Surgery Sans Scars

A new procedure called Prostatic Artery Embolization has been evolved which does not produce side effects as is the case in open surgery. Done under local anaesthesia, it leaves no surgical scar, and makes for faster recovery
By Dr Atul Goswami

Prostate cancer starts in the prostate gland. Cancer causes cells in the body to change and grow out of control. Most types of cancer form a lump or a growth called a tumour. Patient may not know that there is a cancerous tumuor in the prostate. Most cases of prostate cancer develop very slowly. However, in some men, it can grow quickly and spread to other parts of the body.
Men aged 50 and older should be screened during their annual physical exam with a discussion regarding prostate cancer risk. A routine blood test can measure a biomarker called prostate-specific antigen or PSA, which can identify a man’s risk of prostate cancer along with a digital rectal exam. Concern based on the PSA blood test level or digital rectal exam can prompt a biopsy of the prostate gland, which can be further evaluated to determine the presence of prostate cancer and, if found, the aggressiveness of the cancer.
Symptoms of advanced prostate cancer may include dull, deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs; pain in the bones of those areas; loss of weight and appetite; tiredness, nausea, or vomiting; swelling of the lower extremities; weakness or paralysis in the lower limbs, often with constipation.
Symptoms of prostate cancer are rare, and many men show no symptoms before being diagnosed. Once a blood test shows signs of higher PSA levels, a tissue biopsy is required to help determine the grade and stage of the prostate cancer. The presence of prostate cancer may be indicated by symptoms, physical examination, prostate-specific antigen (PSA), or biopsy. Treatment generally involves surgery, various forms of radiation therapy, proton therapy or, cryosurgery. Hormonal therapy and chemotherapy are generally reserved for advanced disease cases.
New research on gene changes linked to prostate cancer is helping scientists better understand how prostate cancer develops. This could make it possible to design medicines to target those changes. Tests to find abnormal prostate cancer genes could also help identify men at high risk who might benefit from screening or from chemoprevention trials, which use drugs to try to keep them from getting cancer.
The prostate is a reproductive gland in men located between the bladder and the penis. The fluid from the prostate is discharged into the urethra at the time of ejaculation as part of the semen to nourish and stabilize sperm for reproductive purposes. One in 5 men gets diagnosed with prostate cancer during their lifetime. While the exact causes of prostate cancer are not known, certain risk factors have been linked to prostate cancer.
A risk factor is something that increases a person’s chance of getting a disease. Aging is the greatest risk factor for prostate cancer. Family history also plays a role. If a man’s father or brother has a history of prostate cancer, his risk is two to three times greater than average. Diet may also be a factor. Men who eat large amounts of animal fat, particularly fats from red meat, may face a greater risk of prostate cancer than men who eat less animal fat.
In prostate cancer, there is a 10% chance of the disease to pass from one generation to other. This means that it’s a hereditary disease and every person with family history of prostate cancer should undergo prostate screening.
Some dietary changes can help maintain good prostate health and may help ward off cancer. Lycopene and selenium reduces the danger of prostate cancer very fast. Vegetables such as broccoli, cabbage and cauliflower contain isothiocyanates, which are phytochemicals and antioxidants that are protective for prostate cancer. Fish and vegetable oils high in omega-3 fats are also very effective. Vitamin E is known to reduce prostate inflammation. Its sources include vegetable oils, nuts and seeds, whole grains, etc.
A study of nearly 50,000 men found that Lycopene, found in foods as tomatoes, tomato products, and watermelons appears to reduce the risk of prostate cancer drastically. Selenium is another mineral that offers great protection. This antioxidant is found in nuts, seafood, meat, fish, wheat bran, oats, and brown rice. Soy products can also help prevent prostate enlargement and may slow tumour growth. This effect is attributed to isoflavones, plant chemicals that help lower dihydrotestosterone (DHT), a male hormone that stimulates the overgrowth of prostate tissue.
Red meat on the other hand is high in saturated animal fats and has been linked to an increased incidence of prostate problems. Excessive weight has also been linked to prostate troubles. Anyone with an enlarged prostate should drink plenty of water and other non-alcoholic fluids to flush the bladder. Caffeine and beer should be reduced to a minimum as they irritate the urinary tract.
If there is something suspicious, more tests are required. Often, the problem may be just an enlarged prostate or a simple infection. Further tests, including urinalysis, blood tests, x rays, ultrasound or a biopsy, may help diagnose your problem. The experts (urologist) may refer you to other specialists for some of these tests and for any needed treatments.
Not all treatments work for everyone. However, you have the right to know all the choices you have so that you play an active part in treatment decision.
The earlier prostate cancer is detected, the more options are available for its treatment. Surgery, radiation therapy (either external beam or internal seed implants), hormone therapy or some combination of these are all commonly used. Depending on age and condition, and your wishes, your health care provider may recommend only that you be watched and tested several times a year. Some urologists feel that, for men over 70, the risks of surgery or radiation treatment outweigh any benefits. Therefore, they recommend watchful waiting.
If you are younger and in good health, your health care provider will be more likely to recommend how the cancer be treated. Any treatment may have side effects. Talk with your doctors about your treatment options. Make sure you understand the risks, benefits and chances of success.
As a man ages, there is a good chance that he will develop an enlarged prostate or benign prostatic hyperplasia (BPH). About 30% of man may need surgery to correct symptoms from this enlarged prostate. The symptoms may include: weak urine stream, difficulty in urination, increased frequency of urination at night, urgent need to urinate and not being able to completely empty the bladder and urine infection. Most of the man may go for traditional open surgeries. But there are complications such as blood loss even few days after surgery, urinary incontinence, retrograde ejaculation, loss of bladder control and erectile dysfunction.
Now a new procedure has been developed that is comparable to TURP in recovery symptoms. It is called Prostatic Artery Embolization or PAE. In terms of advantages, Prostatic Artery Embolization can be performed on any size of prostate; it does not produce the side effects like in open surgery. Done under local anaesthesia, it leaves no surgical scar, requires only one-day hospitalization, leads to no sexual dysfunction after procedure, no blood loss or risk of blood transfusion and makes for faster recovery. Its success rate is about 98 percent.

(The author is Chief of Uro Oncology, Sri Balaji Action Medical Institute, New Delhi)