After all, prostate cancer patients make for 15% of all male cancer patients around the world. And 3% among these are Indians. The Indian Council of Medical Research estimates that around 10 in every one lakh men are diagnosed with prostate cancer, making it the sixth most common cancer in India. The survival rate is relatively low (around 5 for every one lakh), but doctors say new treatments are improving survival rates even for those in the later stages.
In fact, men with early stages of prostate cancer can safely delay treatment without impacting survival by following active surveillance. Doctors say most prostate cancers grow very slowly, taking at least 10 years for a tumor to cause major symptoms. At least 50% of men have cancer in their prostate.
“The overwhelming majority are better off not knowing about it. They may die with the slow-growing cancer; not of it. They may have no symptoms and it may not threaten their lives.”
So what does one do if one gets a positive diagnosis? Prostrate cancer is graded in Gleason scores — Gleason 6 is low grade, Gleason 7 is medium grade and 8,9, and 10 are high-graded cancers.
“Patients with scores 6 and 7 qualify for the active surveillance protocol, which warrants periodic prostrate-specific antigen (PSA) blood tests, annual MRI scans and biopsies. Any sign of disease progression means the surveillance protocol is suspended.” Active surveillance is more of a conservative, wait-and-watch approach rather than a treatment per se. It can improve long-term survival rates and quality of life while minimizing risks of incontinence and erectile dysfunction that aggressive treatments like surgery and radiation can cause.
Even when prostrate cancer has spread to the bones, patients can live 5,7, or 10 or more years with current treatments.
For lower grades, Indian oncologists recommend active surveillance, but several factors determine its efficacy in India — patient’s age, financial status, geographical location, ability to comply with monitoring requirements etc. Not every patient can stick to the wait-and-watch-plan, some get cold feet. Some find frequent tests financially draining, and yet others would rather go for surgery or radiotherapy to get it over with. “There is also the fear factor. We counsel patients and select only those who can live with this fear.”
Active surveillance can test the patients of both doctors and patients. “The patient and his family need to accept the fact of living with cancer, even if it’s a low-risk one. They should also be prepared to go for a definite form of therapy in case of disease progression.” Besides it’s not viable for patients below 50 as they tend to have aggressive tumors that they have already spread by the time they seek medical attention.
The annual expense for active surveillance adds up to more than Rs 50,000 (Rs 20,000 for biopsy, Rs 15,000 for MRI, and Rs 2,000 for PSA test every three months and Rs 12,000 for doctor’s visits). Radiation combined with surgery would amount to around Rs 5 lakh. Health insurance covers radiotherapy and surgery but not active monitoring.
There is an FDA-approved vaccine for prostrate cancer but hardly anyone uses it in India as its import is expensive and tedious. “It’s available only for asymptomatic or minimally available only for asymptomatic or minimally symptomatic castration-resistant metastatic prostrate cancer.”
WHAT IS PROSTRATE CANCER?
It’s a type of cancer that begins in a walnut-shaped gland in the male reproductive system surrounding in the urethra. Men over 60 are at risk, specially with a family history of prostate, colon, or breast cancer.
WHEN SHOULD PSA SCREENING BEGIN?
- Age 55 to 69 is when men benefit most from PSA screening.
- Age 40 to 54 If you have a parent or brother who has had prostrate cancer or two extended family members diagnosed with the disease.
- Beware of false positives: PSA tests assess risk of cancer but only a biopsy is a definitive diagnosis. PSA tests can sometimes show false positives.
