I have never been a gambler and would never be. Notwithstanding, I have been to Casinos and know what it is all about. From black jack, sequence to poker a gambler can only go one way; and that is down the hill. While the poker room may look like a bank’s cash room, the roulette is where the excitement really is. Sometimes the betting can be so intimidating that the dealer is at a loss on how to manipulate the ball when he or she spins the roulette table. Sorry, gambling is not what we set out to do in today.
We will be drawing a parallel between Carcinoma of the prostrate and the so called Russian roulette. It is said that when two gamblers bet on unto death; the Russian roulette is the best option to settle the matter. In this game of death, the two contenders sit opposite the roulette table and a gun is placed in an anchor in the table. Both gamblers are blind folded; and the table is spun around. When the table stops after rotating for a while, the gamblers stretch out their hands to pick the gun in front of them. If you find the gun in front of you, that means that you have won and all you have to do is point it straight and pull the trigger.
Well the winner can be magnanimous and forgiving and let his opponent go. You don’t really need to kill a loser. But the game is not always as simple as that. For the table can be spun in such a manner by the dealer that the gun never stops in front of any of the gamblers! At the end both are frustrated and leave with their egos intact. And quite honestly, a parallel can be drawn between this and cancer of the prostate gland in men.
For a recap, prostate cancer is the commonest non cutenous cancer in men. About one in every six men would be diagnosed of having this lesion in a life time with increasing age and raised life expectancy. The black race has a higher prevalence. Currently, most cases of this disease ironically are identified by screening men without symptoms of the disease. However the following are well known symptoms of the cancer: urinary complaints with retention, blood in urine known as haematuria, low back pains and so on. Please bear in mind also that these symptoms can be found in non cancerous enlargement of the prostate gland known as benign prostatic hyperplasia (BPH).
When the disease is advanced the patient would be asthenic and wasted, may suffer from bone pains, swelling of the lower extremities and distension of the bladder. Other late symptoms would include feeling tired due to low level of red blood cells or rather anaemia; which is common in this class of patients. Cancer of the prostate may also pose challenges with normal sexual functions leading to difficulty in achieving erections and painful ejaculation.
The Diagnosis of Prostate cancer is through biopsy: which entails removing small pieces of the gland and examining them under a microscope. This is obviously an invasive procedure surgically. However there are other tests that could be used in making an informed decision with regards to the state of the prostate gland and are not invasive. These include ultrasound and magnetic resonance imaging. Physical examination of the prostate by passing fingers through the rectum is very useful in detecting prostate abnormalities. In our environment, the use of Prostate Specific Antigen (PSA) as a tumor marker is becoming increasingly popular even as of the cuff screening test for cancer
of the prostate where the index of suspicion is high.
It is almost a slogan that as a male; once you are above 40, you should go for PSA estimation. This is controversial in some climes. Whatever diagnostic path way the caregiver chooses, biopsy and histology still remains the gold standard. Using the GLEASON Scale; based on the appearance of the cancer cells, whether they look like the original prostate gland cells or have completely lost semblance to original cells; an informed management option can be chosen. This also helps in making a prognosis on the patient’s condition with respect to life expectancy.
Our concern today is the unpredictable nature of this cancer. Prostatic carcinoma can be very slow in its progression and may remain completely asymptomatic and only diagnosed at autopsy. On the other hand, the spread of this cancer can be so fast resulting in multiple organ involvement especially the bones, liver and the urinary system. Whatever be the case, the management of cancer of the prostate depends on many factors. Firstly, the question has to be answered: does the patient need treatment at all? This is with special reference to low grade malignancy found in the elderly that grows slowly and would require no treatment. Again if it is almost end of life, aggressive intervention may be counterproductive.
Other factors that may determine treatment options will include age, general health, Gleason score and the PSA level. The patient’s views about potential treatment and side effects must be sort. Erectile dysfunction and urinary incontinence can be a devastating experience for some especially if they were not cancelled on these before commencement of treatment. In practice however, two conservative approaches are commonplace. First is what is generally referred to as SURVEILLANCE: during which the tumor is carefully observed over time with the intention of intervening for a cure if there are signs of progression.
The other is WATCHFUL WAITING. In this instance the whole idea is to avoid unnecessary aggression and overtreatment. It is generally accepted that in this situation palliative and not curative treatment would be the case if advanced symptoms of the disease crop up. Sounds like a waiting game all the same. For completeness the arsenal for the treatment of carcinoma of the prostate is loaded. They include surgery, radiotherapy, chemotherapy, hormonal therapy with castration and so on.
In our environment it is not uncommon for you to see a combination of these modalities of treatment. Usually you find radical prostatectomy followed by radiotherapy. Doing it the other way round is froth with a lot of hazards due to scarring of the pelvis from radiations. Chemotherapy is the dreaded one with untoward side effects. The truth is that carcinoma of the prostate can play a roulette with the patent. One good thing about it is that it gives you time to tidy up your mission here.
It doesn’t matter whether you are a celebrity, man in authority or not. The disease and treatment slows down and you know it
