The Prostate Health Month

Dr PM Deka

(pmdeka@yahoo.com)

The month of September is designated as Prostate Health Month in North America and almost in all the countries the world over, including India since 1999. President George W Bush proclaimed this month as Prostate Cancer Awareness Month in 2003, and this was later supported by the Obama administration in 2015. Men's Health Society of India was established in 2011 with a focus on establishing Men's health as an integrated specialization in India. At present society is preparing the men's health report of India and developing Genito-Urinary disorders of the male (GUDMale) national health programme for India.

The Prostate is a walnut-sized male sexual organ situated between the urinary bladder and the urethra. The prostate gland starts to grow with age particularly after puberty. As men grow older, the prostate gland enlarges and may start giving urinary trouble particularly after the age of 50 years. Since the average life expectancy of males has increased, diseases of the prostate also have increased leading to increased morbidity and mortality. Therefore, the importance of taking care of the prostatic diseases of the male population in society has become imperative. The main cause of prostatic enlargement is the male sex hormone testosterone, amongst many other hypotheses. The three most important diseases of the prostate are:

1. Benign enlargement of the Prostate

2. Cancer of the Prostate

3. Prostatitis – inflammation of the prostate.

Benign Enlargement of the Prostate/Benign Prostatic Hyperplasia (BPH), the incidence of which increases with age leads to a host of urinary problems in the elderly. Once the prostate gland starts enlarging in size, it obstructs the urinary passage and causes symptoms such as the frequent need to pass urine, weak urinary stream, the requirement of force to pass urine, inability to control the passing of urine, dribbling of urine and at times bed-wetting. These symptoms are together termed Lower Urinary Tract Symptoms (LUTS) in the medical literature. Unnoticed and untreated, BPH may cause complete failure to pass urine. This is a medical emergency and has to be relieved by passing a catheter through the urethra into the bladder. BPH can also lead to urinary tract infection (UTI), stone formation in the urinary bladder, etc. The most dreaded complication is an accumulation of urine in the bladder for a long period, which can lead to Kidney Failure. Younger patients with mild symptoms may be treated with drugs. If medical treatment fails, he may have to undergo surgery. Unlike in the earlier days, today surgery is quite safe and many modern procedures are available in the form of Transurethral Resection (TURP), laser vaporization or resection, and many more procedures evolving every day. Even in elderly patients with comorbidities like heart diseases and lung diseases, these procedures are quite safe.

Cancer of the Prostate – Cancer developing in the prostate is a dreaded disease. The incidence of cancer prostate is higher in American Blacks than in Whites. It is the second most diagnosed cancer in males and is the 5th leading cause of death worldwide. It has been estimated (GLOBACON 2018) that 1,276,106 cases of prostate cancer were detected all over the world in 2018. Its incidence and mortality rates are strongly related to age with the highest incidence seen in individuals >65 years of age. Incidences in India and Orientals are reported below. This could be because of the lack of diagnostic facilities in comparison to the developed countries. However, with the introduction of Prostate Screening Tools like PSA estimation, USG and Digital Rectal Examination (DRE), detection of prostate cancer early has increased. Prostate Cancer may be asymptomatic in the early stages, and if it can be detected early, the results of treatments are good. However, if it is detected in the late stages, as is commonly seen in the Indian population, the prognosis is extremely poor. If detected early, the patient can get cured by surgery (Radical Prostatectomy) or Radiotherapy with long survival. If diagnosed late, whatever treatment is done, the average survival is 2-3 years only.

Therefore, awareness for early detection of Prostatic Cancer is extremely important. Early screening is highly recommended for a person with a family history of cancer prostate at 45 years of age. Normally, for individuals after the age of 50 years, a yearly check-up by Urologists is necessary.

There is no particular preventive measure known. However, restriction of high fatty foods, increasing regular intake of vegetables and fruits with regular physical exercise might help.

Prostatitis – Prostatitis or inflammation of the prostate gland though is not life-threatening; it causes varieties of symptoms mostly affecting the younger individuals, leading to physical and mental distress and asymptomatic inflammation. Prostatitis may be a bacterial infection (acute or chronic) and asymptomatic inflammation. It is also called Chronic Pelvic Pain Syndrome. Its prevalence ranges from 2.2–9.7%, which is high and is comparable to the incidence of Ischemic Heart Diseases and Diabetes. Acute bacterial prostatitis is characterized by acute urinary tract infection. Chronic bacterial prostatitis leads to persistent infection in the prostate leading to recurrent urinary tract symptoms. Chronic Pelvic Pain Syndrome is characterized by urogenital pain, voiding and sexual dysfunction. It substantially reduces the patient's quality of life.

Treatment of Prostatitis is difficult and complex. Patients with acute bacterial prostatitis may present with sepsis and acute urinary retention. Supportive treatment with antibiotic therapy is necessary. Chronic bacterial prostatitis requires long-term (4 to 6 weeks) antibiotic treatment and frequent relapse is observed. By far the most difficult to treat is the Chronic Pelvic Pain Syndrome. Multimodality therapy tailored to individual patients is required. Based on clinical phenotype patients are placed into the "POINT" system which classifies symptoms into Urinary, Psychological, Organ-specific, Infection, Neurological/systemic and Tenderness domains.

Protection against sexually transmitted diseases (STD) protects acute or chronic bacterial prostatitis. Psychological stress has been associated with men who develop symptoms of Chronic Prostatitis. Recognition of underlying psychosomatic disease and psychiatric treatment lessens the recurrence and the suffering.

Diseases arising from the prostate gland lead to severe social and economic distress among the male population, young as well as the old. This has become more significant because of the increased life expectancy of the population where prostatic ailments are more prevalent.