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Prostate Cancer- When the Best Medicine is Time

Cancer, knowing it's nature usually demands urgency. Prostate cancer, sometimes, demands something more difficult: PATIENCE!

That may sound counterintuitive. We have spent decades learning that cancer must be detected early and treated quickly. Yet prostate cancer has taught modern medicine an important lesson: finding a cancer does not always mean it needs to be treated immediately.

The story of prostate cancer itself is remarkably old. In 1853, surgeon John Adams documented what is considered the first histologically confirmed case. By the early 20th century, surgeons were attempting radical prostate removal. Today, PSA testing, MRI, PET scan, sophisticated biopsies, molecular pathology as well as hormonal therapyies, chemotherapy, surgery, radiation therapy and newer medicines like targeted therapies and immunotherapy have transformed how the disease is diagnosed and managed. But perhaps the biggest transformation is our understanding that prostate cancer is not one uniform disease.

An Indian concern-

Prostate cancer is increasingly relevant to India's ageing urban population. According to the International Agency for Research on Cancer's GLOBOCAN 2022 estimates, India recorded 37,948 new prostate cancer cases and 18,386 deathsfrom the disease in 2022.

Age is the strongest risk factor; men become increasingly vulnerable as they grow older. A family history matters too, particularly a father or brother with prostate cancer, especially at a younger age. Certain inherited mutations, including BRCA2, can substantially increase risk and may also have implications for treatment.

So, who needs to act?

A man with urinary difficulty, poor or interrupted urine flow, frequent night-time urination or blood in the urine should not simply dismiss these symptoms as “old age”. Importantly, however, such symptoms are often caused by benign prostate enlargement and do not by themselves mean cancer. More importantly, early prostate cancer may cause no symptoms at all.

PSA testing can help identify men who need further evaluation, but PSA is not a cancer diagnosis by itself. The decision to screen should take into account age, family history, overall health and individual preferences. And once cancer is diagnosed, the crucial questions are: What is its grade? How extensive is it? Is it confined to the prostate? How aggressive does it appear to be behaving?

Who can take it easy?- The low risk folks

This is where prostate cancer is different. Some low-risk, localised prostate cancers grow so slowly that immediate surgery or radiation may offer little advantage while exposing a man to potential side effects. For carefully selected patients, active surveillance- regular PSA testing, clinical assessment, MRI and, when appropriate, repeat biopsy can allow doctors to monitor the cancer and treat it if it shows meaningful progression. European guidelines consider active surveillance the standard approach for suitable men with low-risk disease.

Older men with limited life expectancy or significant other illnesses may sometimes be managed with watchful waiting, focusing on symptoms rather than attempting curative treatment. But “take it easy” must never mean “ignore it”. Aggressive or advanced prostate cancers can be life-threatening and may require surgery, radiation, hormonal treatment, chemotherapy or newer systemic therapies.

The real message, therefore, is neither fear nor false reassurance. Prostate cancer is a disease to understand before rushing to treat and a disease to treat when its biology tells us it needs treatment. Sometimes the best medicine is an operation. Sometimes it is radiation. Sometimes it is hormones. And sometimes, under careful medical supervision, the best medicine is time.

Know Your Prostate Cancer Risk. Talk to a Prostate Cancer Specialist at M|O|C Cancer Care

Dr. Arnav H. Tongaonkar
M.D D.M ECMO
Consultant Cancer Physician
MOC Cancer Care & Research Centre, Mahim & Vile Parle.