International Men's Day 2022: What is Movember and why you need to know about prostate cancer affecting men

Every year, the world celebrates Movember in the month of November to raise awareness about men's health. The ‘Mo' in Movember is from ‘moustache', which founders Travis Garone and Luke Slattery realised wasn't seen as much then and since then has gone on to become the identity of the movement. It has been conducted by the Movember Foundation since 2003 in Australia and has since seen a lot of people come together at the global level to join the cause. The movement primarily raises awareness about prostate cancer, testicular cancer, and men's mental health and suicide prevention.

In a first for the series on men's health in November, Mid-day Online focuses on prostate cancer. While the awareness about the disease remains only to those who suffer from it or friends and family around them, the understanding outside of it is debatable. So, what is prostate cancer? Dr Santosh S. Waigankar, consultant, urologic oncology and robotic surgery at Kokilaben Dhirubhai Ambani Hospital, explains, "Prostate cancer is nothing but an uncontrolled (malignant) growth of cells in the prostate gland. The prostate, a walnut-sized gland in men, is placed just below the bladder and in front of the rectum, gripping the urethra. The urethra is a tube that takes urine out of the bladder. The only function of the prostate is to produce and store fluid."

Mid-day Online spoke to Waigankar and Dr Ganesh Bakshi, Uro-Oncology, PD Hinduja Hospital & MRC, to understand more about the cancer. The city-based urologist explains the causes, symptoms and effects of the disease. He also stresses on the need for men to take it seriously by diagnosing it early, along with busting common myths associated with the disease

What is prostate cancer?

Bakshi: The prostate is a reproductive organ in males. It grows throughout life and is dependent on testosterone. Prostate cancer develops in secreting gland cells which divide and grow abnormally and in uncontrolled fashion.

Is prostate cancer seen more in a particular age group?

Waigankar: Men above the age of 50 years do have a considerable risk of developing prostate cancer. It is found more commonly in African men.

Bakshi: Prostate cancer can be sporadic or seen in men with BRCA mutation or family history of prostate, breast, colon and pancreatic cancer. With such family history, men are at higher risk for development. Also, it is seen more commonly in the age group 60-80 years.

What are the causes of prostate cancer?

Waigankar: It's not very clear as to what causes prostate cancer. Scientists and doctors know that prostate cancer begins when cells in the prostate develop abnormal changes in their genetic material. The DNA contains pertinent instructions that tell a cell how to work and what to do. Sometimes these instructions turn ‘bad' and tell the cells to grow and divide uncontrollably and more rapidly than normal cells do.

Bakshi: Prostate cancer can be attributed to genetic predisposition and can also occur in sporadic manner. Imbalances in hormones and many other causes like tobacco and pollution can cause mutations leading to abnormal growth forming cancer.

What are the effects of prostate cancer?

Waigankar: Prostate cancer starts silently with not many symptoms in men. If it progresses, it can cause difficulty in passing urine. If it spreads to the bones, it can cause severe bone pains and sometimes fractures as well of the spine.

Bakshi: Prostate cancer is a slow growing cancer with low cancer related death as it occurs in elderly population. In early stages, it doesn't produce any symptoms. Many times it can spread to surrounding organs (locally advanced), can cause urinary retention, hematuria or related to bowel. It can spread to distant parts like bones and organs like liver and lung causing bone pain, weakness and weight loss.

What are the symptoms one should look for in prostate cancer?

Waigankar: Most men with prostate cancer have no symptoms. Some may have chronic backache not responding to painkillers and affecting sleep and quality of life. Some may have long-standing urine issues which have not improved with medications. Rarely young men may have blood in their semen.

Bakshi: Prostate cancer is commonly detected by opportunistic PSA screening, when patient seeks medical advice for Benign Prostatic Disease. These are many times included in health checkups. Many patients with early disease will have no complaints. As it increases, patient will have urinary complaints like frequency, urgency, nocturia, poor stream, straining for micturition, sometimes blood in urine. When it spreads distantly i.e. metastatic it can present as body/boneache or pathological fractures.

Why should men take prostate cancer seriously?

Waigankar: Prostate cancer is a very indolent cancer. It is very slow to grow. But that doesn't mean one shouldn't be vigilant about it. It can be aggressive at times, also. It is necessary to take it seriously and that can be done by taking a blood PSA test annually as a part of the health check-up programme. Cancer if diagnosed in an early stage can be offered the best treatment with the best possible outcomes.

Bakshi: Prostate cancer if detected at an early stage is curable. If a patient is diagnosed at a later stage such as with spread to distant parts i.e. metastatic, it requires long term therapy, sometimes which is costly, as it occurs in elderly and dependent population, treatment has its social implications. More deaths can occur due to cancer if detected in advanced stages.

What are the misconceptions about prostate cancer?

Waigankar:

Prostate cancer surgery will end your sex life and cause urine leakage: This is a myth. A urine leak is a sequel of surgery and not a complication. If surgery is for treating early-stage prostate cancer, the surgeon can spare the nerves controlling erections during surgery [especially robotic surgery]. With regular pelvic exercises, the patient can become pad-free early.

A high PSA score means you have prostate cancer: PSA is an indicator of prostate health. Its level increases with an infection, size increase, or cancer. Some more investigations are needed to look into the exact cause of the rise in the level.

Only elderly men get prostate cancer: It is rare for men below 40 years to get it. Even men with mothers or sisters who have breast cancer can be at high risk for developing prostate cancer. If there is a family history of one's father or uncle having prostate cancer, and if there is a concern, then it is better to meet the doctor.

You have to start treatment immediately: Sometimes, the doctor may advise 'Active surveillance for early-stage prostate cancers'. This means the patient is only kept on follow-ups with regular PSA, and the treatment is initiated only when the PSA begins to rise.

If you get prostate cancer, you'll die of the disease: The fact is many men with prostate cancer are likely to live to old age or die of some other cause.

Bakshi:

Prostate cancer is less aggressive cancer: This is a misconception. Prostate cancer has a spectrum of severity and aggressiveness. Also, treatment of prostate cancer is available as per stages of disease. Hormone therapy is not a curative treatment for prostate cancer.

What is the severity of prostate cancer in men?

Waigankar: As per statistics, prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About one man in 41 will die of prostate cancer. In India, it is certainly in the top five. One also needs to know that prostate cancer can be a serious disease, but most men diagnosed with it do not die.

Bakshi: Prostate cancer is risk stratified at the time of diagnosis, based on PSA levels, features on biopsy such as Gleason score and expected life expectancy. We generally classify it into localised - low, intermediate and high risk, locally advanced and metastatic (means spread to other areas). Severity can be put as per stage or symptoms.

What is the frequency at which men should get themselves checked?

Waigankar: The recommendation is to do a yearly PSA check-up as part of an annual health check-up plan. When to start is a question often asked. It is generally at 50 years for all men, and for men with a very strong family history, it is recommended to start at the age of 40.

Bakshi: Risk of prostatic cancer increases with age. Annual PSA levels and trends can guide early diagnosis. PSA screening can be suggested after due consultation in men with a good life expectancy. Men with genetic predisposition should undergo genetic testing after counselling from age of 45 years and further frequent checkup is recommended. Your doctor will give you more advice after taking a detailed history from you and examination.

Why is it important to raise awareness about prostate cancer? Is it among the top cancer men should be wary of?

Waigankar: In India, prostate cancer is among the top five cancers and is becoming more prominent with time. Awareness about prostate cancer is essential because now, with the development in science and technology, many newer diagnostic modalities like MRI and treatment modalities like robotic surgery are available in Mumbai. Many medicines are available that control even stage four prostate cancer and improve the patient's quality of life.

Bakshi: Prostate cancer is among the high incidence cancer in men and also can cause mortality in advanced cases. The genetic predisposition also makes younger males at risk to this cancer. As life expectancy is rising globally there are many elderly who will be at risk for prostate cancer. If awareness is increased people will be understanding the symptoms and then do appropriate consultation with doctor. Accordingly, if diagnosed early, the disease would be curable. Nowadays, many patients present with advanced disease in India as compared to western countries or progressive eastern countries. With awareness we shall possibly detect patients in earlier stages and prevent disease related morbidity and deaths. It also saves on the costs of managing advanced disease. Only thing, the screening needs to be in organised fashion and offered to population at more risk of cancer.

Also read: Breast Cancer: Myths, causes, symptoms of the most common cancer in Indian women