Dr. Kardi Suteja, SpU

Ronald Reagan, Francois Mitterrand, Bob Dole, and Mobutu Seseko are a series of famous people who are known to suffer from prostate cancer. Prostate cancer can affect anyone of male origin on the condition that they have prostate and testes. It does not matter whether prostate cancer is about famous people or ordinary people, but the most important thing about prostate cancer is whether the disease is detected early or not.

The incidence of prostate cancer varies from one country to another and is especially lower in developing countries. How come? Firstly, because of the weak system of cancer registration in hospitals or related to health institutions. Secondly, because of the low life expectancy of our society, given the incidence of this disease reaches its peak at the age of 60 to 70 years. So, before the cancer was revealed the patient had already died. The highest incidence was found in Scandinavian countries followed by the United States and Britain. While the lowest numbers were found in China and Japan. In Indonesia, there are no national incident data. Based on pathology data collected from 13 major cities in Indonesia in 1988, prostate cancer was ranked 7th of all malignancies and was the most common malignancy in men. At Cipto Mangunkusumo Hospital, Jakarta in 2000, prostate cancer was the second most common urinary tract cancer after bladder cancer.

Typically, prostate cancer grows slowly and initially causes no symptoms because it occurs in the gland. But this does not happen to all prostate cancers, some are aggressive and quickly spread to other parts of the body. The cause of prostate cancer and why some types have different properties is unknown. Many risk factors for prostate cancer are studied, but to date there are only two factors that are clearly significantly related, namely age and hormonal levels. This disease is rarely found in men aged less than 40 years and 80% found at the age of 65 years. It has also been reported, castration will reduce the risk of prostate cancer and castration will cause a reduction in the volume of the prostate gland including prostate cancer. With castration, it will reduce the production of the hormone testosterone by more than 90%. The testosterone hormone is a hormone that “supports” prostate cancer.

Some risk factors that have recently also shown an association with the occurrence of prostate cancer are high-fat diets. High-fat diets, especially saturated fat, are associated with high mortality due to prostate cancer. Several studies on familial factors report the same thing, namely an increased risk of a person suffering from prostate cancer if there is a similar disease in a father or sibling.

But what is certain is if prostate cancer can be detected early (still limited to the prostate)  it can be cured properly. If cancer has grown out of the prostate and has spread to other organs, healing will be difficult.

Early-stage not detected

The problem that occurs in prostate cancer is that at an early stage there are no symptoms. Therefore, almost 40% of prostate cancer is not detected until cancer spreads out of the prostate capsule, even though the earlier the cancer is detected, the easier it is to be cured.

There are no specific symptoms of prostate cancer. The symptoms suffered are similar to those experienced by benign prostate enlargement patients. Symptoms include difficulty in starting urinating, pain during urination, an urge to urinate often, a weak stream of urine, urinating dripping, urinating always not smooth and frequent urination at night. Therefore, patients who present with lower urinary tract complaints or with a diagnosis of prostate enlargement should always be carefully evaluated.

Symptoms that are more than just the lower urinary tract syndrome are: presence of blood in the urine, pain during ejaculation, pain in the coccyx, hips, and thighs and loss of appetite and weight.

In prostate cancer there are three important tests that are used to ascertain whether or not there is a possibility of prostate cancer. These tests include digital rectal examination, the laboratory examination of prostate-specific antigen (PSA) blood and transrectal ultrasonography (TRUS). It is not enough to draw conclusions from one examination, but each examination is complimentary. If the urologist suspects prostate cancer based on one or two of the tests, a prostate biopsy will be performed.

Digital rectal examination is a simple, inexpensive, and quick test to detect prostate cancer. Despite its sensitivity and prediction of positive values, it is still recognized internationally as a standard way of testing for early detection of prostate cancer, provided it is done by an experienced doctor. Anal plugs can be estimated approximate prostate volume, hard prostate consistency, the presence of nodules (small lumps solid), and asymmetrical enlargement of the prostate.

If in the digital rectal examination the palpable prostate is hard and there are nodules, then the urologist can immediately do a prostate biopsy. With the presence of nodules on the prostate, prostate cancer has most likely come out of the prostate capsule. The cancer is no longer limited to the prostate.

Scientifically in patients who present with lower urinary tract syndrome, it is recommended to check the levels of prostate-specific antigen (PSA) in the blood. Although PSA is not a specific marker for cancer, as early detection of prostate cancer, its value is very important.

Significantly limits the value of serum PSA overlapping between benign prostate enlargement, and prostate cancer. From several studies reported about 28% of patients with benign prostate enlargement has a PSA value higher than normal. Conversely, about 25% of prostate cancer sufferers have lower than normal PSA values. Therefore, an effective way to detect prostate cancer early is a combination of digital rectal examination and PSA values.

Ultrasound examination through the rectum (transrectal ultrasonography – TRUS) is one of the tests to detect prostate cancer if it is not palpated through a digital rectal examination. TRUS can reveal the structure of prostate tissue, prostate size, and whether the prostate capsule is intact. TRUS examination is clearly more sensitive to see prostate cancer that is still limited in the prostate capsule than the digital rectal examination. If it is still limited in the prostate capsule, it means that prostate cancer is still in an early stage. With TRUS examination prostate biopsy can be done. A prostate biopsy is absolutely done if there is a suspicion of prostate cancer on digital rectal examination or TRUS. A biopsy is also carried out if the PSA value is more than 10 ng/ml.

Spread

In prostate cancer, symptoms and signs of lower urinary obstruction can occur exactly as benign prostate enlargement. If cancer has invaded the bladder, especially in the area of the ureter, the obstruction of the upper urethra can occur. Urine from the kidneys can be blocked and cause kidney damage. By itself kidney function will decrease and can even fall in the condition of kidney failure.

Prostate cancer cells can spread as far as to the lymph glands of seeds, bones, and other organs such as the liver, lungs, and brain. If there are symptoms of pain in the bone, decreased liver function, decreased lung function, or impaired consciousness, prostate cancer is already at an advanced stage. To detect the invasion of cancer to surrounding organs and the far spread of cancer to other organs, it is necessary to have a supporting examination in the form of laboratory and radiological examination.

Early detection is a very important keyword in the treatment of all cancers, including prostate cancer. The outcome of therapy depends on whether prostate cancer is known early. If there is no financial problem, there is no harm in screening or checking up on men over 40 years with complaints of lower urinary tract syndrome (lower urinary tract) to detect prostate cancer.

Dr. Kardi Suteja, SpU.  is a specialist in urological surgery at Karsuneka Clinic Denpasar  and several private hospitals in Bali.