As age advances, many men experience urinary changes, caused by an enlarged prostate gland. How can these be managed?

“Prostate” is a term that floats into our conversation only when it comes attached to the C-word, but non-cancer problems associated with the prostate gland beset a lot of men over 50. Of course, research into the causes, prevention, detection and treatment of prostate cancer is on in medical centres throughout the world. Scientists believe new research on the gene-prostate-cancer link will help them understand genetic changes that lead to prostate cancer, design medicines to target the changes, determine genetic groups at a high risk, and whether they would benefit from intensive screening or chemo-prevention trials (use of drugs to keep the cancer away).

But first the basics from Dr. N Sezhian, senior consultant urologist and transplant surgeon, Global Hospitals & Health City. The prostate gland (described as walnut-sized) is present only in men. It contributes to some components of seminal fluid. The urine passage called the urethra passes right through it, from the bladder to outside. As age increases, the PG gets larger, fuelled by the male hormone testosterone. If the size causes problems with urine flow, you have a condition called BPH (benign prostatic hypertrophy). “PG is located just below the bladder neck and is the male reproductive organ,” says Dr. Sanjay Garg, consultant urologist, Columbia Asia Hospital. “Many men experience urinary changes as they age because of the enlargement of PG. In some cases, it may turn cancerous.” “If you have slowing of the urine stream, increased frequency, inability to hold, bleeding, infection or complete blockage of urine, then there is something wrong with the PG,” says Dr. Anurag Khaitan, consultant, Urology, Paras Hospital. “Get medical attention immediately,” he emphasises.

Well, not all men with prostate enlargement need surgery, Dr. Sezhian reassures us. Mild symptoms are treated with medication to relax the passage. Medicine is given to some, depending on their condition, to shrink the prostate. Only those with severe problems/complications from prostate need to go for “needle and sutures” but this is minimally invasive. The obstructing portion is removed with no external cut. A few days in hospital and you can return home. With PG cancer, however, medicos need to figure out if it will stay indoors or grow and spread outside. For example, researchers want to know if the presence of the gene EZH2 in advanced cancers indicates a more aggressive type. The answer could tell which men need treatment and which might be better served by active surveillance.

Curable

Prostate cancers grow slowly, so when caught early are curable, says Dr. Sezhian. Examination and a blood test called PSA (prostate-specific antigen) can reasonably determine if PG harbours cancer. An improvement on this test, say researchers, is to measure only the “complexed” PSA instead of the total and free PSA. One test looks at the level of prostate cancer antigen 3 (PCA3) in the urine. Another looks for an abnormal gene change called TMPRSS2:ERG in prostate cells. And technology helps. Blood flow within the gland is measured using a colour Doppler ultrasound; enhanced MRI helps to find lymph nodes that contain cancer; a newer type of positron-emission tomography (PET) scan uses radioactive carbon acetate to detect prostate cancer in different parts of the body.

“Treatment depends on the stage of cancer,” says Dr. Garg. Adds Dr. Kaitan, “Seventy per cent of treatment is via medicine and 30 per cent is surgery.” Surgery involves complete removal of the prostate gland. It can be done either by open operation or with a laparoscope. New computer programmes allow doctors to better plan radiation doses. One treatment destroys cancer cells by heating them with HIFU — highly-focussed ultrasonic beams. Clinical trials are on for vaccines designed to treat prostate cancer. One such vaccine sipuleucel-T (Provenge) has received FDA approval. Scientists are also looking at angiogenesis (new blood vessels) in prostate cancer specimens to predict treatment outcomes.

Right food and lifestyle help! Lycopenes in tomatoes, isoflavones in soybean, vitamins E and D look promising in reducing the risk. In one study, pomegranate juice seemed to slow the time it took for the PSA level to double. In another, daily flaxseed seemed to reduce the rate at which early prostate cancer cells multiplied. When a group ate a vegan diet, exercised frequently, joined support groups and yoga, they exhibited a slight drop in PSA level on average. “Men after 40 should go for regular check-ups,” says Dr. Khaitan. “A healthy lifestyle is the key to be disease-free.”