DISCUSSING MALE HEALTH ISSUES WITH PROF. DR. PREM RAJ GYANWALI
WHEN MEN SUFFER FROM IT, THEY’RE TOO SHY TO COME UP AND INQUIRE ABOUT IT.
WHAT IS PROSTATE CANCER LIKE IN NEPAL?
The case of prostate cancer is very rare in Nepal. It’s quite rare in developing countries, and there could be 2 reasons for this. One, the diagnosis of it is not up to mark. Targeted investigation is very low for this. During the 1980’s when Japan and Singapore was just starting to grow, the instances of cancer was increasing. So in a way, you can say that the cases of cancer is proportional to the level of development of an economy. Back in 2008, under a program by the WHO, we tried to gather cases of prostate cancer in Nepal, and we couldn’t even come up with 50 cases. So it’s very rare here.
HOW IS THE INVESTIGATION OF PROSTATE CANCER DONE?
One way we do it is by using the finger which is called Digital Rectal Examination. Other is the examination of the PSA (Prostate-specific Antigen) which is the protein produced by the prostate gland. And the last one is by Biopsy once the symptoms are suspected.
FOR MALES, WHAT ARE THE COMMON CASES THAT COME CONCERNING UROLOGY IN NEPAL?
Around the world, the first is urinary tract infection, the second is urinary stone and the pathology of prostate comes in third. Whenever looking at an organ, we look for the injury of it, a metabolic dysfunction, infections or inflammation, and cancer. In our case, most of our patients come to us due to age related enlargements that cause blockages.
ARE THERE ANY PREVENTIONS?
For benign enlargements, there is no measures to take for it occurs with age. The prostate just grows and narrows the urinary channel. The symptoms of cancer too are the same.
WHAT ARE THE SYMPTOMS?
It’s hard to say exactly. The way the prostate gland grows after the age of 40 to 50 and the problems that come with, the symptoms are very similar to it. The difference is that it’s cancer. Other disease just affect the target organ but cancer invade other organs around it and spread. From the prostate, it can move to the lungs, bones and even to the brain through a process called metastasis. Symptoms like very frequent and/or incomplete urination is common.
WHAT ARE THE OPTIONS FOR TREATMENT?
The first thing to know is that Prostate cancer is a slow kind of cancer. It does not spread as quickly as the others. So radical surgery is not recommended beyond the age of 70. The average life expectancy of a person is 80. If he is diagnosed with Prostate cancer at the age of 70, there is no need to go for a surgery as he can live with it till he inevitably passes away. If it is before the age of 70 and if the cancer is confined in the organ, he can opt for a radical surgery which is removing the cancer organ as a whole. The other is via radio therapy. Literature wise, the results of surgery is better, but result wise, therapy is. This is because, after surgery, many patients suffer from poor bladder control for a year and ever up to the rest of their lives. Another drawback for either the options is erectile disfunction for the surrounding organs tend to get injured.
For people over 70, we cut off the supply of nutrients that go to the prostate.
The nutrients come from testosterone that are produced by the testes. So we either medically suppress the testes or surgically remove it. For developing countries like ours, we usually opt for the surgical castration for it is cheaper. In medical castration, one needs to apply a medicine every 3 months that costs more than 1 lakh NRS.
The other is symptomatic treatment, which is just mitigating the disease by looking at the symptoms to make the patient’s life easier.
WHAT IS THE SCOPE OF ERECTILE DYSFUNCTION.
In Nepal, ED stands third for men. Although when men suffer from it, they’re too shy to come up and inquire about it. However, younger men seen to be open about it, so new cases are coming up with it. With that being said, the 90% of the cases are psychogenic. Most men think that they can not get it up and due to the fear of it, suffer a pseudo ED.
WHAT TIP WOULD YOU GIVE TO MEN FROM A UROLOGICAL PERSPECTIVE?
One thing one should keep in mind is that one can not stop metabolic disease. Cancer is not avoidable. The things one can prevent are infections and stones. Drink a good amount of water and regularly check up on the kidneys. Diabetes and blood pressure affect the kidneys largely, so the timely diagnosis and treatment of these are crucial.