Various environmental factors related to industrial chemicals have been identified as potential promoters of prostate cancer, which is mainly a disease affecting men above and around the age of 50.
The world-wide trend towards an ageing population, it is expected that the number of deaths related to prostate cancer will rise significantly, said Khurram Mir, Fellow of the European Board of Urology and Consultant Urological Surgeon at Shaukat Khanum Memorial Cancer Hospital while talking to Business Recorder.
He said that prostate cancer is now the most commonly diagnosed cancer among men beyond middle age in most developed and developing countries. It is second only to lung cancer as a cause of cancer deaths among men. It has been estimated that about 30 per cent of men in the developed western world are at risk of developing microscopic prostate cancer.
However, given that it is a slow growing cancer only about 10 per cent will develop clinical disease, he said. He suggested that men working in nuclear power industry and those exposed to cadmium have an increased risk of prostate cancer. Lastly it is also thought that men exposed to low levels of ultraviolet light may be prone to develop prostate cancer.
The presentation of prostate cancer can vary significantly and can range from mainly asymptotic to symptoms of outflow obstruction or severe effects of metastatic and widespread disease. As men age, the risk of prostates symptoms increases from around 1 in 7 for men in their 40's to around 1 in 2 for men in their 70's. It is impossible to differentiate between symptoms secondary to benign disease from prostate cancer.
The main reason for this is that in both cases the prostate increases in size leading to symptoms. These symptoms mainly present as increased urinary frequency during day as well as during the night. On micturition significant straining may be required and there is a delay in getting started, Khurram Mir said.
There after the stream may be weak with terminal dribbling. The urinary stream may also stop and start. Many patients feel that they are not emptying their bladders and feel the desire to go back to the toilet soon after passing urine. A significant proportion of men with prostate symptoms complain of urgency (strong desire to pass urine) which on occasions may be associated with urinary incontinence.
When prostate cancer spreads outside the prostate but remains local then in addition to the above symptoms a few other complaints can arise, he added. These can be haematuria (blood in the urine), burning on micturition, lower abdominal pain or discomfort, urinary incontinence or even impotence. When the disease spreads a bit further away from the prostate then it can cause obstruction to the drainage of urine from the kidneys leading to loin pain and symptoms of renal failure.
In addition it can also present with blood within the semen. On distant spread of disease serious events like bone fractures, loss of weight, low haemoglobin and spinal cord compression leading to severe neurological symptoms can occur, he added.
Prostate cancer can be investigated with fairly simple tests. Once the disease has been diagnosed it needs to be assessed further by radiological scans like MRI (magnetic resonance imaging), CT (computerised tomography) and radio-isotope bone scans. Khurram Mir further said that prostate cancer is a disease, which can be cured completely if caught in its early stages when it is confined to the prostate leading to an almost normal life span.
Around the world millions of dollars are being spent in research into the diagnosis and treatment of prostate cancer. It has now been recommended both by the American Urological Association (AUA) and the European Organisation for Research and Treatment of Cancer (EORTC) for men around and above the age of 50 years to have an annual PSA check.