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Old disease, new cures

In a five-part print and online exclusive, a world authority on prostate cancer gives information from the frontline of the battle against a disease that continues to fox oncologists across continents. Dr Ashutosh Tewari and Dr Abhishek Srivastava write. Prostate problems

world Updated: Apr 17, 2011 03:00 IST

Prostate cancer is among the top five cancers in men in most parts of the world, and the commonest non-skin cancer in men in developed countries. Fewer cases are reported in developing countries, partly due to racial predilections but mostly because cases either go under-diagnosed or are diagnosed too late. There are relatively few prostate cancer cases in India: it affects 4.6/100,000 (1 lakh) people in India, compared to 104.3/100,000 in the US, shows World Health Organisation data. What’s worrying, however, is that 85% men with prostate cancer in India seek treatment when the cancer is in a late stage (III and IV, when the cancer has spread outside the prostate gland), compared to 15% in the US.

Cancer registry data from five major cities in India shows that even after adjusting for the fact the people are living longer, cases of this age-related cancer have been steadily increasing over the past two decades. This due to a combination of several factors, such as improved diagnostic technology leading to higher detection rates, as well as increases in risk because of people opting for an unhealthy high-fat diet and/or increased exposure to environmental carcinogens.http://www.hindustantimes.com/Images/HTEditImages/Images/17_04_pg18new2.jpg

There’s little information about the biology of prostate cancer in Asian-Indians because radical prostatectomy – removal of the prostate gland and some of the tissue around it – is rarely done, which gives experts vital tissue analysis data.
Since most Asian-Indians start treatment with advanced stage cancer, they hardly ever undergo curative treatment. This offers experts few surgical series to highlight unique pathologic variables in Asian-Indian men with prostate cancer.

In soon-to-be-published study in the Indian Journal of Urology by our group, we have 60 men of Indian origin from a cohort of 2,500 patients. We compared their clinical, biopsy and pathological outcomes data with the rest of the cohort as a control (mostly Caucasians) and found that Indians had a greater tendency for higher Gleason scores (7 or more) in both the pre-operative prostate biopsy and final tissue analysis.

Although the average prostate-specific antigen (PSA) – high blood levels of this protein produced by the prostate gland is an indicator of cancer— in Indian men was not significantly different from the control group, 83% of them had a PSA greater than 4ng/ml compared to 52% in the control group.

A significantly higher incidence of extracapsular extension — cancer that has spread outside the prostate gland — was found (32.3% versus 15.5%) in Indian patients versus the control. This data shows that there is an urgent need for prostate cancer awareness among Indians, not just in the subcontinent but also around the world.

Visit www.prostatecancersymposium.com for details.

Also see:Prostate Problems