Tag: PROSTATE

Andrologist, Urologist

Nocturia – need to look beyond prostate in men

Dr Varinder Attri

Frequent night time urination, otherwise known as nocturia, is extremely common in men, especially elderly. At a time, nealy 60-70% of men older than 60 years of age wake up once or more in night for passing urine. In men older than 80 years, almost each and every man gets up in night to pass urine. In young adults, it is relatively less comapred to elderly, but found in both sexes equally in the range of 10-20%.BPH (Enlarged prostate) Symptoms

There are various causes of passing urine at night. There is no single well defined reason for nocturia. Person having polyuria, behavioural issues with fluid intake called polydipsia in which a person consumes lot of liquids, diabetes mellitus, sleep disorder, heart failure, poor bladder emptying,  overactive bladder and many other reasons are behind this problem. Often persons having dependent lower limb edema suffer from this problem of frequent night time voiding. Besides this, frequently, the enlarged prostate has been associated with this problem though the real association between this remains unclear.NOCTURIA- is it sign of prostate disease in men ?

Read how nocturia is different from nocturnal enuresis or bedwetting  Nocturnal Enuresis (Bedwetting)

The effects of this problem are multifactorial on the person. There is lack of sleep leading to day time fatigue and less productivity, increased risk of falls and fractures in elderly while getting up in night for washroom, increased risk of cardiac morbidity and mortality etc. Majority of these persons produce more urine in night compared to daytime and may feel exhausted.

When such problem gets bothersome to a person, they usually seek urologist opinion. In men, evaluation is often done to look for bladder emptying, prostate enlargement and other parameters.Prostate enlargement diagnosis In females, since there is no prostate organ, evaluation is usually is restricted to bladder emptying. In both sexes, bladder diary where complete record of fluid intake and urine output is made is very helpful in the treatment. It has been seen that the majority of these patients have medical reasons for his or her problem and prostate which often implicated for this problem in men, contributes very less. So the only treatment of prostate may not completely resolves this problem in men.

Treatment often get initiated after initial evaluation to look out for various causes of nocturia. Patients with increased urine production may limit their fluid intake after evening to decrease number of nocturia episodes. 15-20 minutes of walk before going to bed helps reducing waking up at night for urine. Persons with peripheral edema need to wear stocking and keep limbs elevated while seated. Nocturia due to  obstructive sleep apnea get best benefitted with CPAP therapy. Patients with enlarged prostate and poor bladder emptying may be started medical therapy for prostate along with other behavioural therapies for fluid management. 5 tips for healthy prostateThe real cause of small frequent night voiding due to small bladder capacity is extremely rare and may need Surgical therapy.

Uro-oncology, Urologist

Prostate cancer – Part I

Dr Varinder Attri

What is prostate ?

Prostate is a lemon sized reproductive gland, found only in men, below the bladder. Its function is to produce fluid which helps providing nourishment to sperms in semen. Urinary passage goes through prostate, before reaching the penis.

What all diseases can occur in prostate ?

BPH (BPH (Enlarged prostate) Symptoms), Prostatitis (Infection in prostate), Prostate cancer (Prostate cancer)are the most common diseases that originate from prostate.

What is prostate cancer ?

Like rest of the body cancers, prostate can harbour cancer in it. Malignant growth inside the prostate is called prostate cancer. Most of the prostate cancers are slow growing.

What are the risk factors for prostate cancer ?

Older age, African – American race, family history of ovarian/breast and prostate cancer increases the likelihood of a man being diagnosed with prostate cancer. As men increase in age, the risk of prostate cancer increases. About 60% of prostate cancers are diagnosed in men over the age of 65 years. Besides these, diet high in animal fat has been associated with risk of developing prostate cancer.

What are the symptoms of prostate cancer ?

Prostate cancer can be asymptomatic; meaning there can be no symptoms of cancer. If it does causes symptoms, these can be urinary symptoms or more generalised symptoms, depending upon the stage of prostate cancer. Most common symptoms include- urinary symptoms such as frequency or weak urinary stream, blood in urine (hematuria), erectile dysfunction (ED), Hematospermia (Blood in semen), urinary and bowel incontinence, pain in hips/back/legs etc.

Can we detect prostate cancer in patient who does not have symptoms ?

Prostate cancer can be easily screened with combination of Digital rectal examination (DRE), conducted by doctor and blood test called PSA (Prostate specific antigen). (Prostate cancer and PSA testing). These tests are recommended annually in men over 50 years of age. Combination of these tests can diagnose prostate cancer in men, in whom there are no symptoms of this disease.

What is PSA test ?

The PSA is a blood test which is commonly used to detect possible prostate cancer in a person. Elevated PSA levels may indicate the presence of prostate cancer, but it can be also elevated in certain conditions of prostate such as BPH, prostate infections (prostatitis), UTI (Urinary tract infection), retention urine etc.

If initial tests shows risk of prostate cancer, what happens next ?

The final diagnosis of prostate cancer is made after prostate biopsy done most commonly by ultrasound guidance called TRUS (Trans rectal Ultrasound). Sometimes doctor orders MRI called mpMRI (multiparametric MRI) prostate before undertaking biopsy. Once biopsy shows evidence of prostate cancer, the cancer is staged to look for the extent of cancer spread into the body. This is done by combination of various modalities such as CT scan, MRI , Bone scan and more recently PSMA PET scan.

Urologist

Prostate cancer

Dr Varinder Attri

INTRODUCTION

  • Prostate is a small walnut-shaped gland in males situated below the bladder in front of the rectum.
  • Prostate cancer is the most common cancer among men (after skin cancer).
  • Prostate cancer is the cancer in prostate gland.
  • Many prostate cancer grow slowly and remain confined to prostate gland, however, few prostate cancer grows rapidly and present in advanced state. Treatment depends upon the stage of prostate cancer.

SYMPTOMS

  • Weak urinary stream

• Difficulty in passing urine

  • Frequent urination
  • Blood in urine
  • Blood in semen
  • Bony pains
  • Loss of weight and appetite
  • Erectile dysfunction

Risk factors

•Older age- Prostate cancer is more common after 50 years of age.

•Familial factors – more common in a person whose relative such as father or brother has prostate cancer.

•Race – black race has more incidence of prostate cancer compared to white race.

•Genetic factors – rarely, few genetic FACTORS lead to development of prostate cancer.

•Obesity- obese people are more prone to development of prostate cancer.

Screening

•Most urologist encourage men after 50 years to undergo screening for prostate cancer which include DRE (digital rectal examination) and serum PSA (prostate specific antigen) measurement.

diagnosis

•DRE – prostate gland is felt through rectum and checked for any nodule or hardness of gland which is suspicious for cancer.

•Serum PSA – normal value in average sized prostate vary from 0-3 ng/ml. Increased PSA level suggests possibility of prostate cancer.

•MRI prostate – in suspicious cases with PSA 4-10 ng/ml, multiparametric MRI prostate is advisable. it tell the doctor about the estimated risk of prostate cancer in that patient.

•TRUS biopsy – final diagnosis of prostate cancer is made on prostate biopsy. systematic 12 core prostate biopsy is taken by ultrasound guidance. Severity of disease is also assessed by Gleason scoring on biopsy.

CANCER STAGING

•Staging of prostate cancer is done after checking the level of serum PSA, findings on DRE and biopsy report.

•Staging of prostate cancer is done by PSMA PET scan or CT scan/MRI scan abdomen with bone scan. •After staging tests, patients are segregated into localised, locally advanced or metastatic prostate cancer.

TREATMENT

Treatment of prostate cancer depends upon various factors such as stage of disease, level of serum PSA, overall health of patient, life expectancy of patient.

•Deferred treatment – very low risk cancers with minimal risk of spread may be kept on surveillance. Similarly, treatment may be avoided in patients with low life expectancy.

•Surgery – surgical removal of prostate (robotic surgery- RARP/lap surgery) is done in patients with localised disease. Sometimes it is done in locally advanced prostate cancer in combination with other treatments. •Radiation therapy – radiation therapy involves use of high energy to kill the prostate cancer cells. It is achieved by radiations from external source (ebrt) or from internal source after placing radioactive source in the prostate gland (brachytherapy). 

•Hormone deprivation therapy – this therapy is useful in advanced and metastatic stage to decrease the testosterone level in blood. Testosterone hormone helps in growth of prostate cancer. Many injections such as lhrh antagonist and agonist are available which helps in reduction of testosterone hormone level. This can also be achieved by bilateral orchiectomy (testes removal).

• Chemotherapy – chemotherapy such as docetaxel/cabazitaxel is used in patients with metastatic prostate cancer.

•Bone health – bisphosphonate injections are used to prevent osteoporosis associated with the metastatic prostate cancer.