What do John Kerry, Ben Stiller and Warren Buffet have in common? Besides being among the most successful men in their professions, they have all battled prostate cancer.
More than 1.1 million people, a population roughly the size of Mauritius, were diagnosed with prostate cancer in 2012, which accounts for around 8 per cent of all new cancer cases and 15 per cent cancers in men. And now more than ever before, men in India are arriving at hospitals presenting aggressive disease.
India has always recorded low rates of cancer when compared to the rest of the developed world, but that’s changing very quickly. After lung and mouth cancers, prostate cancer is the third leading cancer in men in India, accounting for 7% of all cancers. Since the 1990s, cases of prostate cancer have shot up by over 220% and India’s National Cancer Registry Programme estimates incidence is expected to grow rapidly by the year 2020.
Prostate cancer rates in India still remain lower compared to developed countries. In the US, for example, the incidence rate of prostate cancer is more than 12 times that of India’s. So, why is it imperative for men in India to know more about the disease?
Faulty gene?
Indian men may genetically be more predisposed for developing aggressive prostate cancer. Research shows that men of South Asian descent can be up to 40 percent more likely to die from prostate cancer compared to other races. Even when compared with men of African descent, the most affected ethnic group as reported in medical literature, men of Indian origin had similar aggressive forms of prostate cancer.
Many doctors are using MRIs in addition to PSA tests and rectal exams to better confirm severity of disease, says New York’s Dr Ashutosh K Tewari.
Adverse genes play a role, but so do unhealthy lifestyles. A bad diet, physical inactivity and smoking are likely to increase a person’s chances of getting prostate cancer. The same holds true for diabetes, which is alarming for India’s close to 70 million diabetics.
The standard method of screening for prostate cancer is a digital rectal exam and blood tests for prostate-specific antigen (PSA), a protein that signals to the body that cancer is present. But since prostate cancer is a slow-growing disease and PSA levels get elevated by several benign conditions, the chances of the cancer being mistaken for benign conditions is high. For example, a man with an inflamed prostate that emits the same protein as cancerous cells can render the PSA test inaccurate. This has led to fierce debates within the medical community on whether a PSA test should remain the gold standard when more advanced diagnostic technologies are available.
When PSA levels are abnormal, a biopsy is typically ordered to confirm cancer and if the result is a false-positive, doctors may jump towards an incorrect diagnosis and offer complex treatment options. The resulting over-treatment can lead to men who can live with the disease undergo unwarranted procedures, therapies and health complications that can lower their quality of life.
Diagnosis debate
In 2012, organizations like the US Preventive Services Task Force started to recommend against routine PSA-based screenings, leading to a drop in the number of diagnosed cases. Yet, as the growing numbers in India show, forgoing screening completely could be the wrong solution.
Doctors don’t need to screen less for prostate cancer, they need to screen smarter. Newer forms of genomic analysis, diagnostic imaging, blood tests and urine tests that complement PSA information hold promise for far more precise diagnoses and personalised treatment options.
Many doctors are opting to use MRIs in addition to PSA tests and rectal exams. This tool allows them to better confirm the severity of disease. Over the past few years, doctors have also been using a variety of tests for tumour biomarkers — genetic material or proteins, such as PSA, that help characterize the disease — to learn about more about their patients’ cancers. These tests can tell how likely it is for somebody to contract prostate cancer, whether a tumour is present, or even what a patient’s predicted prognosis is likely to be.
