Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi
Series overview · 8 articles
Prostate Cancer
May 5, 2024
Prostate cancer is the second most commonly diagnosed cancer in men worldwide, and its incidence and mortality in Africa are believed to be especially high. Dr. Anurag Puri, Additional Director, Urology at Fortis Hospital, Shalimar Bagh, New Delhi, used his Jivo Masterclass to walk through the risk factors, symptoms, diagnostic workup, staging, and the full range of treatment options available today, from active surveillance through robotic surgery to hormone-resistant disease.
What this series covers
This series works through who is at risk of prostate cancer and why, how it presents at different stages, the PSA and biopsy workup used to diagnose it, how it is staged and risk-stratified, the full spectrum of treatment from watchful waiting to robotic radical prostatectomy, and how advanced and hormone-resistant disease is managed.
This article is based on a Jivo Masterclass session conducted by Dr. Anurag Puri, Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Anurag Puri taught doctors across Africa on May 5, 2024.
FROM THE LIVE Q&A
Moderator
What operation procedure is ideal for prostate cancer in a 74-year-old elderly patient?
Dr. Anurag Puri
Age is not the only barrier. If the patient has a good physiological (not just chronological) age, is fit, has a life expectancy of more than 10 years, has no significant comorbidities, and the disease is limited to the prostate, robotic surgery can still be offered. If the patient is frail with a shorter life expectancy, treatment is tapered to the patient's needs instead, such as relieving urinary obstruction combined with hormone ablation.
Frequently Asked Questions
Which PSA test is more specific for diagnosis: total PSA or free PSA?▼
Total PSA is checked first and should not by itself guide a biopsy decision; if there is doubt, it should be repeated after two to three weeks. When total PSA is borderline (4 to 10) and there is still doubt, a free PSA test helps: a free PSA under 10% of total PSA leans towards malignancy, while over 25% suggests a lower chance of malignancy.
Who should perform an ultrasound-guided prostate biopsy: a urologist or an interventional radiologist?▼
Both can perform it, but a urologist is better equipped to manage complications if they occur, such as bleeding in the urine or from the rectum.
Is there a specific disease stage for which robotic treatment is used?▼
Robotic radical prostatectomy is used for low-risk and intermediate-risk disease, and can be used for high-risk disease too, provided the lymph nodes are not involved, in which case it is combined with an extended lymph node dissection. If the lymph nodes are already positive, radical surgery is not performed.
Should a PSA test be sent for all patients with BPH?▼
It is not mandatory as routine screening, but a baseline PSA is checked before starting an anti-androgen such as dutasteride, which is commonly prescribed for BPH.
What is the benefit of alfuzosin in the symptomatic management of BPH, and is there a newer drug?▼
Alfuzosin is a commonly used drug that relieves the urinary symptoms of BPH. Silodosin is a newer, more potent alternative. Alfuzosin is generally preferred in younger, sexually active men, while silodosin is preferred in older patients because of its sexual side-effect profile.
What does this masterclass series cover?▼
Prostate cancer risk factors, symptoms, PSA and biopsy diagnosis, staging, and the full range of treatments from active surveillance to robotic surgery and hormone-resistant disease management.
Who is Dr. Anurag Puri?▼
Additional Director, Urology at Fortis Hospital, Shalimar Bagh, New Delhi.
In This Series: Prostate Cancer: Diagnosis and Latest Treatment Guidelines
- 1.Prostate Cancer
- 2.Prostate Cancer Risk Factors and How It Presents
- 3.Diagnosing Prostate Cancer: PSA, Biopsy and Staging
- 4.Gleason Score and Risk Stratification in Prostate Cancer
- 5.Prostate Cancer Treatment: From Active Surveillance to Robotic Surgery
- 6.Advanced and Hormone-Resistant Prostate Cancer Management
- 7.Managing BPH: Medications and When Size Doesn't Matter
- 8.When to Refer a Prostate Cancer Patient for Treatment Abroad