Every year, a whopping 1.5 million prostate cancer cases among men are detected in India, of which 85 per cent fall into stage four category, meaning that doctors do not give them more than three years to live. The irony is that, unlike other cancers, the chances of treating prostate cancer are almost 100 per cent if it is detected early, according to specialists.

The greatest risk factor is age and this risk increases significantly after the age of 50 for men with no family history of the disease. About two-thirds of all prostate cancers are diagnosed in men aged 65 and older. The older the patient, especially if over 70 years, the less aggressive the disease usually behaves. Men whose relatives have had prostate cancer are considered to be at high risk. Having a father or brother with the disease more than doubles your risk. Besides, high-fat diets, less exposure to the sun, exposure to heavy metals such as cadmium, infectious agents or smoking can put you at risk of developing the disease. Not everyone experiences the symptoms of prostate cancer. Many times the signs are first detected by a doctor during a routine check-up. Some men, however, will experience changes in urinary or sexual function that might indicate the presence of the ailment. These symptoms include:

❏ A need to urinate frequently, especially at night;

❏ Difficulty in urinating or holding back urine;

❏ A weak or interrupted flow of urine;

❏ Painful or burning urination;

❏ Difficulty in having an erection;

❏ Painful ejaculation;

❏ Blood in urine or semen; and

❏ Frequent pain or stiffness in the lower back, hips or upper thighs.

Because these symptoms can also indicate the presence of other diseases or disorders, such as BPH or prostatitis, men need to undergo a thorough check-up to determine the underlying cause.

Diagnosis is done with a per rectal examination of the prostate. If it is hard or irregular, then cancer is suspected. A blood test PSA is done and if found to contain more than four ng/ml, then it is suspected. In such a situation, a prostatic biopsy is advisable. Previously, a trans rectal ultrasound biopsy used to be done but this was blind and did not specifically target the cancer, so diagnosis could be missed.

Accurate prostate tumour diagnosis and treatment depends on the ability to efficiently perform a biopsy on specific areas of the prostate. In this procedure, first a multiparametric Dynamic MRI of the prostate is done. According to the images, Passive Infrared Detector (Pirad) scoring is done to indicate the specific areas of the cancer. These recorded MRI images are fused with a live trans rectal ultrasound by a doctor who performs a MRI/TRUS fusion biopsy. By fusing the MRI and live ultrasound images, a more effective targeted biopsy of the selected tissue is revealed by the MRI imaging, leading to a more accurate diagnosis and better treatment.

The good news is that the current survival rate for prostate cancer is more than 97 per cent when the disease is diagnosed early and limited to the prostate. A variety of treatment options like robotic surgery and radiotherapy are available. Of course, prostate cancer is best treated when in an early stage, but even in an advanced stage it responds to treatment options.

The writer is Chairman, Academic & Research, Medant Kidney and Urology  Institute, Medant, Gurgaon.