Men’s health: Prostate problems and decreased urine flow are not natural. Doctors bust myths
With the massive rise in the elderly population that is growing by the day, prostate problems are becoming a major concern but people are unaware of the severity of the situation and believe that prostate is just a natural occurrence with age. The prostate is the second leading cause of cancer among males in large Indian cities like Delhi, Kolkata, Pune and Thiruvananthapuram, the third leading cause of cancer in cities like Bangalore and Mumbai and it is among the top ten leading causes of cancer in the rest of the population.
Despite significant advances in healthcare, around 60 – 65% of prostate cancers that doctors encounter on a regular basis are in stage 4 because they are detected at a later stage. If we get routine check-ups, it is conceivable that health experts can diagnose it in the early stages and men can be cured.
Prostate cancer is on the rise, and the symptoms make it difficult to differentiate whether it is cancer prostate or a benign prostate condition. In an interview with HT Lifestyle, Dr Ramesh K Juvekar, Urologist, Andrologist, Reconstructive and Transplant Surgeon at Mumbai Central’s Wockhardt Hospitals, revealed that the patient with symptoms of prostatic obstruction usually presents:
• Frequent and urgent need to urinate
• Difficulty starting urination
• Slow (prolonged) urination
• Increased frequency of urination at night
• Stopping and starting again while urinating
• The feeling you can’t completely empty your baldder
• Urinary tract infection
• Blood in the urine.
Myths and facts:
Dr Abhay Kumar, Head – Urology, Surgical Oncology, Robotic Surgery at Medica Superspecialty Hospital, listed various myths when it comes to the prostate:
– Very often it is believed that prostate problems and decreased urine flow are natural as they age but this is not the case.
– It is a common misperception that prostate problems always necessitate surgery; however, the fact is, many times, prostate problems can be treated with medications.
– A spike in PSA (a blood test) is thought to represent prostate cancer, but in reality, a patient’s PSA might be elevated for a variety of reasons that may not be cancer.
– Normal PSA is sometimes said to rule out prostate cancer, but roughly 25% of prostate cancers have normal PSA.
– It is widely assumed that once a person has been diagnosed with prostate cancer, there is no cure. However, it can be very easily cured, and patients suffering from stage four cancer also can have a meaningful life. However, if detected early on, it can be completely cured using various new techniques and robotic surgery.
He said, “As doctors, we would always advise our patients to have a routine check-up for their prostate health and awareness and get it cured if there are any problems.” Dr Ramesh K Juvekar shared some facts about prostate problems which cannot be ignored:
1. An enlarged prostate – An enlarged prostate is common in men over 50 years. This condition is when the prostate gets bigger as you get older. It is sometimes called benign prostatic hyperplasia (BPH) or benign prostatic enlargement (BPE). It is not cancer and there are ways to treat it. BPH can co-exist with CA Prostate. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.
2. Prostatitis – Prostate inflammation- this is kind of a urinary tract infection in men. This infection is rarely serious but consulting a Urologist is important.
3. Prostate cancer – Prostate cancer is most common among men, together accounting for nearly one-third of all male cancers (reference). The growth of cells is controlled in the body. Dead cells are replaced in an orderly manner. If the cells grow in an un-uncontrolled manner inside the prostate, this can lead to cancer.
Bringing his expertise to the same, Dr Balaji Ramani, Senior Consultant, Department of Surgical Oncology at MGM Healthcare, spilled the beans on other prostate cancer myths and facts:
Myth 1: Prostate Cancer is for older men
Fact: While majority of men diagnosed with prostate cancer are older, it can affect younger men, too. In fact in the Western world 40% of this Cancer occurs in men 65 years of age
Myth 2: My father had Prostate Cancer, so I will too
Fact: Not everyone with a family history of prostate cancer will get it. Generally a positive family history will double the risk as compared to the general population but still is overall less. Such patients and individuals may need Genetic testing and proper screening and we can easily detect and treat prostate Cancer in them.
Myth 3: Prostate Cancer treatment always causes incontinence/ sexual dysfunction
Fact: While radical surgical treatment may lead to minor incontinence/impotence; with current advances of Laparoscopic and Robotic surgery and better techniques of radiation many men are essentially normal after therapy
Myth 4: Increased serum PSA is always prostate Cancer
Fact: Rise in serum PSA can occur in a variety of conditions ranging from a simple physical examination to prostate infection and surgery to prostate cancer. A rising level should be the trigger to look for prostate cancer but it’s usually due to benign enlargement of the gland. Currently serum PSA is used as a screening tool to identify prostate cancer early after discussing the risks and benefits of treatment of early prostate cancer
Myth 5: Prostate Cancer always needs surgery and radiation for treatment
Fact: The management of prostate cancer is multidisciplinary and often involves minimally invasive surgery like robotic or Laparoscopic surgery and/or Radiation therapy. Advanced cases may need various types of chemotherapy immunotherapy etc. That said there are a number of low grade prostate cancers that can be kept on Active Surveillance quite safely. In fact many patients die with Prostate Cancer rather than OF Prostate Cancer as it is usually one of the most indolent human cancers.
Dr Muruganandham K, Senior Consultant and Head, Department of Urology and renal transplantation at Chennai’s Gleneagles Global Health City, added to the list:
Myth 1: All urinary symptoms are due to Prostate in men
Fact: Urinary symptoms can also be caused by Bladder problems, urinary infection, urinary stones, and other medical illnesses.
Myth 2: Bigger the prostate worse are urinary symptoms
Fact: While this may seem logical, it is not true. In some cases, significant swelling can result in minimal symptoms, while minor swelling causes serious complications.
Myth 3: Benign enlargement of the Prostate may become cancer in the long term
Fact: Its initial symptoms are close to those of prostate cancer, but BPH itself is a non-cancerous condition.
Myth 4: BPH affects men only in the 70s and 80s
Fact: Age is a risk factor, but not a demarcation line. Even men in their 50s can have BPH
Myth 5: There is a strong link between sexual function and prostate enlargement
Fact: Neither infrequent sexual activity nor frequent sexual activity has shown any impact on the rate of BPH or prostate cancer
Myth 6: BPH is part of aging, and you cannot do much about it
Fact: Lifestyle changes and safe medicines help improve prostate patients’ quality of life.
Myth 7: All BPH patients need treatment
Fact: Prostate enlargement alone does not warrant any medical treatment. Needs further clinical evaluation by a urologist to rule out prostate cancer and to decide on treatment
Myth 8: Take excess water if you have urinary symptoms
Fact: Taking excess water does not help in many of the prostate-related symptoms and sometimes it can aggravate existing symptoms or risk life.
Myth 9: I don’t have any symptoms….so I don’t have prostate cancer
Fact: Prostate cancers can be completely symptom-free in the initial phase
Myth 10: Surgical treatment for prostate is very risky
Fact: Minimally invasive surgical procedures are safe and effective in relieving the symptoms and improving the quality of life
According to Dr Ramesh K Juvekar, symptoms of prostatic obstruction on routing screening of PSA together with biopsy in suspected cases can diagnose prostate cancer, therefore PSA screening in elderly patients every year is mandatory. Routine sonography together with PSA screening. If PSA is high above the prescribed level then a prostatic biopsy is done under sonography guidance. If the biopsy is positive then further investigations to detect the spread of prostatic cancer need to be followed. Every patient with prostatic symptoms should report to the urologist and not a physician for screening of his prostatic symptoms