PROSTATE PROBLEMS
News about former President Joe Biden suffering from advanced prostate cancer was shocking. Many of us wondered why it was not detected earlier and how it can be treated.
Prostate is a walnut-size organ located in the male pelvis at the very lower end of urinary bladder where the urethra begins. It generates the seminal fluid, which gets mixed with the sperms made from the testes, then stored in the seminal vesicles. In addition, it controls urine flow and generates certain hormone-like substances.
Disorders of the prostate gland are common, affecting most of the male population particularly as they get old. Benign hypertrophy of prostate (BPH), cancer of prostate and infection of the gland called prostatitis make up most of such problems. Urologists are the medical specialists who manage these problems.
Most common among these is benign enlargement of prostate (BPH) affecting 90 percent of men above age 80 and 50 percent of men above age 50. It is not cancer, and it will not turn into cancer either. As the gland enlarges it compresses the urethra, causing a variety of urinary symptoms. Such symptoms include hesitancy, frequency, urgency, nocturia, incontinence, incomplete emptying, straining to urinate, weak stream and eventual retention of urine. One may notice occasional hematuria from congested veins or backpressure to kidneys resulting in hydronephrosis.
Diagnosis is made by physical examination that includes digital rectal examination, PSA levels, urinalysis and ultrasound examinations. Treatment is individualized depending upon the age of the patient, their comorbidities, and patient preference. Some of them can be watched and followed. Others may prefer to take medications that decrease the volume of the gland. Some others may prefer surgery, which can be done by different techniques. All the treatment modalities have side effects and complications. It is best for the individual to consult a urologist.
Prostatitis is inflammation of the prostate. Often it is secondary to sexually transmitted infections or related to urinary tract infections. Patients may experience fever, pelvic or perineal pain or urinary symptoms of burning on micturition. Antibiotics are useful in controlling the infection.
Cancer of the prostate affects one out of eight men above the age of 65. While the exact cause is unknown, there are certain risk factors. Genetics, family history of cancers, African American background, obesity, diet with heavy fat, red meat and dairy products are some such risk factors.
In the early stages, it does not cause any symptoms, or minor signs are passed off as age related urinary problems. Routine physical checkup that includes a digital rectal examination to feel the back wall of the prostate gland to detect any nodules and routine blood test for prostate specific antigen (PSA) for people above the age of 50 are the two important evaluations for early finding.
It is now widely accepted that PSA level is a good screening test as a starting point. Normally, it should be below 4. If it is above 7, it will raise alarm bells. PSA level could be raised to mild levels with benign enlargement of prostate gland. Hence, it is important to do serial measurements once every six months. If they keep climbing up or if a nodule is felt on digital examination, further evaluation is done with an ultrasound. Needle biopsy of the abnormal nodule is performed with ultrasound guidance or MRI guidance for tissue diagnosis for final confirmation. Once the diagnosis is confirmed, the severity of the disease and extent of the spread is assessed with different tests.
The treatment of prostate cancer is individualized depending upon the stage of the disease, presence of metastasis, age of the patient and their own personal preferences. Patients above the age of 80 with early prostate cancer can be left untreated since the cancer is slow growing and may not be the cause of death. Those in younger age between 50 to 80 are treated aggressively, especially if they are early cancers. For them the choices are radical surgery to remove the prostate gland completely or give radiation therapy or hormonal therapy. Those who have advanced cancers with spread to bones or lymph nodes can also be remedied with hormonal therapy, radiation treatment, immunotherapy, or bone targeted therapy.
Prognosis of prostate cancers has improved significantly with advances in robotic surgery, new medications and immunotherapy. Ninety-five percent of early prostate cancers can be cured. Even a good number of advanced prostate cancers can have their disease held in control and the patient’s life span extended. Men should be encouraged to seek routine medical evaluation and upon noticing any urinary symptoms.Guest Coloumn
Thirty years of Living with a Kidney Transplant
How many of us get a chance to start a 'new life', a second life, after developing a serious disease like kidney failure? At the age of 47, the peak of my health and profession, I developed an incurable kidney disease called Ig A Nephropathy that would progress to kidney failure soon. My initial bewilderment and shock gave way to a whirlwind of emotions, including severe anxiety, depression and despair, not knowing what the future held for me.
That was when my sister stepped forward to donate one of her kidneys. Yes, I am that lucky recipient of a kidney transplant from my loving sister. Receiving a kidney from a living or cadaveric donor is truly life changing and I can vouch for this from my own experience, first as a patient with kidney failure and then a 30-year span of life as a successful kidney transplant recipient. And what is equally important is that I was able to continue my profession as a full-time cardiologist serving two hospitals and a large number of patients in my private practice, till I retired at 70 years of age.
Here is a brief chronology of what happened. When my creatinine climbed up to nearly 11 mg/dl (normal <1.3) which meant kidney function was down to just 10 percent, my nephrologist suggested, “Ravi, time has arrived for you to go on dialysis unless you can get a kidney transplant.” My sister in India agreed to willingly donate one of her kidneys but getting her to USA turned out to be a little complicated because the Madras American Consulate initially refused her visa initially but relented eventually. Then we decided to go to University of Minneapolis Medical Center for transplant surgery by Dr. John Najarian, considered to be one of the best kidney transplant surgeons in the world. And on that fateful day, Nov. 10, 1994, I received the precious kidney transplant from my loving sister Ratnam, truly a life-changing moment. Thank God, I am saved now, I thought.
“Not so quickly,” somebody seemed to say. My recovery was stalled with one complication after another. So many fiery ordeals, you wouldn’t believe. A second surgery to remove clots from the femoral and renal vein and later another clot in the leg followed by pulmonary embolism (clot in the lung). Then came a heart attack that needed an emergency angioplasty. Later, a surgery for a ruptured Achilles tendon in the right leg. I survived all those and continued with a happy life till my retirement. We took a trip to Europe and then several trips to India and everything was going well. Then came further setbacks.
It was early 2020. Covid-19 was spreading fast all over the world and already many had lost their lives. I happened to be vacationing in India when I developed a bout of angina that needed another angioplasty. And we had to get a quick flight from Kochi, India to Orlando before the airports closed. For the next five months, I was okay but then needed a coronary bypass surgery and a year later a permanent pacemaker implant too.
In the final analysis, there is no doubt that a 'pre-emptive' kidney transplant was the best treatment for my renal failure, a cure for the disease. I didn’t have to go through the process of hemodialysis and the many related complications. Also, transplant patients enjoy double the life expectancy compared to dialysis patients. However, just because you receive a matching kidney, don’t think everything is going to be hunky-dory from here onward. Many complications like heart problems, rejection issues, infections, etc., can occur, so you have to be quite vigilant throughout your life. The good thing is that all these are treatable but early diagnosis is the key. And my donor, my sister, aged 85 years, is also doing well with her one kidney, very heartening indeed.
As I celebrate the 30th anniversary – kidneyversary – of my transplant, I want everybody to know that kidney transplant is the best treatment for kidney failure and even if you encounter complications after surgery, with proper management you can recover and go on to lead a normal life. At present, nearly 100,000 people are on the waiting list for a deceased-donor kidney in the U.S. and many more in India, with an average waiting time of 3-5 years. Obtaining a kidney from a living donor eliminates that wait. Since we have two kidneys and we need only one kidney to live healthy, donating one kidney is quite safe for the living donor. What is more noble than that?
(For further details of my kidney transplant journey, read my book, “Second Chance -A Sister’s Act of Love.” www.amazon.com or www.bn.com)
Dr. M. P. Ravindra Nathan is a retired cardiologist, a writer, and his articles have appeared in “Medical Economics,” “Cortlandt Forum,” “Florida Journal of Medicine,” “India Abroad,” “Tampa Bay Times,” “Tampa Tribune,” “Hernando Today” and “Hernando Sun.” He is the author of two books, “Stories from My Heart, A Cardiologist's Reflections on the Gift of Life” and “Second Chance – A Sister’s Act of Love.”
EYE CARE
Protect Your Vision This Summer
By Dr. ARUN GULANI
We all look forward to June as the month brings bright days and warm weather. It’s the season to step outside, enjoy the sun and make memories. But while we’re out there living life, it’s important not to forget that our eyes need protection too. The summer sun’s rays can be stronger than we think, and the heat, allergens and activities we enjoy can take a toll on our vision if we’re not careful.
Ultraviolet rays, or UV rays, are invisible but harmful. They can damage the eyes over time and increase the risk of conditions like cataracts and macular degeneration. Even a short time without protection can cause discomfort or more serious issues like photokeratitis — essentially sunburn to the eye. So, wearing sunglasses that block 100 percent of UVA and UVB rays is not just a fashion choice — it’s a necessity. I always recommend wrap around styles because they help keep harmful rays from sneaking in at the edges.
Summer also brings dry air, whether from the heat or a/c, which can cause your eyes to feel irritated or gritty. Drinking plenty of water and using preservative-free lubricating drops can help keep eyes comfortable. And if allergies bother you, especially with the pollen that peaks around this time, avoid rubbing your eyes — even though it’s tempting. Rubbing only makes things worse. Instead, rinsing your eyes with clean water or using allergy drops can bring relief.
Swimming pools, lakes and oceans are wonderful for cooling off but can introduce irritants or bacteria to eyes. Goggles aren’t just for competitive swimmers — they’re a smart choice for anyone spending time in the water. And if you’re playing sports or working outside, protective eyewear can prevent injuries that sometimes happen too quickly to react to.
Kids, especially, need our help with eye protection. Their eyes are more sensitive to UV rays, and besides children tend to spend hours outside. Make sure they wear good sunglasses, hats with wide brims, and understand why it’s important not to rub their eyes or swim with contact lenses. Regular eye checkups are equally important, especially if kids are active or have a family history of eye issues.
Nutrition also plays a big role in eye health. Vitamins like A, C and E, omega-3 fatty acids and antioxidants such as lutein and zeaxanthin, support vision and help protect eyes from damage. Eating colorful fruits and vegetables is one of the simplest, most effective ways to keep eyes healthy for the long term.
Today’s eye care has advanced tremendously. Treatments like next-generation dry eye therapy (MOIST®) and new surgical techniques can restore vision even in cases once thought untreatable. If you or someone you know struggles with dry eyes, irritation, or vision problems, don’t settle for the idea that nothing can be done. There are often real, effective solutions available that can improve comfort and clarity — often without invasive surgery or long recovery times.
If you notice sudden changes in vision, persistent redness, pain or discharge, seek professional care promptly. And don’t skip your annual eye exam — many eye conditions show no symptoms until they’ve progressed.