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Magazine
Dealing with prostate cancer
DR SANJIVA WIJESINHA
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Since there are no symptoms in the early stage, add this to your annual medical checklist.
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Photo: Sandeep Saxena
Better to be safe: Check for prostate trouble regularly.
One of my friends (let’s call him Virender for purposes of confidentiality) developed prostate cancer last year. Virender has a doctorate and has spent most of his life reading, teaching and writing about English Literature. He is a highly crea
tive thinker, a prolific writer and a great raconteur.
Every year around the time of his birthday, Virender used to undergo his annual check up — subjecting himself to an ECG, having his blood pressure checked and getting blood tests done for diabetes, cholesterol, kidney and liver function. For the past six years he also got an annual blood test and digital rectal examination done for prostate cancer.
This last test — which measures a substance called Prostate Specific Antigen or PSA — is not a foolproof method of detecting cancer of the prostate. However, since the presence of cancer cells in the prostate gland is one of the causes of a raised PSA, measuring the level of PSA in the blood can give a suggestion that a prostate cancer may be present and thereby indicate the need for further investigation.
Alarming results
When Virender’s test results came back, everything else was normal, except for the PSA, which was found to be elevated. Until a few years ago, the normal level of PSA in a man was accepted to be four units but recent evidence has shown that PSA levels naturally rise gradually as a man gets older, so while a level of four is considered normal for a man in his fifties, the normal level in a man in his forties is about 3.5 while a man in his late sixties should be considered to have an abnormal test only if his PSA level was over 5.5. Virender’s PSA unfortunately came back as 11.3.
Just to make sure that the result was accurate the test was repeated two weeks later. The result this time was reported as 11.5. So without further ado, I referred him to a specialist who has experience in dealing with urological cancers.
Now the prostate gland is situated in the lower part of a man’s pelvis; it sits just underneath the bladder and cannot be felt unless the doctor inserts a gloved finger into the patient’s rectum and feels towards the front of the rectum. When the specialist performed this examination (called a Digital Rectal Examination or DRE) he thought that there were no cancer nodules to be felt but, being concerned by the high level of PSA, decided to perform a biopsy of the gland.
It was fortunate that he did because this biopsy from the interior of the gland revealed the presence of high grade cancer cells. These were not the indolent “slow growing cancers” that is associated with the prostate gland, but virulent forms that would soon spread unless dealt with aggressively.
Different options
Today, we have several different methods of dealing with prostate cancer. One option is radical surgery where the surgeon cuts into the abdomen and removes the affected prostate gland completely. Another option is to use radiotherapy — special forms of rays (like X-rays) that destroy the tumour. Another method is to employ chemotherapy — injecting cancer-destroying drugs into the body — while different forms of hormone treatment can also be utilised to slow down the growth of these tumours.
Several factors affect the choice of therapy in an individual patient, so Virender and his specialist discussed in detail the options for treatment, and decided to go for radiotherapy. One of the better known disadvantages of radiotherapy is that the rays employed to destroy the cancer cells can also destroy normal cells in the vicinity of the tumour. Patients undergoing radiotherapy for prostate cancer would often suffer serious side effects such as nausea, vomiting, bloody diarrhoea and bladder irritation. Today however, radiotherapists have developed methods of very accurately focusing the cancer-killing rays and precisely delivering carefully calculated doses of radiation on to the target area (far more precisely than the “precision bombing” that the Americans inflicted on Baghdad). Virender underwent 48 days of radiotherapy with no adverse side effect.
Lessons
The three lessons that can be learned from Virender’s experience are
Having your PSA measured annually along with a digital rectal examination to feel the prostate is a good way to keep track of your prostate gland’s behaviour. If the level is higher than would be expected for your age, or if nodules are felt on the gland, it does not necessarily mean that you have prostate cancer but it is useful information that your doctor will use in helping to decide whether to perform further investigations to exclude a prostate cancer.
Prostate cancers cause no symptoms in the early stages. If you wait for symptoms (the standard ones described in surgical textbooks are bone pain and passing blood in the urine) this only means that the cancer has spread to the bones and the bladder, and has progressed beyond the curable stage.
Radiotherapy today is a different entity to the blunderbuss type therapies of the last century when cancerous organs were bombarded with rays that killed cancer cells and laid waste some of the surrounding tissues as well. Radiotherapists now have methods (implanting radioactive seeds into the prostate is one, using computer-focused external beams is another) of accurately delivering treatment to the prostate so as to maximise efficacy and minimise side effects.
Today, with his PSA back to less than one, Virender feels well and, at 66, still reads, writes, cycles, and continues to entertain us with his stories. Listening to his own story of dealing with prostate cancer, however, can be a salutary lesson and education for all of us.
Dr. Sanjiva Wijesinha practises as a family physician in Australia.
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