Feb 20: It is pertinent to note that many men are unaware of the existence of the prostate gland let alone it's diseases, symptoms thereof and implications. The prostate is a small walnut shaped gland encircling the urethra and located just below the bladder. Secretions from the gland constitute a significant part of seminal fluid.
Prostate gland enlargement can be considered an inevitable part of aging much like greying and loss of hair and like these conditions manifest across a wide spectrum. On the other hand, a malignant tumour arising from the prostate - ‘a cancer’ albeit a source of similar symptoms can have far reaching implications on an individual’s health.
By compressing on the urethra, the enlarged prostate can cause symptoms such as difficulty in starting to pass urine, straining to void, poor stream and a feeling of incomplete emptying of the bladder. More alarming symptoms are bleeding in urine, formation of bladder stones and repeated urine infections. On occasion, painful retention of urine can result which needs placement of a urine catheter temporarily. If untreated this can progress to renal failure because of long standing back pressure changes on the kidney.
Most cases of BPH can be treated medically provided that medical opinion is taken in time. Various medications can be used to help relax the prostate gland area or to shrink the gland. In more severe cases the condition may have to be treated surgically by endoscopic resection of the prostate.
Most cancers also produce symptoms similar to BPH in the initial stages, hence it is not surprising that especially in the country like India many cases of prostate cancer are detected at a very late stage by which time the cancer has already widely spread to the bones and other areas. It is therefore logical that all the attempts should be made to detect the cancer in its early stage. This is however possible only by certain blood tests and visit to your urologist. A common test for the detection of cancer prostate is a serum PSA. Serum PSA unfortunately is not an accurate test and can cause both diagnostic confusion and unnecessary testing apart from the constant fear of harbouring a cancer. Both evaluation and treatment of prostate cancer is quite distinct from that of BPH. Initial testing may involve use of MRI and prostate biopsy to confirm the diagnosis followed by imaging to assess the spread of the disease. Thereafter in consultation with your urologist an appropriate treatment plan will be tailored depending upon the stage of the disease. This may include surgery- that is removal of the prostate by robotic or laparoscopic approaches or radiotherapy. In case of disease which has already spread well beyond the confines of the prostate (also known as metastatic disease) we resort to palliative therapy to control the disease while best maintaining quality of life.
It is also important to remember the not all prostate cancers behave identically, some can simply be observed while others can progress very rapidly and need to be treated aggressively.
Cancer in its myriad forms can be debilitating to the patient and family alike, what should be emphasized is a holistic approach to its diagnostic and therapeutic challenges keeping patients’ quality of life paramount.
Dr. Prajwal Ravinder, Senior Consultant Urologist and Renal Transplant Surgeon, KMC Hospital, Mangaluru.