The prostate gland (shown in picture) is an accessory sexual organ situated underneath the urinary bladder, in front of the rectum and covers a part of the urethra (the pipe through which urine is excreted). Its secretions form a part of the male ejaculate and nourish the sperm and keep the semen liquid. It is the size of a walnut in a normal adult male and increases in size with age. The development and growth of the prostate gland is dependent upon the male sex hormone testosterone.

The main conditions that affect the prostate gland are infection (prostatitis), abnormal age related increase in size with age (also termed as BPH or benign hypertrophy of the prostate) and prostate cancer. Benign prostate hypertrophy (or BPH) is not cancer and does not cause cancer but can cause an increase in size of the gland leading to problems with urination and may require medications and in some cases even surgery. This article will mainly deal with Prostate cancer.

Prostate cancer is one of the leading causes of cancer in men above the age of 60.  Most cases could be slow growing and may even go undetected and not cause any problem. Some could be aggressive and can spread to other parts of the body and are difficult to treat. It usually presents with difficulty and pain during urination, blood in the urine along with sexual dysfunction. In many early cases there may be no symptoms and it may be detected incidentally on performing rectal exam, blood test, scan and biopsy. Advanced cases may present with bone pain in addition to the urinary symptoms.

Prostate cancer is very rare before the age of 40 but the risk increases with age and most cases are detected in the late 60s. Susceptibility to this cancer depends on various other factors:

• Men who consume a diet rich in red meat and high fat dairy products and do not consume vegetables and fruits are more susceptible.
• Men in the West, especially African-Americans are more susceptible than Asians
• Obese men are more susceptible to it as compared to non-obese
• A person is more susceptible to suffer from prostate cancer if he has a family history (if his brother or father suffered from the same). Genetic basis for prostate cancer has been identified and certain gene mutations can cause it.
• There are some data linking prostate cancer to chronic prostatitis, sexually transmitted infections, smoking and alcohol consumption.

Prostate cancer is most often detected in the early stages by a combination of clinical exam (rectal exam) and Serum PSA (Prostate specific antigen), a tumor marker that is useful in this disease. Further confirmation involves a biopsy of the prostate from the rectal route (most often) under local anesthesia and ultrasound guidance. This is a fairly painless procedure done usually by a Urologist and involves taking pieces from the prostate which will be examined under the microscope. If the diagnosis is confirmed a MRI scan of the pelvic area may be performed to look at the extent of disease. A chest X ray, ultrasound of the abdomen and bone scan may be ordered if there is suspicion of spread to these regions.

Fortunately in most cases, cancer of the prostate is not very aggressive and can be detected at a fairly early stage and treated by various modalities. The Urologist will make the decision regarding the modality of treatment to be used based on a combination of factors which includes age, physical fitness, co-morbidities, clinical stage of disease, biopsy findings and PSA levels. The options available for treatment are:

• Active Surveillance (wait and watch): No active treatment is done and the patient is followed up at regular intervals to see the progression of disease. This modality is used in elderly patients with short life expectancy and early disease.
• Surgery: The operation performed to remove the cancerous tissue is called Radical prostatectomy. Depending on the extent, patient factors and expertise available it can performed via a fairly long cut in the abdomen, laparoscopically (key hole surgery) or even with Robotic surgical methods which is available at a few centres in India as well. The surgery has good success rates in expert hands but may have long term side effects like sexual dysfunction, urinary incontinence and narrowing of the urethra. Sometimes removal of the testes (orchidectomy) is advised in advanced disease to minimize the effects of testosterone on the growth and spread of cancer.
• Radiotherapy: Can be administered as a primary modality via needles implanted into the prostate under ultrasound guidance or as an external beam. Radiation can be administered after surgery if the resection of cancer tissue has not been complete.
• Hormone therapy: Medications that suppress testosterone levels are used as primary treatment and in advanced cases of prostate cancer.
• Chemotherapy: In advanced cases, when the disease is not controlled with hormonal treatment the patient may be a candidate for chemotherapy wherein strong medications are used to kill the cancer cells and prevent spread.
• Other local ablation treatments like Cryotherapy, Radiofrequency, High intensity focused ultrasound (HIFU) are used to treat early cancers or when the patient is not fit for a major surgery.

The aforementioned treatments could be used singly or in combination depending on the clinical situation, patient factors and expertise available.

Regular follow-up as advised by the urologist with blood tests including PSA levels and imaging investigations will have to be adhered to prevent recurrence or progression of disease. Side effects of various modalities of treatment will have to be understood and may play a role in the decision-making process. With further advances in surgical techniques, hormonal, radiation and chemotherapy, adverse effects are minimised to a large extent. Leading a normal life with normal physical and sexual activity is possible with the available techniques in modern medicine.

Valuable information on prostate cancer can be found on www.pcf.org ( prostate cancer foundation) and www.cancer.gov

February 4 is World Cancer Day

Being diagnosed with cancer can be traumatic but what you have to realise is that it’s not the end of the world. Cancer like all other diseases is very treatable. The theme of World Cancer Day this year is dispelling the myths and misconceptions about cancer and the biggest one is that cancer is a death sentence.  Dr Ashwin Mallya tells what to do when you’re diagnosed with cancer.

Relax: That is the first step. Take a deep breath and tell yourself that it’s not the end of the road. With early diagnosis, treatment and regular follow-ups many patients end up living a near normal life. Just take a look at Yuvi; he is back in the Indian cricket team!

Confide: You don’t have to do it alone. Tell your near and dear ones about your ailment, especially your partner or whoever you’re close. Their strength and support will help you get through this.

Trust your doctor: A lot of people tend to lose faith in their treatment options and opt for other methods. Your doctor will give you the maximum insight into your disease and the treatment options available. However, if you’re in doubt you can always go for a second opinion.

Be regular: Many people tend to stop their treatment regimens after a while. You should be very particular about your check-ups, follow-ups and investigations to get the maximum benefits. Also avoid self-diagnosing and self-medication and don’t start taking medicinal advice from everyone.

Stay positive: Good nutrition (follow your doctor’s recommendations), exercise (within tolerable limits) and a positive frame of mind will make you stronger, in order to tolerate the medications which at times may be of strong nature.

Don’t get fooled by soothsayers: If you are considering indigenous systems of medicine or alternative therapies do mention this to your treating oncologist. Don’t be fooled by soothsayers and astrologers regarding ‘guarantees’ about their treatment.

Don’t stop living: Many people tend to go into a shell once they discover they’ve cancer.  Do not cut yourself from your social circle. Genuine friends will always be there for you. Suffering from cancer does not make you a social outcast.

Meditate:  It’s vital to maintain peace of mind. You need to do things that will keep you from being stressed out. Why not try some meditation and other relaxation techniques?

Join support groups: Most Oncology set ups have support groups or at least a network of patients and their families who have suffered the disease, gone through treatment and in most cases survived the ordeal. Small tips and anecdotes can lighten the burden that you may be feeling.

And finally, Believe: Know that you will beat the disease. Read up as many survival stories and books with information about coping with the disease. You will be surprised to find how many, many people have beaten the disease.

 Always remember cancer is not a death sentence. There are lots of people who have been diagnosed with cancer that have gotten over this ailment and lived a normal enriching life. 

Also read: War on Cancer

The liver is a highly under-appreciated organ. In the post, I’ll try and explain what the liver does, the diseases which can affect it and end with tips to maintain it in top shape.

Your liver is a one and a half kg organ that sits behind your right rib cage. If you did not have your liver, you would not be able to process nutrients like carbohydrates, proteins, fats, vitamins and minerals from your food. Your body would not get rid of all the toxins and microbes. Your blood would probably never clot! The liver plays a vital role in maintaining the body’s metabolic balance.

As the liver performs a variety of important functions it is extremely vulnerable to a variety of metabolic, toxic, microbial, circulatory and cancerous insults. Awareness of the liver’s functions and what all can cause liver disease can help you take the road to great health.

Let’s start with a few commonly known diseases that can affect the liver:

1. Fatty Liver: This disease was traditionally known to occur in association with excessive alcohol intake but now the non-alcoholic variant is reaching epidemic proportions in the developed countries. Known to occur in association with metabolic syndrome consisting of hypertension, diabetes, obesity and hyperlipidemia this disease occurs because of faulty fat metabolism in the liver. Prevention is the best treatment and if uncontrolled can even end up in liver failure.
2. Viral hepatitis is an infection of the liver that is caused by a group of viruses that have particular affinity for the liver. Out of these, hepatitis A and E are caused by eating food contaminated with the virus. Hepatitis B, C and D are acquired through blood, body fluids and by unprotected sexual contact.
3. Alcoholic hepatitis is inflammation (swelling) of the liver due to ingestion of alcohol.
4. Cirrhosis or scarring of the liver is caused mostly due to alcohol intake, viral infection due to hepatitis B  and C , bile duct disease or iron overload. It is among the top 10 causes of death in the world. The liver ceases to function normally due to irreversible damage. It progresses gradually and can lead to end stage liver disease.
5. Drug induced damage caused due to the various medicines we take and chemicals we are exposed to. As liver is the major detoxifying organ in the body, it is subject to an enormous variety of drugs and chemicals. Always be careful when consuming medicines. Even over the counter medications like paracetamol can cause fulminant liver failure. Never take medications beyond the recommended dosage. It is always better to consult a doctor before taking medications and follow up at the slightest evidence of ill health. Certain herbal medications could also cause damage to the liver and so can medications for tuberculosis.
6. Liver cancer can be caused by many factors including viral infections (hepatitis B and C), chronic alcoholism, certain food contaminants, genetic factors, cirrhosis of the liver.

What are the symptoms of liver disease?

 This depends on the onset and rapidity of progression of liver damage.

In case of acute liver damage (due to drugs, toxins, viral hepatitis A, B or E), there may be fever with yellowish discoloration of sclera (the white of the eye), skin and urine. In most cases this may be self-limiting. In a small percentage, this may progress to fulminant liver failure leading to coma, altered blood clotting, kidney failure, secondary infections and may even require liver transplantation.

In chronic liver damage (due to hepatitis B, C or alcohol), the symptoms would be more gradual in onset:

• Jaundice or yellowish discoloration of skin and the white of the eye.
• Swelling especially in the legs and feet due to low protein levels.
• Enlargement of breasts known as gynecomastia (in a male).
• Reddish spider like discolorations (spider nevi) beneath the skin especially over the chest.
• Accumulation of fluid (ascites) in the abdomen giving it a protruded appearance.
• Problems with clotting of blood
• Vomiting of blood or blood in stools
• Altered senses with change in behavior, confusion, forgetfulness and other symptoms related to the brain also known as hepatic encephalopathy.
• Gradual worsening of kidney function

The above symptoms are not comprehensive and it is best to consult a doctor at the earliest onset of any of the above.

 Tips for a healthy liver:

Diet and Alcohol: A balanced diet with low fat content would be well suited to prevent fatty liver. Alcohol is best avoided.

Exercise: Plays a role in controlling cholesterol and in the metabolism of fat thus indirectly protecting the liver.

Vaccination: Hepatitis B is preventable by vaccination. Three shots of the hepatitis B vaccine taken over three months can provide long term protection against the dreaded disease.

Hygienic food and drinking water: Hepatitis A and E are known to spread via the oral route. Think twice before having road side delicacies! Boil the water that you intend to drink. It is the best way to prevent communicable diseases.

Avoid self-medication: Various drugs can damage the liver if taken indiscriminately

Regular check-ups: Once diagnosed with liver disease, be regular in follow ups with the doctor. Reversible damage can become irreversible if neglected.

 This World Liver day, let’s strive not to abuse our liver, one of the most useful organs that we have. Let’s treat it with the love and respect it deserves. 

1. Most of us have latent TB foci inside our lungs. We all are exposed to the organism early on in life and would have formed foci of infection in the lungs (primary TB). Our immune system would have contained the infection and prevented us from suffering the disease. It is when our immune system becomes weak for some reason or is overwhelmed by the infection or any other cause, that we suffer the disease (reactivation). The organisms can travel from the foci of infection in the lungs to other sites leading to secondary infection (TB of lymph nodes, spine etc).

2. By maintaining good health and immunity, you can prevent getting infected with tuberculosis. Nutritious food, adequate sleep, exercise and leading a life with minimal stress go a long way in helping our immunity fight any infection well including TB. Work on improving your immunity by including diet rich in antioxidants. Have atleast 4-5 servings of fresh vegetables and fruits everyday. If you cannot have it due to certain practical constraints, make sure you take your daily dose of antioxidants/multivitamins after consulting your doctor. Anti-oxidants help fight free radicals produced in the body due to any kind of disease/stress and help in cell repair.

3. Fresh air and sunlight can help prevent TB. The microbes in TB thrive in cold, damp places. Whether you are at home or office, remember to open all your windows for a major portion of the day to let the sunlight and air in.

4. Tuberculosis primarily affects the lungs but can affect other organs too. Cough that lasts for more than 3 weeks, streaks of blood in the sputum (phlegm), low-grade fever, difficulty in breathing and unexplained weight loss are the commonest symptoms of TB of the lungs. TB of other organ systems present with varied symptoms. For example: TB of the skin could present with a non healing ulcer, TB of the spine could present with backache, stiffness or even swelling in the back/groin, TB of the intestines could present with abdominal distension and  absolute constipation. Even a non-healing anal fistula could be due to TB. TB of the lymph nodes can present with swellings at multiple sites of the body. TB of the covering of the brain and spinal cord can cause TB Meningitis, especially in children.

5. With the BCG vaccine, you cannot be resistant to TB throughout your life. It also doesn’t help in secondary forms of TB. That said, one still needs to get the BCG vaccine soon after birth.

6. TB is a fully treatable disease if the full course of medications are taken properly and regular follow-ups are done with the doctor. The TB control program in India, was started as RNTCP (Revised national tuberculosis control program) in 1993. The program has made great progress over the last two decades. Having collaborated with private hospitals and medical colleges the reach of the program is 100% in India. The mainstay of the program is prompt diagnosis (by sputum testing and X ray of the chest), commencing the treatment as early as possible and making sure that the patient is compliant with the treatment (Directly observed treatment-DOTS). The main drugs used for TB are Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin. But always take these medicines under the doctor’s supervision because indiscriminate use can lead to jaundice and liver failure, kidney failure.The duration of the treatment varies from case to case and is at least for 6 months. Testing and treatment is available free of cost at all government hospitals, primary and community health centres.

7. Not taking the full course of TB medicines as per the doctor’s prescription is one of the major hurdles faced by the TB prevention programs. It can lead to the organisms developing resistance to the first-line drugs used in treatment causing MDR-TB (multi-drug resistant TB).

8. Multi-drug resistant TB does not respond to standard TB drugs, is difficult and costly to treat.  The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases. One of the best ways to prevent it is by completing the entire course of anti-TB drugs in the dosages prescribed by the doctor.

9. One of the major causes of infertility among women from the lower socio-economic conditions is genital TB. When latent bacilli in the lungs get reactivated, they often spread to different parts of the body including the genital tract. It can infect either the uterus and/or the fallopian tubes and usually does not show any symptoms. A very difficult disease to diagnose, only the culture from a tissue sample obtained from a genital tract can help.

10. Children including babies can suffer from TB, but often go undiagnosed. According to the WHO, around half a million babies and children get ill with TB every year and 70000 die due to it. Children under three years of age, especially those who are malnourished and with compromised immune systems are particularly prone to the disease. However, the symptoms often go unnoticed causing higher mortality rates. To prevent TB in children, get them immunized with the BCG vaccine soon after birth. People in your family, including house-help, who would come in close contact with the children need to be screened. Also, breastfeeding the baby for at least six months increases their immunity against all infections including TB.

a)     First-aid box – the best thing to have handy when faced with situations involving wounds, burns, cuts etc, whether it’s at home or office. A basic first aid box must contain an antiseptic solution, burnol, sterile cotton, gauze , adhesive  medicated plasters, roller bandage, scissors and some basic pain killers. Check the box once in a while to see if any of the items mentioned above need to be replaced if they are beyond their expiry date.

b)    Personal details – Everyone at home/office  should have a card in their purse  containing –a list of medications they are on (if any), health conditions eg – diabetes, hypertension, heart disease, known allergies, previous surgeries or procedures , blood group, contact number and address in case of emergency , treating doctor’s  contact details. This can prevent a lot of confusion and disasters in the emergency room.

c)     Important numbers – There are some numbers which ought to be stored on all family members’ mobiles – Emergency numbers for hospitals nearby, numbers of ambulance services (102 in the national number for ambulance services), two of your neighbors’, numbers of two relatives or friends who stay close by, your doctor’s numbers. At home, maintain a small diary for all this information and let everyone in the family including house-help learn to use it well.

d)    Medical records – Never and I repeat, never discard any medical records and prescriptions. Everyone in the family should have a dedicated file which contains all the medical records for ready reference. CT scan, MRI, X-ray films should be stored safely and can even be kept in CD format as most centers provide at present. This not only prevents medical disasters but can go a long way in saving you from unnecessary tests, medications and surgeries. Nowadays, there are websites that let you store your medical records online. All you need to do is upload your records diligently and in the case of an emergency, just remember your login and password!

e)    Medical Insurance – With the rising costs of health care it is prudent to set aside a certain amount of money for medical insurance. There are a good number of schemes available. It is best to contact your agent for this. Make sure that the annual premium is paid in time to prevent embarrassing situations at the hospital later. Get yourself educated well about the conditions that are covered by your insurance company and the requirements you need to fulfill in order to get reimbursed. If you have a TPA card, make sure you carry it with you in your wallet all the time.

 f)      Getting trained in First aid/Basic life support – For those who think that being prepared is serious business, get one step ahead in by getting certified in basic life support techniques. These are one-day courses conducted at various hospitals. All you have to do is approach them for guidance. The most important part of this course is CPR (cardio-pulmonary resuscitation). This can be a real life saver when faced with an unresponsive person who has stopped breathing or whose heart may have stopped beating due to various causes like heart attack, drowning, sudden collapse to lung problems, stroke, severe allergic reaction etc. Till medical help arrives, on-site CPR has saved many lives the world over.

   g)      In the emergency room - It can get very busy in the ER and doctors will need a quick history and examination to make some critical decisions regarding investigation and treatment. The doctor will ask details about the present event and a past history of other medical conditions, personal history and a family history of other ailments. It was stressed earlier regarding the need for a card containing all the personal details handy. It is important to remain calm and composed and not get ruffled by the happenings on at the ER. An accurate description of the sequence of events can be very helpful to the physician.

 h)    Keep your medicine cabinet well stocked – Make sure you have a supply of medicines that you keep aside and will last you at least a week. This can be really useful when it comes to unforeseen circumstances like the medicines getting out of stock at your pharmacy or you have to suddenly go out of station.

 Here is a list of common medical emergencies that you may face in day to day life and the measures you should take:  

This list is not exhaustive. The bottom line is that prevention is always better than cure and to be well prepared is to avoid dangerous medical catastrophe. The scouts’ motto ‘Be prepared, be prepared and be prepared’ holds very true.