Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Series overview · 10 articles
Diagnosis and Management of Prostate Cancer
July 7, 2024
Prostate cancer is often asymptomatic until it is already advanced, which makes physical examination and structured PSA testing the two pillars of catching it early rather than waiting for symptoms to appear. Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology at Artemis Hospital, Gurgaon, used his Jivo Masterclass to walk through exactly when to suspect prostate cancer, how to use PSA correctly without over-testing or over-treating, and when biopsy and surgery are the right calls, before opening the floor to one of the most detailed live Q&A sessions in this masterclass series.
A session built around real clinical decisions
Doctors on the call asked pointed, practical questions on PSA interpretation, BPH management, TURP limits, post-surgical incontinence, and nutrition, and Dr. Shrivastava answered each with the same direct, numbers-first approach he uses in his own clinic. This guide introduces a series built around both his core lecture and that discussion.
What this series covers
This series works through why physical examination remains essential even with modern imaging, how PSA should be interpreted using age-adjusted thresholds, density and velocity, who counts as high-risk and needs earlier screening, how to decide between observation and biopsy without over-treating, biopsy technique and safety, the full spectrum of BPH management from lifestyle to surgery, TURP's real-world limits, what happens after prostate surgery including incontinence and neobladder reconstruction, and the nutritional and multidisciplinary questions raised during the session.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). 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.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
What is the value of PSA to say increased in a catheterized old patient, assuming 60 plus?
Dr.Nitin Shrivastava
There is no cut-off value for a catheterized patient. Slight PSA increase is expected, sometimes to 8, 9 or 10, or occasionally near 20. If the PSA remains rising, an MRI should be done to find out what's going on inside the prostate.
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Frequently Asked Questions
What is the role of physical medicine and rehabilitation in the treatment of prostate cancer?▼
Rehabilitation does not treat the prostate cancer itself, but it is an integral part of the treatment process. After prostate surgery, patients need to do Kegel exercises to regain continence.
What factors should we consider when interpreting age-adjusted PSA levels, other than UTI?▼
The rise in subsequent PSA levels, PSA velocity, and PSA density all give more clues when a reading is borderline, and these additional tests should be done before deciding on a biopsy.
What is the time range that should be considered between two PSA measurements during screening?▼
Routine mass PSA screening is not recommended. But for high-risk patients, yearly PSA is a good idea. If the PSA comes out abnormal, it should be repeated after four to six weeks.
What is the best method of managing BPH?▼
First make sure BPH is not causing damage to the kidneys. For mild symptoms, only lifestyle management is needed. For bothersome symptoms, a single alpha blocker is used. There is no one universal method; if it's damaging the kidneys, surgery is needed.
Apart from PSA, what other hormones should be monitored in case of prostate cancer?▼
None. PSA is the only one.
What does this masterclass series cover?▼
Physical examination and PSA interpretation for prostate cancer, high-risk screening groups, biopsy decision-making, BPH management, TURP limits, and post-surgical incontinence and reconstruction.
Who is Dr. Nitin Shrivastava?▼
A Consultant in Urology and Uro-Oncology; at the time of this masterclass he practised at Artemis Hospital, Gurgaon.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer