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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Recurrent Headache

A headache is one of the most common and painful conditions for which a patient seeks medical attention. Globally, the percentage of the adult population with active headache disorders are 46% for headaches in general, 11% for migraines, 42% for tension-type headaches and 3% for chronic daily headaches. The disability attributable to tension-type headaches is larger, worldwide than that due to a migraine. On the World Health Organization’s ranking of causes of disability, headache disorders fall into the 10 most disabling conditions for the two genders, and into the five most disabling conditions for women.

Headaches are divided into two broad categories which are, primary headaches (without any underlying cause) and secondary headaches (with an underlying cause).

Primary headaches usually include Migraines, Tension-type headaches and Trigeminal Autonomic Cephalalgias. With migraines and tension-type headaches being the most common causes of headaches.

About 90% of headaches are caused by primary headaches, with the remaining 10% being caused due to secondary headaches. The responsibility of the clinician is to identify a secondary headache (which is more dangerous) as early as possible in order to prevent complications. There are some warning signs or red flags for the diagnosis of a primary headache. The presence of these red flags indicates the diagnosis of a secondary headache. The red flags are as follows.

  • A headache that is worse in supine, disturbs sleep or presents immediately upon awakening
  • A headache triggered by a cough, Valsalva, bending & exertion
  • A headache associated with Visual obscuration’s, double vision, transient changes in vision with change in posture
  • Vomiting preceding the headache
  • Headache onset after the age 50
  • First severe headache of life
  • Worsening of headache day by day
  • A headache associated with known systemic illness or systemic symptoms (Fever, neck stiffness)
  • A headache with abnormal neurological examination
  • New onset severe Headache during pregnancy or post-partum
  • A headache worsened in standing & relieved in supine
  • A thunderclap headache (time to peak headache intensity is sec to 5 min)
  • A new headache in a patient with AIDS and cancer patients

If the patient has a headache and presents any of the above features, it is important to rule out the secondary causes of a headache by doing the appropriate investigation (which in most cases is a brain MRI).

If the patient does not have any of the red flags, and their history is suggestive of one or more of the primary headache syndromes then the diagnosis does not require further tests and investigation.

The historical points in favour of the diagnosis of migraines are as follows:

  • One-sided headaches with alternating sides getting affected
  • The presence of visual or sensory aura symptoms before a headache begins.
  • Associated with nausea, vomiting, irritation of light, sounds and or smell during a headache
  • Pulsating nature of a headache
  • Triggered by a lack of sleep, stress, fasting, excess sunlight exposure, strong smell, travel, food items etc.
  • A headache worsened by and causing the restriction of the movements

The historical points in favour of tension-type headaches are as follows:

  • Both sided headache
  • Pressure like or band-like sensation
  • No or mild nausea, irritation of light or sounds (Any one of them)
  • Mild to moderate in severity
  • Usually not aggravated by movement

 

Patients with recurrent headaches should seek medical attention to decide whether they are suffering from the primary or secondary cause of a headache.

If it is a primary headache condition, it is important to prevent the medication over-use i.e. overuse of over the counter painkillers. They are detrimental because of two reasons 1) Painkiller overuse itself can trigger a headache 2) Long-term effects on the kidneys

If it a secondary headache condition, it is important to determine the appropriate cause by relevant investigations to prevent any further complications.

 

Dr.Vishal Pawar

Specialist in Neurology 

Aster Speciality Clinic, International City 

Dr.-Vishal

 

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Are you feeling SAD this season?

Have you ever experienced being sad, irritable, moody or have you lost interest in your usual activities all at the same time every year? We have all heard about seasonal changes, even in areas that have only two seasons, but have you heard of seasonal changes in a person?

As surprising as it may sound, some people experience a serious mood change with the change in weather, some people feel down and experience seasonal depression during the winter months particularly. This is a psychological condition known as Seasonal Affective Disorder or SAD.

When the temperature levels drop and winter begins to set in, we all begin to function a little slower. We feel like staying at home and cuddling in a blanket to stay cosy. For some people, this feeling gets critical to an extent that it begins interfering with their lives. It is normal to feel irritable or tired during the winter months because of reduced light and shorter days but if this becomes a recurring issue every year during the winter months, making it difficult to function normally, chances are that you may be suffering from Seasonal Affective Disorder. SAD is a sub-type of depression that comes and goes during seasons.

Feeling slightly down every now and then is normal as everybody goes through this feeling at some point in time. However feeling sad and depressed can sometimes become incapacitate and have severe consequences to the extent of the person feeling suicidal.

Symptoms of Seasonal Affective Disorder vary from feeling depressed throughout the day for almost every day, having very low energy, no interest in things you generally like to do, to feeling irritated, having difficulty in concentrating, sleeping etc. Symptoms also vary depending on seasons. The winter specific symptoms of SAD include tiredness, changes in appetite, weight gain, feeling lethargic, feeling of heaviness in the limbs, hypersensitivity to rejection, withdrawal symptoms etc.  However, the symptoms of depression aren’t always as obvious, as they manifest themselves in many other ways. Sometimes the changes may be very subtle and the person undergoing the changes may fail to realise it, although people surrounding will surely notice the changes.

Melatonin is a hormone produced in our body to regulate sleep and wakefulness. Light affects the amount of melatonin produced in the body. Normally melatonin levels remain high throughout the night and drop in the morning. This may differ with seasonal changes, during the shorter days the body may produce melatonin either earlier or later than usual, hence leading to symptoms of SAD. This causes a disruption in the normal functioning of the body’s internal system because melatonin slows down the nervous system and induces sleep and low levels of energy.

Seasonal depression in the winter is linked to excess production of melatonin, however, SAD may affect people even in the summer months. Research shows that people in the UAE suffer from the inverted form of SAD where people feel that they are trapped indoors because of the scorching heat in this region during the summer months. The study also established a link between depressive symptoms and decreasing levels of Vitamin D.

SAD, however, is a treatable disorder and the awareness among people about the condition is rather less. There are some ailments that can be resolved without medical help, however certain symptoms, particular symptoms of SAD when appears all together is an indication that urgent medical attention is required.  Consulting a specialist on noticing any of the visible and obvious symptoms of depression is recommended. At an individual level, on noticing symptoms of SAD, one can undertake a few steps like;

  • Soaking up some sun even in the winter months. Sitting by the window, opening all the blinds or curtains during the day will help absorb as much sunlight as possible. Even the smallest amount of sunlight counts.
  • Regular physical activity is a must to keep the body from feeling lethargic and to keep the blood flowing. Simple exercises like stretching or yoga can be done indoors.
  • Photo therapy, the practice of light treatment can be used to mimic sunlight, the feeling of being in the sun indoors. It can also be used even during the dark hours.

Despite all this, medication and therapy may be required if the symptoms get too extreme. Getting over the symptoms of SAD may not be as easy as it may seem. Sometimes people require extra help because if the symptoms get severe, people may resort to activities like excess alcohol intake, drug abuse and even suicide. There are a number of treatment options for SAD and it is best to visit a doctor sooner than later when new symptoms develop.

Dr.Mohammed Yousef

Specialist Psychiatrist

Aster Clinic, Al Muteena (DMPC)

Dr.-Mohammed-Yousaf- muteena

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