Prostate Cancer – Diagnosis & Tests

Prostate cancer is the cancer of the prostate gland, and one of the most common cancers that affects older, adult men. Although this disease has been found in adult men of various ages, the risk of getting it increases considerably once men reach the age of 50. Which is why hospitals and doctors recommend getting checked for the risk of prostate cancer at least once, as early as the age of 40.  The standout feature of prostate cancer is that unlike other forms of cancer, it does not manifest itself in the form of any physical symptoms until it becomes too late. However, the argument for screenings for men is made of the fact that statistics show that those men that get diagnosed with prostate cancer early, have a nearly 90% survival rate. So what exactly do the tests for diagnosing prostate cancer entail?

Prostate cancer screening tests are two distinct types:

  • Digital Rectal Exam (DRE): Is a physical exam where the doctor inserts a gloved, lubricated finger into the patient’s rectum in order to examine the prostate gland. This test is carried out in order to find and identify any abnormalities in the shape, size or texture of the prostate gland.
  • Prostate Specific Antigen (PSA) test: In this test, a blood sample is drawn and analysed for the substance, PSA which is naturally produced in the body by the prostate gland. High levels of PSA in the bloodstream may be an indicator of prostate infection, inflammation, enlargement or cancer.

If the DRE and PSA tests lead to the detection of an abnormality, your doctor might recommend getting an MRI or a biopsy done. Both these additional tests are used to determine whether the initial abnormalities that were discovered are because of cancer or some other prostate disorder such as a prostate infection or prostatitis.

Once the presence of prostate cancer has been determined, it now becomes imperative to go forward and analyse the cancer cells for their degree of aggressiveness and their degree of spread during the time of diagnosis. In order to determine the degree of aggressiveness of the cancer cells, they are sent to be examined by a pathologist. Once examined, the cancer cells are then given a Gleason score. These scores range from 2 to 10 and indicate how likely it is that a tumour will spread. A low Gleason score indicates that the cancer cells are similar to normal prostate cells and are less likely to spread (less aggressive). Conversely, a high Gleason score indicates that the cancer cells are very different from the normal prostate cells and are more likely to spread (more aggressive).

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of cancer. If your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as bone scan, CT scan, MRI, and PET scan might be recommended. Once the testing phase is complete, and the diagnosis and level of aggressiveness of cancer have been determined, the doctor then assigns cancer a stage. The stage at which cancer has reached is the most important factor in determining treatment options. The stages of prostate cancer are:

  • Stage 1 – This stage signifies very early cancer that’s confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren’t considered aggressive.
  • Stage 2 – Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage 3 – Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage 4 – Cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

Knowing the type and stage of cancer helps the doctor decide what treatment option would be best suited for a particular situation.

Dr.Rahul Bhatt 

Specialist Urologist 

Aster Clinic, Bur Dubai (AJMC) 

Dr.-Rahul-Bhatt

 

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Prostate Cancer – It’s Causes and Symptoms.

The prostate gland is part of the male reproductive system and is located below the bladder and in front of the rectum. The size of the gland changes with age, being smaller in young men and larger in older men. Being a part of the male reproductive system, the prostate gland functions to produce and release a fluid that forms part of the semen.

Cancer is a condition in which the cells in a particular part of the body start growing uncontrollably and crowd out the normal cells. Cells in any part of the body can become cancer cells and spread to the other parts of the body. Prostate cancer begins when cells in the prostate gland, in men, start to multiply uncontrollably. Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland itself, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. Unlike other forms of cancer, however, if detected early, prostate cancer has a very high rate of survival attached to it.

Despite the high rate of diagnosis for prostate cancer in older men, doctors have not been able to pinpoint one or more exact causes as to why prostate cancer presents itself in some men. What doctors do know is how the process of prostate cancer begins and spreads. Cancer begins when cells in the prostate become abnormal. Mutations present in the DNA of the cells cause them to grow and multiply more rapidly than normal cells would. These mutated cells continue surviving while the normal cells around them perish. The accumulating mutated cells form a tumour that can grow to invade the nearby tissue. These abnormal cells can also break off (metastasize) and spread to other parts of the body.

Although doctors have not identified a direct cause for the advent of prostate cancer in men, they have been able to identify risk factors that increase the chances of getting prostate cancer. These risk factors include:

  • Age: Statistics show that the older a person is, the more likely they are to be diagnosed with prostate cancer. The rate of diagnosis for men under 40 is 1 in 10,000. However, this rate shoots up considerably as the age bracket increases. The rate of diagnosis for men between the ages of 40 and 59 is 1 in 38, while the rate of diagnosis for men above the age of 60 is 1 in 14.
  • Family history/ Genetics: Another risk factor is the presence of prostate cancer in the family. If men in a family have a history of prostate cancer, then it is likely to be passed down onto the successive generations. Furthermore, if the women have a family history of containing the gene that increases the risk for breast cancer (BRCA 1 or BRCA2), then to the risk of prostate cancer increases for the offspring.
  • Obesity: Although there is no direct linkage between a high BMI and the risk of getting prostate cancer, it has been observed that obese men that have been diagnosed with prostate cancer usually suffer from the aggressive form of the disease.

One of the standout features of prostate cancer is also the reason why doctors strongly suggest that men over 40 get regularly screened for the disease, namely, that has no overt symptoms. Since prostate cancer starts in a relatively small gland, located in a relatively obscure position in the body, the disease stays silent for many years. In some cases, it has been seen in autopsies in patients that have died from other causes that they were suffering from prostate cancer as well, without having shown any physical symptoms for the same. However, in more aggressive forms of the disease, there are certain physical discomforts that can arise, these include:

  • A need to urinate frequently, especially at night; sometimes urgently
  • Difficulty starting or holding back urination
  • Weak, dribbling, or interrupted flow of urine
  • Painful or burning urination
  • A decrease in the amount of fluid ejaculated
  • Blood in the urine or semen
  • Pain or stiffness in the lower back, hips, pelvis, or thighs

However, these symptoms may also be indicative of the presence of other diseases such as Benign Prostatic Hyperplasia (BPH) or prostatitis.

Almost all forms of prostate cancer are adenocarcinomas, and they might vary between gestating slowly and gestating rapidly. Due to the lack of symptoms, until very late into the disease, physicians and doctors are usually adamant about their male patients above 40 getting checked for prostate cancer. Despite the widespread nature of the disease, there is still a lot of misinformation about it and a general lack of knowledge about it, amongst the general public. In the UAE itself, 20% of all cancer cases were those of the prostate kind. As men get older it is imperative that they get themselves checked for any signs of prostate cancer, because as mentioned earlier, early detection of the disease can go a long way in eliminating it from the body completely.

Dr.Nazeer Ahamed

Specialist Urologist 

Aster Clinic, Bur Dubai (AJMC)

Dr.-Nazeer-Ahamed

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Myths About Prostate Cancer

Prostate cancer is one of the most prevalent cancers among adult men in the UAE. In the larger conversation about male organs and glands, the prostate gland often gets overlooked. Part of the male reproductive system, located under the bladder in front of the rectum and surrounding the beginning of the urethra, the prostate is actually a small gland. As a key part of the male reproductive system, the prostate gland produces and secretes fluid into the semen. Despite its small size and limited function, however, the prostate gland too can become cancerous.

Cancer begins when cells in one part of the body grow uncontrollably and then start spreading to other areas. The spread of the cancerous cells may be slow or rapid depending on the type of cancer and the body’s response to it. Just like other forms of cancer, prostate cancer too begins when the cells in the prostate gland begin to grow uncontrollably. Although the prostate gland functions as part of the reproductive system in men, its close proximity to the bladder results in individuals with prostate cancer exhibiting many urinary symptoms such as burning sensation or pain during urination; difficulty urinating; loss of bladder control; blood in the urine (hematuria) etc. However, these are not definitive symptoms, hence, it is strongly advised for adult male’s post the age of 40 to get themselves screened regularly for prostate cancer.

Despite the wide prevalence of prostate cancer, the conversation about it is only limited within the medical community, which has led to the perpetuation of many myths and a serious lack of awareness about the condition in this region. Myths and misconceptions about such a serious medical condition can be harmful to those who might be at risk for prostate cancer but ignore their symptoms as signs of a less detrimental condition. Some common myths regarding prostate cancer include:

  • Prostate cancer only affects older men: Statistics show that the probability of getting prostate cancer is higher in older men, however, middle aged and men in their late 40’s are also at risk for prostate cancer. The risk factors for prostate cancer extends beyond age including race, family history, physical health, geography and lifestyle.
  • Lack of symptoms implies the absence of prostate cancer: Unlike other forms of cancer, prostate cancer can be completely asymptomatic, particularly in its early stages. In such cases, a diagnosis can only be made by a doctor during a checkup and follow-up tests.
  • Prostate cancer is a slow-growing cancer: This isn’t always the case. There are different types of prostate cancer often present in different parts of the prostate. There are those that advance slowly as well as those that advance rapidly and can be fatal in their outcome.
  • Since prostate cancer doesn’t run in my family, the odds are that I will not get it: Although the probability of developing prostate cancer is higher if it runs in the family, the fact remains that even those without a predisposed hereditary risk factor can develop prostate cancer.
  • The Prostate-specific antigen (PSA) test is a cancer test: The PSA test only determines the amount of PSA/ protein present in the bloodstream and not cancer. If an abnormal level of PSA is found, then the doctor recommends further tests to determine if the cause is prostate cancer. PSA test is not a prostate cancer determining test, for instance sometimes a high number may not mean you have the disease and a low number may not mean you don’t.
  • Vasectomy can cause prostate cancer: After extensive research, it has been concluded that vasectomy does not increase a man’s chances of getting prostate cancer.
  • Prostate cancer treatment results in incontinence or impotence: Although chemotherapy might have some side effects such as erectile dysfunction and urinary incontinence, these effects are subject to the patient’s age and physical health.
  • Prostate cancer is contagious: The chances of having prostate cancer increases in men who have a family history of the condition. But in no way, shape or form is prostate cancer contagious among men.

Despite the widespread prevalence of prostate cancer, early detection and treatment have led to a complete recovery for a majority of the patients. To put things into perspective, the 5-year, 10-year and 15-year survival rates are nearly 100%, 98% and 95% respectively. But it is important that men get regular screening involving either a Digital rectal exam (DRE) or the PSA test if they notice any unusual symptoms or urinary functions. It is also recommended that all men above the age of 40 get prostate cancer screening despite not showing any symptoms because it will help identify cancer early when the treatment is most effective. Prostate cancer is one of the few cancers that can be neutralised completely, once detected. All that is required is the right knowledge about the condition and the initiative to get yourself tested regularly.

Dr.Rahul Bhatt

Specialist Urologist

Aster Clinic, Bur Dubai (AJMC)

Dr.-Rahul-Bhatt

*Aster Clinics are currently running a 50% discount on prostate cancer screening in line with the aim of promoting awareness about the importance of regular screening especially for men over 40. For more information, visit – http://asterclinic.ae/prostate-cancer-screening/

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