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Latest advances in Diagnosis of Prostate Cancer

Dr N P Gupta,

Every year, a whopping 15 lakh prostate cancer cases among men are detected in India of which 85 per cent are stage four cancers, which means doctors do not give them more than three years to live. The irony is that unlike other cancers, if prostate cancer is detected early, then chances of treating it is almost 100 per cent, cancer specialists point out.

Who are at risk

The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease

About two-thirds of all prostate cancers are diagnosed in men age 65 and older. The older the patient, especially if they are over 70, 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 for prostate cancer

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 prostate cancer.

Symptoms

Not everyone experiences symptoms of prostate cancer. Many times, signs of prostate cancer 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 prostate cancer. These symptoms include:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • 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 will undergo a thorough work-up to determine the underlying cause.

Diagnosis: Per rectal examination of the prostate is done. If it is hard or irregular than cancer is suspected. A blood test PSA is done and if found more than 4 ng/ml, than prostate cancer is suspected. In a such situation, prostatic biopsy is advisable. Previously, trans rectal ultrasound biopsy use to be done which was blind and not specifically targeting the cancer, therefore diagnosis can be missed.

Latest advancement: Advanced MRI/TRUS Fusion biopsy

An accurate prostate tumour diagnosis and treatment depends on the ability to efficiently perform the biopsy on specific areas of the prostate. In this procedure, first multiparametric Dynamic MRI of the prostate is done. According to images, PIRAD scoring is done which indicates specific areas of cancer. These recorded MRI imagesare fused with a live transrectal ultrasound by a doctor who performs a MRI/TRUS fusion biopsy.

By fusing the MRI and live ultrasound images, the doctor can perform more effectively a targeted biopsy of the selected tissue revealed by MRI imaging.

The biopsy results leads to more accurate diagnosis leading to better management.

Survival rate

The good news is that the current survival rate for prostate cancer is more than 97% if diagnosed early when it is limited to the prostate. . A variety of treatment options like Robotic surgery and radiotherapy are available for this malignancy. Cancer of prostate is best treated when it is at an early stage. Even in advanced stage this cancer has best response to the treatment options.

Chairman,

Academic & Research, Medanta Kidney and Urology Institute,

Medanta, Gurgaon

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