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.
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.
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