers or has suffered from prostate cancer.”

Dr. Irfan Ahmad is our consultant Urologist & Uro-Oncologist at SKMCH. We spoke to him about prostate cancer, its symptoms, prevention and treatment.

What is the prostate?

The prostate is a small gland at the base of the bladder in males. It encircles the first part of the urethra. The prostate gland plays an important role during the reproductive years of life.

What is prostate cancer?

Prostate cancer is a disease common to elderly men, with more than 75% of cancers being diagnosed in men over the age of 65. In recent years, however, the incidence has increased in younger age groups.

What are the symptoms?

In the earlier stages of the disease, prostate cancer rarely causes any specific symptoms. Later, it can present the following symptoms in the lower urinary tract:

• Difficulty passing urine
• Poor flow when passing urine
• Incomplete emptying of the bladder
• Increased frequency and urgency to pass urine
• Nocturia – excessive urination at night
• Ejaculatory problems
• Hematospermia –the presence of blood in semen
• Erectile dysfunction

A locally advanced case of prostate cancer may obstruct the kidneys and cause renal failure. Prostate cancer usually spreads to the bones and may cause bone pain, anaemia or fractures.

Is it hereditary?

Approximately 10% of prostate cancers are inherited. This means that men with one first degree relative with prostate cancer has a twofold risk of developing it; while men with two or more affected first degree relatives, have a 5-11 fold risk, and so forth.

Is it curable?

If it is diagnosed early and the disease is localized to the prostate gland, then it’s potentially curable. In the last two decades, earlier diagnosis and treatment, has led to marked decrease in fatalities caused by prostate cancer.

Are there any preventative measures?

Prevention is always better than cure. Research shows that dietary fat increases the risk of prostate cancer. Eliminating saturated fats and maintaining a healthy diet is essential. Dietary supplements which can decrease the risk of developing prostate cancer include:

• Selenium
• Vitamin E
• Lycopene

In the event that someone develops prostate cancer, an early diagnosis is essential! I would strongly recommend older men who suffer from lower urinary tract symptoms, to see their doctor. Especially if they have a first degree relative who suffers or has suffered from prostate cancer.

How is a diagnosis made?

The diagnosis is made on the basis of symptoms, digital rectal examination (DRE) and a blood test (PSA). It is confirmed by biopsy. Once the diagnosis is confirmed the next important step prior to any treatment is staging. This is when we find out what stage the disease is at, whether it is locally advanced or has spread to other parts of the body. At SKMCH we do this through a bone scan, and in selected cases, through pelvic MRI scan.

How is prostate cancer treated?

Treatment plans vary widely between patients. Two main modalities of treatment for localized disease are:

• Radical Surgery (Radical Prostatectomy)
• Radical Radiation treatment

Often Radical Prostatectomy has an edge over the radiation treatment in achieving long-term cancer control. It carries a minor risk of incontinence and erectile dysfunction, but provides good cancer control, accurate staging and helps in further treatment planning if required. In selected cases, hormone treatment is given alongside radiation treatment.

In Pakistan majority of the cases are advanced on presentation and therefore, are not fit for radical treatment. Also for a cancer that is so common, the public awareness, the diagnostic and therapeutic modalities available are extremely limited.