Dr Vinod JaveriConsultant Urologist / Andrologist
410 Doctor HouseOpposite Jaslok Hospital
Tel: 2351 9179, 9820039428
“Choice is
ours”AWARENESS
OR IGNORANCE
Awareness or ignorance Is it difficult to choose?We gather information of• Finance sector• Real Estate • Political Situation• Entertainment• Spiritual
This information is• processed• analyzed • understood and• implemented
With the aim to Develop & Evolve
What about Health?
• Limited Awareness – Chest Pain, heart attack, heart stops means ...
• Rest of the body ? How much do you know your body ?
• How many people read health related literature and ask questions to the doctor ?
• How many doctors like answering questions?• Medical faculty – lost people’s faith• How can we as doctors get it back ?• Spread Awareness
How much does
one try to know ?
Body, a Vehicle
• Soul and Body• Birth to Death
Womb to Fire/Grave
• Sanskar • Owner and Car• Factory to Scrap• User’s manual
Awareness
• CAR• Good use and Care• Regular maintenance• Engine Tune ups• Good Fuel and Good Oil• Smooth running• Serves for a long time
• BODY• Good Use and care :
Good health: Health physical mental social and spiritual well being (WHO definition)
• Regular diet exercise• Health checks
screening for diseases awareness.
• Better quality of life till as long
• Bad Oil, bad fuel, improper use, accidents
• Increased maintenance, more troubles,
• Small troubles ignored • Car breakdown• Owner in trouble blames
the manufacturer
• Bad food & drink habits • Stress, Anger etc• Frequent diseases,
admissions to hospital etc. • Health Emergencies or last
stage diseases - CANCER• Starts blaming – GOD,
somebody but never himself finally when nobody can be blamed; blames the DOCTOR
Neglect
Urology
Organ found only in
Males
located between
Urinary Bladder
And
Urethra (peeing tube)
Prostate
What does it do ?
• The sperms that are formed in testes are transported through a tube that opens in the prostate. They are released in the form of Semen
• It thus, plays a role in Reproductive function
• Contributes in the formation of Semen, Virya, dhatu (20%)
• Prostatic Secretions are important for liquefying the semen normally within half an hour after ejaculation
Nonliquefyin
g semen
can cause
infertility
What controls it ?
Benign enlargement of prostate
The functional control of Prostate, its size and development depends on the male hormone. Name it ? Testosterone
Beyond the age of 45yrs prostate starts to increase in size.
What happens when it grows beyond a certain point? Peeing Problems
“When the hair becomes gray and scanty, when
specks of earthly matter begin to be deposited in
the tunics of the artery, and a white zone is
formed at the margin of the cornea, at the same
period the prostate gland usually - I might
perhaps say invariably - becomes increased in
size”- Sir Benjamin Brodie
Symptom Score and
Quality of Life Score
IPSS: International Prostate Symptom Score questionaire Multilingual validation
Urgency
Intermittency Straining and Weak stream
Nocturia
Incomplete evacuation, Frequency
Men Age 50 years and moreAfter 45 yrs prostate starts growing.
Roughly at 50-50% have big prostate, 60-60%, 70-70%, 80-80%
Increasing peeing problems
Sleepless nights busy days
Bathroom MAPPERS
Stops going outdoors
SymptomsA man walks into his doctor's office and sits down in thewaiting room. While he is waiting his turn to be seen, a
casual acquaintance walks in and sits down next to him. The newcomer asks
"W w what are yyy you ddd doing here?" The man replies, " I am waiting to see the
doctor." "W wwhy dd do yyy you wwant to sss see hhim?"
The man replies, "Well, if you must know, I have a prostate problem.
“A pp prostate ppp problem, wwhat's ttthat?”
"Well, if you must know. I pee like you
talk."
Definitions• Frequency: urinate again within 2 hours• Nocturia: Number times you get up to urinate
after you go to bed• Hesitancy: difficulty in starting urine• Intermittancy: stop and start urine • Urgency: difficulty to control or postpone• Urge incontinence: leak due lack of control• Weak Stream: narrow slow and near• Straining: put pressure with belly to pass urine• Incomplete evacuation: feeling of incomplete
emptying of bladder
Types of symptoms
Irritative
FrequencyNocturiaUrgencyUrge Incontinence
Obstructive
HesitancyWeak StreamInterruption of streamNarrow and weak
streamFeel of incomplete
emptying of bladder
Infections Bleedin
g
Sudden retention of Urine
Kidney& Bladderdamage
Bladder stone
OverflowOf Urine
Complications
Seek help earlier than you think you will
Treatment started at right time will give better results
Stitch in time saves nine
TreatmentMedicinesWhen can we treat With medicines ?
Mild to Mediumsymptoms
No complicationscaused by the diseaseprocess
In Patients who are Not fit for surgery
Two groups of medicines:To reduce spasm of prostate
musclesTo reduce size of prostate
SurgeryIf - The medications fails to
achieve satisfactory goals and peeing problems are persistent or worsening
If - Stone in bladder
If - Pumped up Bladder
If - Back pressure on kidneys has set in
Transurethral Resection of Prostate ( TURP )
CancerIgnorance
Awareness
Cancer American Cancer Society (ACS)Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells without any function.If the spread is not controlled, it can result in death.
Cancer Prostate
If you wait…It may be late
FACTS
• In USA• Prostate Cancer
commonest cancer in males -- 33%
• Bladder Cancer – 6th commonest cancer in males 4%
Cancer facts and Figures 2004 American Cancer Society
• In India• Prostate Cancer 3rd
commonest Cancer in males of Mumbai
• Bladder cancer 8th commonest cancer in males of Mumbai
Mumbai Cancer Registry
Ca Prostate some more facts….
More than 80% disease come
when the cancer has already SPREAD
Srinivas et al 1995
Some more
Mumbai 4th most populated city in the world with a population of 18 million (1 crore 80 lacs) United Nations 2005 report published on expressindia.com press trust of India
How many Cancer prostate are we diagnosing, treating for cure or for palliation ?
1 in every 59 male will contract Ca ProstateAsian Pac J Cancer Prev. 2004 Oct-Dec;5(4):401-5.Related Articles, Links
Tip of an iceberg….
Diagnosed Cases
Undiagnosed cases
Deaths caused by prostate cancer1990-1996 data
Mumbai Cancer Registry
3 6 1829
45
74
127
279
0
50
100
150
200
250
300
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75 >
CaP deaths
• Graph shows Number of deaths by five year age group • Total deaths : 583 (4.02% of all, highest being esophageal cancer 9.7%)
Its there…we are getting it late..
Why are we getting it late ?
“I have no problems why should I go to the doctor, he will unnecessarily do some tests and fish money out of me, don’t you know these modern day commercialized doctors”
Mumbai Cancer Society 740 patients CaP 1987-1991
Survival Information on 602 patients
35.1
41.649.2
23.5
12.7
0
5
10
15
20
25
30
35
40
45
50
Overallsurvival
Relativesurvival
Organconfined
Localspread
Distantspread
Percentage
8.9
5.2 5
0
15.2
8
13.2
5
14
9.1
12
8.6
11.4
3.6
18.6
0
18.7
5.3
11.4
0
7.8
6.6
9.3
4
0
2
4
6
8
10
12
14
16
18
20
Banglore Barshi Bhopal Chennai Delhi Mumbai Ahmbd Krngplly Kolkata Nagpur Pune Thirup'm
CommonestProstate
Stomach
Hypo pharynx
LungStomach
Lung
Lung Lung
Lung Lung
Esophagus
Mouth
Mouth
Prostate cancer in comparison with theleading site of Cancer in various PBCR’s
4th
5th
8th
3rd 4th
7th
5th 5th5th
Does Cancer Prostate have any symptoms signs or indications?
We need to look for it…. HOW?
Of all patients with urinary symptoms 20%
may have prostate cancerThus 80% patients who may be having
Prostate cancer in its early stage do not have
Urinary symptoms or any other symptoms
Awareness
If aware one cannot be fooledIgnorance invites trouble
When early prostate cancer has no
symptoms what can be done to avoid being
late before the cancer really spreads?
Mantra for Early Detection
Blood test : PSA ( prostate specific antigen)
Examination:Digital Rectal Examination
( feeling the prostate with a finger)
Once in a
year
PSA (Prostate Specific Antigen)
• 0 - 4 ng/ml considered normal, if they undergo biopsy25-30% may have cancer all will be organ confined
• 4 – 10ng/ml patients if undergo prostate biopsy more than 70% willhave Cancer Of them 70% are likely to have prostate confined disease
• 10 – 20ng/mlhigher risk of hidden spread to bones more than 50%
• 20 – 50ng/ml risk of spread to bones more than 70%
• 50ng/ml and > spread to bone and LN more than 80%
Digital Rectal Examination
Doctor to whom you goshould know what, how to and what to feel on the prostateIf not done by a right person there Can be some accidents in the clinic
Feeling the prostate gland
with the finger (digit)Hard or bumpy prostate higher the risk of Cancer
Smooth big softer prostate – non cancer enlarged prostate
TRUS BIOPSY
DiagnosisGrade - Type of Cancerunder the microscope Gleason’s Score out of 10 ( e.g. 7 / 10)
Stage - How much has it spread in local area or fardistant area Bone Scan
Radical removal of prostateRadical Prostatectomy
After effects of surgery…• Leaking of urine upto 3mon
sometimes upto 1 year (waiting increases the risk)
• Sexual function: Nerve sparing and non nerve sparing
• In experienced and skilled hands the chances of above are less but it depends upon the stage and grade of disease
• If you wait, it may be late…
• In more than 90% cases leaking stops by 1year
• More than 70% cases recover sexual function by the end of year
• Viagara helps
Recovery time• Eat in the evening or next morning• Walk in 24hrs• Discharge in 5 – 7 days• Tube to drain urine kept for 2 weeks then
removed• Complete recovery in 4 weeks … • Start normal routine 6 weeks and beyond• Some may need to manage temporary urine
leaking problems • If need be Viagara can be started as early as
8 weeks• No lifting heavy weights for 6months
Radiation Therapy• Types• External Beam RT• Conformal RT• Intensity Modulated RT• Brachytherapy
• Can offer curative treatment in selected cases
• Except for Brachytherapy after effects of RT are more as compared to surgery
• Brachytherapy expensive and technologically and technically challenging
Its already late….What do we do?
• No curative treatment can be offered
• Other Forms of therapy
• Hormone therapy• Palliative
Radiation therapy• Palliative Surgery• Chemotherapy
Hormone therapyMost practiced – Bilateral Orchidectomy
Removal of Testes (both sides)Injections to block testosterone (male hormone)
• Is Bilateral Orchidectomy mutilating?
• Does anybody disagree?• What after Orchidectomy?• Irreversible• Hormone dependant CaP
becomes Hormone refractory independant CaP 12-18months
• Elderly patients bone pains/spine fractures? CaP metastasis
• Pain, neuropathy, disability, morbidity, gradual end of life.
• Survival this group of patients: 2-3 years
Literacy and Prostate Cancer
• Wolf et al (Chicago USA)• 197 men • African American, >65yrs, low
socioeconomic status, 7th grade or less of literacy
• Low health literacy subjects – More than twice likely that PSA levels will be high at the time of diagnosis
Awareness• Best way to fight any disease• Prevent if preventable• If not…• Early Detection• Better chance of cure• Hence we should strive to…..• Create & Spread Awareness
Thank you