Download Prostate

AWARENESS
OR
IGNORANCE
Dr Vinod Javeri
Consultant Urologist / Andrologist
410 Doctor House
Opposite Jaslok Hospital
Tel: 2351 9179, 9820039428
Awareness or ignorance
Is it difficult to choose?
We gather information of
• Finance sector
This information is
• Real Estate
• processed
• Political Situation
• analyzed
• Entertainment
• understood and
• Spiritual
• implemented
With the aim to
Develop & Evolve
What about Health?
• Limited Awareness – Chest Pain, heart attack,
heart stops means ...
• Rest of the body ? How much do you know your body ?
• How many people read health related literature
and ask questions to the doctor ?
• How many doctors like answering questions?
• Medical faculty – lost people’s faith
• How can we as doctors get it back ?
• Spread Awareness
Body, a Vehicle
• Soul and Body
• Birth to Death
Womb to Fire/Grave
• Sanskar
• Owner and Car
• Factory to Scrap
• User’s manual
Awareness
• BODY
• Good Use and care :
Good health: Health
•
•
•
•
•
•
•
CAR
Good use and Care
Regular maintenance
Engine Tune ups
Good Fuel and Good Oil
Smooth running
Serves for a long time
physical mental social and
spiritual well being (WHO
definition)
• Regular diet exercise
• Health checks
screening for diseases
awareness.
• Better quality of life till
as long
• Bad Oil, bad fuel,
improper use, accidents
• Increased maintenance,
more troubles,
• Small troubles ignored
• Car breakdown
• Owner in trouble blames
the manufacturer
• Bad food & drink habits
• Stress, Anger etc
• Frequent diseases,
admissions to hospital etc.
• Health Emergencies or last
stage diseases - CANCER
• Starts blaming – GOD,
somebody but never
himself finally when
nobody can be blamed;
blames the DOCTOR
Urology
Organ found only in
Males
located between
Urinary Bladder
And
Urethra (peeing tube)
Prostate
What does it do ?
• Contributes in the formation of
Semen, Virya, dhatu (20%)
• Prostatic Secretions are
important for liquefying the semen
normally within half an hour after
ejaculation
• The sperms that are formed in testes
are transported through a tube that
opens in the prostate. They are
released in the form of Semen
• It thus, plays a role in Reproductive
function
What controls it ?
The functional control of
Prostate, its size and
development depends
on the male hormone.
Name it ?
Beyond the age of 45yrs
prostate starts to increase in size.
What happens when it grows
beyond a certain point?
Benign enlargement of prostate
“When the hair becomes gray and scanty, when
specks of earthly matter begin to be deposited in
the tunics of the artery, and a white zone is
formed at the margin of the cornea, at the same
period the prostate gland usually - I might
perhaps say invariably - becomes increased in
size”
- Sir Benjamin Brodie
Symptom Score
and
Quality of Life Score
Incomplete
evacuation,
Frequency
Intermittency
Straining and
Weak stream
IPSS: International Prostate
Symptom Score questionaire
Multilingual validation
Urgency
Nocturia
Men Age 50 years and more
After 45 yrs prostate starts growing.
Roughly at 50-50% have big prostate,
60-60%, 70-70%, 80-80%
Increasing peeing problems
Sleepless nights busy days
Bathroom MAPPERS
Stops going outdoors
Symptoms
A man walks into his doctor's office and sits down in the
waiting room. While he is waiting his turn to be seen, a
casual acquaintance walks in and sits down next to him.
The newcomer asks
"W w what are yyy you ddd doing here?"
The man replies, " I am waiting to see the doctor."
"W wwhy dd do yyy you wwant to sss see hhim?"
The man replies,
"Well, if you must know, I have a prostate problem.
“A pp prostate ppp problem, wwhat's ttthat?”
"Well, if you must know. I pee like you talk."
Definitions
• Frequency: urinate again within 2 hours
• Nocturia: Number times you get up to urinate
after you go to bed
• Hesitancy: difficulty in starting urine
• Intermittancy: stop and start urine
• Urgency: difficulty to control or postpone
• Urge incontinence: leak due lack of control
• Weak Stream: narrow slow and near
• Straining: put pressure with belly to pass urine
• Incomplete evacuation: feeling of incomplete
emptying of bladder
Types of symptoms
Irritative
Obstructive
Frequency
Nocturia
Urgency
Urge Incontinence
Hesitancy
Weak Stream
Interruption of stream
Narrow and weak
stream
Feel of incomplete
emptying of bladder
Complications
Overflow
Kidney
Of Urine
&
Bladder
damage
Bladder
stone
Infections
Sudden
retention of
Urine
Bleeding
Seek help earlier
than you think you
will
Treatment started at
right time will give
better results
Stitch in time saves
nine
Treatment
Medicines
When can we treat
With medicines ?
Mild to Medium
symptoms
No complications
caused by the disease
process
In Patients who are
Not fit for surgery
Two groups of medicines:
To reduce spasm of prostate muscles
To reduce size of prostate
Surgery
If - The medications fails to
achieve satisfactory goals and
peeing problems are persistent
or worsening
If - Stone in bladder
If - Pumped up Bladder
If - Back pressure on kidneys has
set in
Transurethral Resection of
Prostate ( TURP )
Cancer
American Cancer Society (ACS)
Cancer is a
group of diseases
characterized by
uncontrolled growth
and spread of
abnormal cells
without any function.
If the spread is not
controlled,
it can result in death.
Cancer
Cancer Prostate
If you wait…
It may be late
FACTS
• In USA
• Prostate Cancer
commonest cancer
in males -- 33%
• In India
• Prostate Cancer 3rd
commonest Cancer
in males of Mumbai
• Bladder Cancer – 6th
commonest cancer
in males 4%
• Bladder cancer 8th
commonest cancer
in males of Mumbai
Cancer facts and Figures 2004
American Cancer Society
Mumbai Cancer Registry
Ca Prostate some more facts….
More than
80% disease come
when the cancer has
already
SPREAD
Srinivas et al 1995
Some more
1 in every 59 male will
contract Ca Prostate
Asian Pac J Cancer Prev. 2004
Oct-Dec;5(4):401-5.Related Articles, Links
Mumbai 4th most populated city in the world
with a population of 18 million (1 crore 80 lacs)
United Nations 2005 report published on expressindia.com press trust of India
How many Cancer prostate are we diagnosing,
treating for cure or for palliation ?
Diagnosed
Cases
Tip of an
iceberg….
Undiagnosed
cases
Deaths caused by prostate cancer
1990-1996 data
Mumbai Cancer Registry
•
•
Graph shows Number of deaths by five year age group
Total deaths : 583 (4.02% of all, highest being esophageal cancer 9.7%)
300
279
CaP deaths
250
200
150
127
100
74
45
50
3
6
40-44
45-49
18
29
0
50-54
55-59
60-64
65-69
70-74
75 >
Its there…
we are getting it late..
Why are we getting it late ?
“I have no problems why should I go
to the doctor, he will unnecessarily
do some tests and fish money out of
me, don’t you know these modern
day commercialized doctors”
Mumbai Cancer Society
740 patients CaP 1987-1991
Survival Information on 602 patients
50
41.6
45
40
49.2
Percentage
35.1
35
30
23.5
25
20
12.7
15
10
5
0
Overall
survival
Relative
survival
Organ
confined
Local
spread
Distant
spread
Prostate cancer in comparison with the
leading site of Cancer in various PBCR’s
20
Commonest
Prostate
18
16
Lung
15.2
18.6
18.7
Lung
Lung
Stomach
14
Lung
13.2
14
Lung
Lung
12
12
Esophagus
11.4
11.4
Stomach
3rd
10
8
8
6
4th
5.2
4th
9.1 8.6
5th
8.9
Mouth
Mouth
7.8
5th
8th
5
5
5.3
7th
5th
6.6
5th
4
3.6
4
Hypo pharynx
9.3
2
0
0
Banglore Barshi
0
Bhopal
Chennai
Delhi
Mumbai
Ahmbd
Krngplly Kolkata
0
Nagpur
Pune
Thirup'm
Does Cancer Prostate have any symptoms
signs or indications?
Of all patients with urinary symptoms 20%
may have prostate cancer
Thus 80% patients who may be having
Prostate cancer in its early stage
do not have
Urinary symptoms or any other symptoms
We need to look for it….
HOW?
Awareness
If aware one cannot be
fooled
Ignorance invites trouble
When early prostate
cancer has no
symptoms what can be
done to avoid being
late before the cancer
really spreads?
Mantra for Early
Detection
Blood test :
PSA ( prostate specific antigen)
Examination:
Digital Rectal Examination
( feeling the prostate with a finger)
PSA (Prostate Specific Antigen)
• 0 - 4 ng/ml considered normal, if they undergo biopsy
25-30% may have cancer all will be organ confined
• 4 – 10ng/ml
patients if undergo prostate biopsy more than 70% will
have Cancer
Of them 70% are likely to have prostate confined disease
• 10 – 20ng/ml
higher risk of hidden spread to bones more than 50%
• 20 – 50ng/ml
risk of spread to bones more than 70%
• 50ng/ml and >
spread to bone and LN more than 80%
Digital Rectal
Examination
Feeling the
prostate gland
with the finger (digit)
Hard or bumpy prostate
higher the risk of Cancer
Smooth big softer prostate –
non cancer enlarged prostate
Doctor to whom you go
should know what, how to
and what to feel on the prostate
If not done by a right person there
Can be some accidents in the clinic
TRUS BIOPSY
Diagnosis
Grade - Type of Cancer
under the microscope
Gleason’s Score out of 10
( e.g. 7 / 10)
Stage - How much has it
spread in local area or far
distant area
Bone Scan
Radical removal of prostate
Radical Prostatectomy
After effects of surgery…
• Leaking of urine upto 3mon
sometimes upto 1 year (waiting
increases the risk)
• Sexual function: Nerve sparing
and non nerve sparing
• In experienced and skilled
hands the chances of above
are less but it depends upon
the stage and grade of disease
• If you wait, it may be late…
• In more than 90% cases
leaking stops by 1year
• More than 70% cases recover
sexual function by the end of
year
• Viagara helps
Recovery time
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Eat in the evening or next morning
Walk in 24hrs
Discharge in 5 – 7 days
Tube to drain urine kept for 2 weeks then
removed
Complete recovery in 4 weeks …
Start normal routine 6 weeks and beyond
Some may need to manage temporary urine
leaking problems
If need be Viagara can be started as early as
8 weeks
No lifting heavy weights for 6months
Radiation Therapy
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•
•
•
•
Types
External Beam RT
Conformal RT
Intensity Modulated RT
Brachytherapy
• Can offer curative
treatment in selected
cases
• Except for
Brachytherapy after
effects of RT are more
as compared to surgery
• Brachytherapy
expensive and
technologically and
technically challenging
Its already late….
What do we do?
• No curative
treatment can be
offered
• Other Forms of
therapy
• Hormone therapy
• Palliative
Radiation therapy
• Palliative Surgery
• Chemotherapy
Hormone therapy
Most practiced – Bilateral Orchidectomy
Removal of Testes (both sides)
Injections to block testosterone (male hormone)
• Is Bilateral Orchidectomy
mutilating?
• Does anybody disagree?
• What after Orchidectomy?
• Irreversible
• Hormone dependant CaP
becomes Hormone refractory
independant CaP 12-18months
• Elderly patients bone
pains/spine fractures? CaP
metastasis
• Pain, neuropathy, disability,
morbidity, gradual end of life.
• Survival this group of patients:
2-3 years
Literacy and Prostate Cancer
• Wolf et al (Chicago USA)
• 197 men
• African American, >65yrs, low
socioeconomic status, 7th grade or less of
literacy
• Low health literacy subjects – More than
twice likely that PSA levels will be high at
the time of diagnosis
Awareness
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Best way to fight any disease
Prevent if preventable
If not…
Early Detection
Better chance of cure
Hence we should strive to…..
Create & Spread Awareness
Thank you