November ends but prostate cancer concerns remain

Early screening and lifestyle changes key to prevention

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Dubai: November may have come to a close but there is no end in sight to the concerns surrounding the rise of prostate cancer, awareness about which is typically raised during the month,

One question that has come to the fore during the month-long focus on prostate cancer is whether taking health supplements with testosterone to bulk up muscles be the reason for the rising incidence of prostate cancer in the UAE?
According to the International Agency for Research on Cancer (IARC) at the Global Cancer Organisation in the UAE, nearly 12.2 per cent new cases of cancer among males in 2018 were that of prostate cancer.

The UAE is determined to bring down cancer fatalities to 18 per cent by 2021. Reducing the number of deaths due to cancer is one of the key performance indicators of the pillar of world-class healthcare of the UAE National Agenda.

 

According to the European Association of Urology, prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.1 million being diagnosed with it worldwide in 2012, accounting for 15 per cent of all cancers diagnosed globally. Anabolic steroids used by older men can expose them to risk of prostate cancer.

 

Dr Ahmed Moharram, Specialist – Urology at Bareen International Hospital – MBZ City in Abu Dhabi, UAE said while it is difficult to detect such health supplements, the incidence of the cancer in advanced ages is real. “There are no reliable statistics about abuse of anabolic steroids as they are given by non-licensed personnel without prescription. But generally speaking, the risk of testosterone injection leading to prostate cancer is directly proportional to a person’s age as the risk becomes higher with getting older,” said Dr Moharram.

 

He added that most urology specialists strictly advise men to avoid taking anabolic steroids for non-medical and recreational conditions due to the adverse effects on the fertility status, sexual performance and testes atrophy with time. “It is important we draw the attention to this abuse on the possibility of accelerating the risk of prostate cancer in older men. This should not be confused with hypogonadal men receiving testosterone as replacement therapy because keeping testosterone on normal levels even by injectable testosterone does not increase the risk of prostate cancer.”

 

What is prostate cancer?

This is a cancer that develops in the prostate gland in males. The gland stores semen and is part of the male urogenital anatomy.

According to Dr Sanjay Bhat, specialist urologist at the Prime Hospital, “ Prostate cancer is definitely among the top five cancers in the Middle East and is probably the second commonest cancer in men over 60.”

 

Who is at risk?

According to Dr Bhat, men with a clear genetic history of prostate cancer in the family are in the high risk group. “In addition, obesity, lack of high fibre in the diet, advancing age are some of the factors that can trigger tumours in the prostate.”

 

Dr Moharram added: “it is clear above that as every man gets older, his risk of having prostate cancer gets higher. Besides that, a positive family history (paternal and maternal) also increase the risk of having prostate cancer in younger ages. Statistically speaking, Africans and African Americans are more prone to contract this condition. Obesity and bigger waist circumference are associated with increased risk of high-grade prostate cancer (European Association of Urology 2019). Other factors include balding, gonorrohea, HPV 16, and cigarette smoking may have increased risk of developing prostate cancer (European Association of Urology 2019).”

 

Is it asymptomatic?

The key for early detection is annual screening even without any symptoms. Doctors say not to wait for symptoms to develop and go in for preventive screening after the stipulated age.

Dr Moharram added: “A sign of advanced metastatic disease incudes urine outflow obstruction, blood in urine and semen, bone pains or coughing blood.”

 

1. A burning sensation while passing urine

2. Emptying bladder completely seems difficult

3. Frequent urge to urinate especially in the night

4. Blood in the urine

5. Back pain in case the cancer has metassed to other organs

6. Loss of bladder control

What age should men go for screening?

According to the European Association of Urology 2019 guidelines, men over 50 years or over 45 years with a family history of prostate cancer or if they are African-Americans.

Diagnosis

More than 90 per cent of prostate cancers are reversible.

“The good news is that prostate cancer is reversible if detected early. So it is important for men to get a Prostate Specific Antigen (PSA) screening done annually once they cross 50 years. For those with a family history of the cancer, it is advisable to go in for screening from the age of 45 onwards,” said Dr Moharram.

The PSA is a protein found in the prostate gland and a high PSA reading is a marker for this cancer and when it is found high doctors have to conduct physical examination such as a transrectal biopsy and MRI to confirm diagnosis.

 

Preventive steps:

• Stop smoking

• Exercise to reduce obesity and waist-hip ratio

• Avoid consumption of rich foods, red meats

• Avoid high fat and rich dairy products

Treatment

1. If detected early, radical prostectomy, followed by chemotherapy to destroy traces of all cancer cells. In case it has spread to the bones, radio frequency ablation or RFA is done.

2. Hormone therapy is used in the early stages to neutralise the prostate gland. Dr Khalid added: “If the cancer has metasised to the other organs we usually try and do a hormone therapy. If a person develops prostate cancer beyond the age of 75 we usually put this individual on active surveillance.”

3. Cryo therapy including freezing of the cancer cells.

 

Robotics the best technique for prostate surgery

 

DUBAI: Robotic surgery that is minimally invasive and promotes faster healing has been recognised as the best method of dealing with prostate, kidney and bladder cancers worldwide and might soon be introduced in the UAE.

 

Dr Mani Menon, an Indian born American surgeon, distinguished chair of the Raj and Padma Vattikutti Foundation at the Henry Ford Hospital in Detroit, thinks the time is ripe for the UAE to adopt robotic surgery for major urological cancers. During his visit to Dubai last week, Dr Menon who is the chairman of urology at the Henry Ford Hospital, spoke about the efficacy of robotic surgery in treating urology cancers especially prostrate.

 

“I have spoken to at least two hospital groups here and both have initially agreed upon looking at the possibility to introduce robotic surgery for treating certain kinds of tumours as this is the next natural and logical step as we enter into an area of sophistication guided by modern technology.

 

As a pioneer of robotic surgery in US, Menon has performed several robotic surgeries that include nearly 4,000 robotic prostatectomies and is considered a world authority on the use robotic surgery for prostate cancer. Menon told Gulf News: “Robotic surgery allows for precision and magnifies the image of the site several times making it far more convenient for the surgeon to perform intricate procedures. The surgeon sits in the same room and is enabled by wifi to see the surgery site magnified several times. He is able to go in using the robotic arm through a very small incisions, conduct precise excision and suturing. It’s neat and almost blood less that makes healing far more quicker. The virtual reality view provides the surgeon with a unique insight and perspective and a sense of ease in conducting the surgery. The prognosis for these kind of surgeries is very positive, Most modern surgeons can train in the techniques and perform surgeries with high precision reducing the margin of error,” said Dr Menon.


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