By Dr Vipin Sisodia, Consultant- Urology, Yatharth Super Specialty Hospital, Greater Noida
Prostate gland is the most talked about organs in men that usually enlarges with aging (especially after 50 years of age) and obstruct the urine flow. There is a dire need to raise awareness about the importance of the effective functioning of this gland, and if someone notices a change in the pattern of the normal passage of urine, it is important to seek urologists’ opinion. A urologist would categorize your symptoms and run some tests like urine exam, ultrasound, uroflowmetry and Prostate-specific Antigen (PSA).
For most of the mild symptoms one may not need any treatment but only lifestyle changes would help. But in case if the symptoms are bothersome, affecting sleep or disturbing daily routine, further group of medications may help in subsiding the symptoms. The first group of medicines helps in relaxing the muscles outlet and the second group of medicine is prescribed to reduce the size of the prostate.
“In some patients, despite medications the symptoms worsen leading to blood in urine, recurrent Urinary Tract Infection (UTI) or changes in the backpressure in the kidneys, and a prostate surgery remains the only option. The surgery is different from the one done for treating prostate cancer, it is an endoscopic surgery done by passing an endoscope through the urethra, a tube inside the penis, and the prostate is removed in chips to create a lumen for smooth passage of urine. Energy to cut the prostate may vary from electric current to laser energy, and as the procedure is done under anesthesia, the patient may require hospitalization for 2 to 3 days.
The second common problem of the prostate is cancer. 15% of all men have a chance to develop prostate cancer with increasing age (after 80 years of age) irrespective of the genetic condition. In such cases, the progression of the disease is slow with high survival rates in comparison to prostate cancer caused due to gene mutation.
Despite the fact that the prevalence of prostate cancer among Indian men is 25 times less than those in western countries, it is still the 12th leading cause of mortality and morbidity in India.
Prostate cancer being one of the most common types of cancers among males usually grows slowly and during the initial stages remains confined to the glands. In comparison to other cancers that are highly metastatic in nature, prostate cancer is less common under the age of 50 years.
As the stages progress, the condition worsens and may lead to bone fractures, spinal pain, fecal and urinal incontinence and weakness in legs. Those vulnerable need to undergo PSA test to confirm or rule out the possibility of prostate cancer, and if the prostate levels are high, MRI of the prostate followed by prostate biopsy may be done. Once the diagnosis of the prostate cancer is confirmed, then imaging in the form of bone scan or PSMA PET CT is done to check if the disease is localized within the prostate or metastasized to other body parts.
If cancer is localized to the prostate, then surgical treatment is the best option particularly if the patient has symptoms. Radiation and hormone therapy is an alternative to surgery. For surgery, the whole prostate is removed instead of channelling done for non-cancerous enlargement of the prostate. The robot is used by the surgeon to facilitate the removal of the prostate and it is not done by the robot as commonly perceived. Surgery may affect men’s sexual power and may cause temporary urine leaks for which they have to wear diapers for 2 weeks to 3 months. 98% of men get better as for as continence is concerned by one year.