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 more

After 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 Bleeding

Sudden retention of Urine

Kidney

&

Bladder

damageBladder

stone

Overflow

Of 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 5th

5th

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

Diagnosis

Grade - 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