Saturday, August 20th, 2022 04:28:02

Advanced Medtech and Health Care Coverage to Close the Cancer Care Gap for the Second Most Common Cancer in Men

By Prof (Dr) Anup Kumar
Updated: March 7, 2022 12:12 pm

This World Cancer Day marks the first year of a three-year campaign centered on the theme ‘Closing the care gap’ that recognizes the power of knowledge and challenges assumptions in cancer care. The year 2022 is aimed at raising awareness about the lack of equity in cancer care and explains the barriers that exist for many people in accessing services and receiving the care that patients need – and how these barriers potentially reduce a patient’s chances of surviving.

This year to question the status quo and help reduce stigma; listen to the perspectives of the people living with cancer and their communities and let those lived experiences guide our thoughts and actions. There arefive most common cancers found in males (lung, mouth, prostate, tongue, and stomach) of which prostate cancer constitutes 36% of all cancers. There are certain such stigmas associated with Urological cancer like prostate cancer in men.

The prostate is a walnut-sized gland in men. It is closely linked with the urinary system and is a key part of the male reproductive system. Prostate cancer forms in the cells of the prostate. Though several types of cells are found in the prostate, almost all prostate cancers develop from glandular cells (adenocarcinomas).

Today, globally prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in men. In India, prostate cancer incidents are showing a consistent increase. Prostate cancer is a slowly growing cancer and therefore early detection becomes critical as no specific symptoms raise clinical suspicion until cancer has advanced. Hence, the majority of the cases are diagnosed at an advanced stage. That is why it is considered a common condition in elderly men. However, early detection of prostate cancer can help diagnose prostate cancer at an early stage and early age and help reduce the critical statistics.

Out of a number of deaths in menwhere the cause is unrelated/ unknown, it is likely that the reason could be undiagnosed prostate cancer. Once prostate cancer begins to grow quickly or spreads outside the prostate, it may become fatal. There are number of factors that can lead to prostate cance. Some such key aspects that one needs to be vary of are as follows:

  • Genetic factors and Family history: The risk of prostate cancer increases proportionately with the number and degree of related family members diagnosed with the disease.
  • Dietary factors: The dietary pattern in India is diverse and the ‘westernization of Indian diet’ is proposed as a reason for the rising incidence of prostate cancer in the country. Processed meat increases the risk of prostate cancer and this risk is amplified when meat is grilled, due to the generation of mutagenic aromatic compounds.
  • Lifestyle: Smoking has been shown to increase cancer-related mortality and smokers are twice more likely to die of prostate cancer than non-smokers. Heavy alcohol consumption (>15g ethanol/day) is also a risk factor promoting prostate cancer, although several studies have shown only a weak association.
  • Obesity: Obesity is an important risk factor that perpetuates physical inactivity and also dilutes the

PSA leading to delayed prostate biopsy and hence a late diagnosis. One of the modifiable risk factors is physical inactivity and men who exercise regularly have been found to have a significantly lower risk of prostate cancer.

  • Sexually transmitted infections: The viruses like the Human Papillomavirus(HPV 16/18) can cause the transformation of genes leading to prostate cancer.
  • Drugs and Environmental toxins: Recent evidence points to the potential protective effect of Non-steroidal anti-inflammatory drugs and Aspirin in prostate cancer. The environmental toxins present in preserved food products such as Agent Orange, Chlordecone, Bisphenol-A have been implicated in prostate carcinogenesis.

Despite having a number of modern diagnostic tests, the statistics observed all over the world are critical therefore it is imperative to raise awareness on the early detection and life-saving technologies available today for timely care and management of prostate cancer. There are a number of diagnostic tests available such as,

  • Digital Rectal Examination (DRE)
  • Prostate-Specific Antigen (PSA)
  • Multi-parametric Magnetic resonance imaging (MP-MRI)
  • Transrectal Ultra Sonography (TRUS)
  • Prostate Biopsy

Patients with intermediate-risk of prostate cancer are counseled about a multi-modality approach like radiation and chemotherapy. With timely screenings,Radical Prostatectomy (RP) can be performed by open, laparoscopic, or robot-assisted (RARP) approaches. The total surgical removal in the form of RP provides high chances of a cure for localized prostate cancer. However, Radical Prostatectomy is a complex procedure to learn and can lead to serious complications.In my experience, the most advanced minimally-invaisveapproach of robotic-assisted radical prostatectomy (RARP), using the da Vinci robotic surgical system, provides several advantages over traditional prostatectomy. The key benefits includes possible preservation of potency and continenceincluding, the potential for lesser blood loss and blood transfusions, as well as a shorter hospital stay.

India has a very low rate of screening for cancers. The need for screenings becomes more critical in the case of prostate cancer which does not show specific symptoms in the early stages.There are a number of limitations as compared to the western world in India such as poor access to health care services that constitute the true burden of prostate cancer in India. One of the primary reasons for the same is the healthcare coverage. The OOPE (out-of-pocket expense) is relatively very high for Indian patients. Studies have observed that the health of a nation depends critically on its citizens having access to an equitable, affordable, and the accountable healthcare system. The OOPE, for the total health expenditure, can be helped when public health expenditure increases, and alternatively adequate healthcare coverage is offered. The inclusion of advanced and efficient med-tech like robotic-assisted surgeries can greatly help inefficient management of the disease and help bring down statistics of prostate cancer. Thereby, this will lead to closing the care gap for the second most common cancer in men.

 

By Prof (Dr) Anup Kumar

(The writer is Professor and HOD, Urology, Robotics and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi)

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