Prostate Cancer: A Common Cancer among Indian Men
Prostate gland is located in front of the urinary bladder and encircles the male urethra, which is the channel for urine outflow. This gland is prone to become cancerous, as men grow older. It is typically diagnosed in men in their 60’s (median age at diagnosis in the US is 68 years but the range is wide, upwards of 45years). Prostate cancer is the most commonly diagnosed cancer in American men. It is estimated that 240,000 Americans will be diagnosed with prostate cancer in 2011. More than 34,000 men will die of the disease, making prostate cancer the second largest cancer killer in men. Prostrate cancer is an uncommon cancer in the developing countries affecting 4-5 men per 100,000 population in India. The rate of prostate cancer per 100,000 population in the US is 85 (20 fold difference versus men living in India). The number of prostate cancer cases among Indian immigrants to the US has gone up substantially probably due to change of life style in their adopted country. This unfortunately is the case with all other cancers as well (such as breast and colon cancer) with current numbers for cancer, which are intermediate between the US figures and the natives in India.
Prostate cancer, like most deep cancers (like colon cancer) is a silent disease until it is quite advanced in its evolution. Consequently men should undergo a digital rectal examination (DRE) and or a simple blood test, which measures a protein called prostate specific antigen (PSA). PSA is produced by the normal prostate gland but the normal blood level is quite low in younger aged men (under 50 year olds). It is typically under 2.5 ng/ml) in the 50-60’s but goes up to >2.5 to 4 ng in men in their 70’s and 5-6 ng in the 80’s. High PSA levels (>4.0ng) raises a flag for possible diagnosis of prostate cancer. However PSA level can also go up in some benign conditions (like prostatitis) and it is therefore not diagnostic of prostate cancer by itself (unless the level is >10 ng). An elevated PSA level is an indication for further investigation to rule out prostate cancer. A biopsy of the prostate gland is required in order to confirm a suspected diagnosis of prostate cancer. Prostate biopsy is typically done by an Urologist
Staging of Prostate Cancer
All cancers, including prostate Cancer are divided into 4 stages, depending on their size/extent and degree of spread beyond the confines of the organ of origin, which is prostate gland in this instance. Early prostate cancer (stage 1 and 2) means it is still localized to the prostate gland whereas stage 3 is locally advanced cancer and stage 4 disease means it has spread into distant organs like, bone, lungs or liver. Metastatic prostate cancer commonly spreads into bones and often causes back pain, which can sometimes be the first symptom of this cancer unless localized disease is detected by means of a DRE or an elevated PSA blood test. Staging of cancer is done by means of additional blood tests and radiological tests such as CT scans or MRI imaging. The stage of cancer dictates the choice of appropriate treatment for each cancer.
Most cases of prostate cancer are indolent and rarely fatal, at least for 5-10 years after diagnosis. The grade of biopsy, called Gleason score, is a good predictor of the pace of disease. High grade cancers (Gleason score of 8-10) tend to grow and spread faster whereas those with Gleason score of 6 or less, generally follow an indolent course. The overall 5-survival rate for prostate cancer is 99-100%, which is the highest for any cancer. Yet in 5-10% of cases this cancer tends to be more virulent and spreads to the bones within 5-10 years and can prove fatal.
For localized prostate cancer (Stage 1 and 2) surgery (called Prostatectomy) or radiotherapy to prostate gland appears to be equally effective. For Stage 3 cancer hormonal therapy using androgen deprivation with drugs like Lupron injections and radiotherapy are commonly used. For metastatic (Stage 4) cancers the best initial therapy is hormone (androgen) deprivation which is quite effective but the benefit does not last more than 1-2 years. For androgen insensitive disease, several chemotherapy agents such as Taxotere (Docetaxel) and Cabazitaxel provide useful palliation for 9-12 months each. Abiraterone (Zytiga) is the newest androgen antagonist, which was approved in 2011 for treatment of metastatic prostate cancer. Once metastatic, prostate cancer is invariably incurable, survival limited to an average of 2-3 years.
The Indian American Cancer Network (IACAN) is committed to promote cancer awareness and prevention through education by organizing outreach educational events in the community.
The upcoming event:
“Early Detection and Treatment Options for Prostate Cancer…. A Common Cancer among Indian Men” on Sunday, September 11, from 3-5pm at India House. Speakers are Pulin Pandya, M.D. Urologist Ganesh Palapattu, M.D., F.A.C.S. Chief of Urologic Oncology The Methodist Hospital
For more information, visit www.iacannetwork.org or call 713-370-3489