Last month, Buckingham Palace dropped a bombshell: King Charles III of the United Kingdom has been diagnosed with a “form of cancer.” While rumors swirled about an enlarged prostate, the diagnosis turned out to be benign. Yet, the specific cancer type remained shrouded in mystery. Across the Atlantic, a similar saga unfolded in the White House. Defense Secretary Lloyd Austin’s hospitalization for prostate cancer in January caught even President Joe Biden off guard. The hush-hush handling of Austin’s condition raised eyebrows, sparking questions about “transparency and communication within the administration”, as flagged by CNN.
These two high-profile cases highlight the level of secrecy and taboo surrounding prostate cancer—a condition that affected 1.4 million men with new cases in 2020 alone. This secrecy is not limited to royalty or those in positions of power; it extends to men from all walks of life, highlighting the pervasive nature of the issue.
Anup Chauhan, aged 55, was diagnosed with prostate cancer in 2022. Reflecting on his journey with Health on Air, he reveals the isolating experience this diagnosis has brought. “I’ve been the one taking care of my family for over 30 years. Even though I have a loving family, I go to get my PSA test and attend therapy sessions all by myself. I don’t really talk about it with my wife and kids. It’s hard for me. I guess I just don’t want them to worry or see me differently,” shares Chauhan.
Prostate cancer affects the gland responsible for producing seminal fluid, which nourishes and transports sperm. The diagnosis of prostate cancer invariably imposes a psychological toll on men. It often evokes a sense of relinquishing control over their bodies and futures, leading to feelings of vulnerability and helplessness. When this loss of control extends to sexual function, it profoundly affects self-esteem and self-image.
“Sexuality is most commonly avoided in such discussion and I believe these problems should be properly addressed to remove the taboo/concerns,” says Dr. Dodul Mondal, Director of Oncology/Radiation Oncology at Max Super Speciality Hospital, Saket, Delhi
Men frequently make rushed decisions to undergo prostate removal, often without thorough consultation or exploration of alternative treatment pathways, even when dealing with low-risk cancer that could be effectively managed through a strategy known as “active surveillance.”
Dr. Keshav Sharma, Psycho-Oncologist at the Bagchi Karunashraya Palliative Care Center in Bhubaneswar, notes that the concept of active surveillance is still unfamiliar to many. When advising a patient diagnosed with low-risk prostate cancer about considering active surveillance, the first step is to address their fears and concerns. “I encourage patients to engage in open discussions with their oncologist, asking specific medical questions. Queries about prognosis, life expectancy, and potential effects on other organs are best addressed by a medical specialist,” she adds.
Sharing his experience opting for active surveillance, Chauhan recounts that when faced with an intermediate-risk prostate cancer diagnosis, he initially considered surgery or radiation without realizing active surveillance was an option. However, his doctor recommended otherwise. “It took me three weeks to decide if I wanted to proceed with this newer, lesser-known concept,” says Chauhan. Today, he has no regrets about his decision.
What is active surveillance?
Active surveillance is a method to manage prostate cancer in men with low-risk, localized cancer. It involves regular check-ups, including blood tests and biopsies, to closely monitor the cancer without immediate treatment. This approach helps avoid unnecessary treatment side effects until treatment is truly necessary.
Dr. Mondal explains that active surveillance means closely watching the tumor’s behavior and intervening if certain criteria, like changes in the tumor’s size or other indicators, are met.
Who should consider active surveillance?
Doctors consider factors like life expectancy, cancer aggressiveness, PSA levels (a protein measured through a blood test to screen for and monitor prostate cancer), and cancer stage to determine if active surveillance is suitable. For those with low-risk cancer and a life expectancy of over 10 years, active surveillance may be considered.
Why can active surveillance be beneficial?
Active surveillance can help avoid or delay the need for invasive treatments like surgery or radiation, which can cause side effects like urinary problems and sexual dysfunction. This approach can improve the quality of life for patients and may even eliminate the need for treatment altogether.
It’s important to know that active surveillance is just one treatment option among others, and the decision depends on individual circumstances. Treatment choices should be tailored to each patient’s needs and preferences.
Treatment Stages
The treatment stages for prostate cancer typically progress through several key phases, which may vary based on the cancer’s characteristics and the patient’s overall health:
- Diagnosis and Staging: Confirming the presence of prostate cancer through tests like PSA blood tests, biopsies, and imaging studies. The cancer is then staged based on its size, location, and whether it has spread.
- Treatment Planning: Depending on the stage and grade of the cancer, as well as the patient’s health and preferences, a treatment plan is developed.
- Active Treatment: This phase involves the direct treatment of cancer, which can include: – Surgery (such as radical prostatectomy) to remove the prostate,- Radiation therapy (external beam or brachytherapy),- Hormone therapy to reduce testosterone levels and slow cancer growth,- Chemotherapy, especially for more advanced cancer,- Targeted therapy or immunotherapy in certain cases.
- Follow-up and Monitoring: Regular checks like PSA tests and other imaging tests for cancer recurrence and treatment effectiveness.
- Management of Side Effects and Rehabilitation: Managing side effects like urinary incontinence, erectile dysfunction, and the psychological impact of cancer for maintaining quality of life.
- Palliative Care: Focusing on symptom relief and quality of life for advanced cases.
The specific course of treatment and its stages can vary greatly from one patient to another, based on individual circumstances and evolving standards of care in oncology.
