Prostate cancer is one of the most controversial cancers in the medical world. Even the governing medical bodies of urology, oncology and general practice find it difficult to agree. And when guidelines are released, they are usually a compromise. For example, in the most recent guidelines, it was suggested that the digital rectal examination maybe left out of the evaluation for prostate cancer. I beg to differ.

Just this week I saw a gentleman who had a normal PSA (prostate blood test) who had some urinary symptoms, who on examination had a firm nodule which turned out to be cancer. There are so many layers to the discussion that it’s impossible to cover in a blog like this. Urologists have been criticised for overtreating non significant cancers. In the past this may have been true, but back then we didn’t know which cancers were dangerous and which ones could be watched safely. We now know that many low grade cancers may be safely monitored with active surveillance (wait and see).

In 2016 we are much better at diagnosing and treating the prostate cancers that genuinely do need treatment. The problem for patients is that the dilemma is which treatment to choose. “Dr Google” causes much confusion for patients and there are a range of treatments which could be best described as investigational or even experimental. I have had patients die who have chosen some of these non mainstream treatments.

But even the most proven treatments such as radical prostatectomy (complete removal) and external beam radiation comes with their own unique issues. The cancer maybe cured, but with some negative consequences. Thankfully with modern technology the side effects of both these modalities has reduced. We do the surgery with minimally invasive instruments and even use robotic technology to reduce collateral damage. Blood loss, transfusions, length of stay are all reduced compared to open surgery. Most patients achieve good urinary control eventually and can tolerate minor leakage. Even erectile function can return with the aid of medications. Radiation is much better tolerated too, due to more focussed, less “scattergun” treatment.

But it’s never easy and it always pains me to see my patients’ lives be thrown into turmoil when they receive the diagnosis and go through the treatment. The good news, is that once they get to the “other side” of the treatment, most of them are happy and relieved to live a normal life.

In Health and Wellness

Ranjit