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Prostate cancer, What should I know?

Sharing experience from recent visit and what everyone should know.

I was recently visiting home in India. Being a urologist, as you would expect, I often get asked questions on a range of urological issues. This time, a friend in his mid-50s wanted to know the symptoms that could indicate prostate cancer. I mentioned difficulty in urination, weak stream, frequent urination, getting up at night etc. He was a bit perplexed. To him, these were symptoms of ‘prostate’, a benign (non-cancerous) condition that most men get with age. He was expecting me to mention pain, weight-loss, loss of appetite, blood in urine, as this is what cancer did to people in his mind. I had to explain that the urinary symptoms that men beyond a certain age get are due to enlargement of the prostate and are the same regardless of whether the enlargement is cancerous or non-cancerous. In fact, if you get pain, weight-loss etc. with prostate cancer, it is often too late. He got worried. If what I was saying was true, how does one know when to take the ‘prostate’ symptoms seriously?

I then mentioned that most commonly early (and when it is most curable) prostate cancer causes no symptoms at all. Now he was even more perplexed. I was telling him that prostate cancer is the most common cancer in men and most commonly, causes either no symptoms or symptoms no different from the ‘prostate symptoms’ he knew of. So, do the men folk just wait to have their likeliest cancer diagnosed late and die of it? Or is there something they can do?

And then I told him what men like him can and should do. They should get themselves checked regularly by a urologist (or a general surgeon or even physician, if they live in a small town where doctors are not divided into categories of specialists yet) and undergo a digital rectal examination (DRE) and a blood test to check PSA. In DRE, the feel of the prostate is assessed with a finger in the rectum (back passage) — a hard and uneven or nodular prostate is likely to indicate cancer. PSA is a simple and inexpensive blood test that is abnormally raised in prostate cancer. While the combination of a normal PSA and DRE does not give a guarantee against prostate cancer, it is very reassuring. My friend was mightily relieved. So, after all, there was something simple that he and other men could do for this huge peace of mind.

Screening tests are fortunately available to detect many cancers when they have not started causing symptoms yet and are at their most curable stage. PSA is a simple screening test for prostate cancer and has played a major role in reducing mortality (and morbidity or suffering) from it globally. It is recommended that men over 50 years of age should undergo a DRE and PSA testing annually. In fact, those with a family history of prostate cancer should start getting the screening test at an earlier age (45 years or even 40, depending on the number of affected family members and their age at diagnosis). It does not cost much, is painless and easily available anywhere. So, no excuse for not having it!

For answers to many such questions, please log on to www.secondmedic.com. Good luck!

Dr Vibhash Mishra, UK, MBBS with Honours,MS General Surgery,FRCS Edinburgh,FRCS UROLOGY, UK FEBU

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