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Doctor's Consultation  by Dr. Iain Corness


Will you die from cancer of the prostate?

There has been some interest in prostate cancer in the social media, which prompted me to write this article. Let me state, right at the outset for all the men reading this, that most probably you will not die from prostate cancer. Let me also state quite categorically that the old finger in the bottom is a test that has been surpassed as a diagnostic necessity. When I was a medical student we were told, “If you don’t put your finger in it, you’ll put your foot in it!” However, since those days we invented many other ways of ‘visualizing’ internal glands, the prostate being just one of them.

Now for some statistics: Prostate problems are very common, something we men have to live with. The incidence increases with age. For a man in his 40’s - 1 in 1000; for a man in his 50’s - 12 in 1000; for a man in his 60’s - 45 in 1000; for a man in his 70’s - 80 in 1000.
With all our older friends getting prostate problems, does this mean there is a rise in the incidence? Are our underpants too tight? Simple answer - No! One reason for the ‘apparent’ increase in prostate cancer is the fact that prostate cancer is a disease of aging, and we are all living longer. The statistics would also show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer. By age 75, almost 75 percent of men will have some cancerous changes in their prostate glands. Do the maths. By 100 we’ve all got it!

So does this mean that life really ends at around 76? Fortunately no. Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health.

The good news is you die of something else before the prostate gets you! You die with it, rather than from it. While the numbers quoted above look fearsome, the real situation is not quite so bad. A much smaller number of men will actually be treated for prostate cancer. About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease. Put another much more positive way, 97 percent won’t die from prostate cancer. This means I must be OK, as my three friends with prostate problems hopefully make up the three percent of my acquaintances.

While prostate cancer can be ‘aggressive’, breaking out from the prostate gland itself and attacking other tissues, including brain and bone, fortunately this is the minority scenario. The great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms.

So let’s look at diagnosis and get the “blood test” out of the way first. The blood test is called Prostate Specific Antigen, or PSA for short (we medico’s love acronyms). Up till then we had another test called DRE (digital rectal examination), which, quite frankly, was not all that popular and ‘buyer resistance’ was high, so when news came through about a “blood test”, millions of men began rejoicing and the sale of rubber gloves plummeted. Unfortunately, PSA is not a go-no go test. A normal range test doesn’t guarantee you haven’t got it, and an elevated result doesn’t automatically mean that you are about to claim early on your life insurance (or your dependents, anyway).

However, there is good news. We are becoming smarter with the PSA test. Serial PSA examinations can show the rate of this growth, another good reason for regular check-ups.
Like many other cancers, prostate cancer can only be fully diagnosed by examining prostate tissue samples under the microscope. The definitive diagnosis will need a biopsy.
So let’s imagine that now you have had a positive biopsy. You’ve got it! What are the real options? Actually very many and depend mainly upon the ‘stage’ of the cancer and your age. Discuss this and the options with your doctor. There may be no need for any operation.

SuperSight Surgery - Read all about it! Without glasses!

It is a couple of years since I wrote about SuperSight Surgery. This is a revolutionary procedure that has changed the lives of many in Thailand, and as the news traveled throughout the world, the world traveled to Thailand to have this life-changing operation. In fact, two of my doctor friends here in Thailand have had this done, and both are very happy with the end result.

So, are you over 50 and using spectacles to read this article? Do you hate your reading glasses? If so, help is at hand! This is SuperSight Surgery (not to be confused with LASIK).

SuperSight Surgery is in the forefront of ophthalmic procedures. The world leader is Dr. Somchai Trakoolshokesatian and he consults out of the Bangkok Hospital Pattaya. He has been carrying out this procedure for nine years on over 3000 patients and has perfected the technique to ensure good results for each individual patient, with success and satisfaction rates of almost 100 percent.

Unfortunately, the need for reading glasses is a natural progression of aging. The first signs are the fact that you have to hold this newspaper further away to be able to read it, and you also find that you need a good light to be able to see the words clearly. Eventually you succumb and buy reading glasses, to which you become a slave. Eventually you keep one pair at home, another in the car and another in the office. And your nose gets funny indentations either side of the bridge, where the spectacles settle.

As you get older, all the ‘elastic’ tissues in your body become less pliable. Knees, lower back, fingers, neck, the list is endless. However, you have to add to that list, the lens in your eye. The fiddly little lens, supplied at birth as a standard feature, does not have a fixed focus, but under your control you can make it focus close up (to read) and then also focus at a distance. The way you do this is by ‘bending’ the lens to be able to focus on near objects. Unfortunately, as the lens becomes less pliable, the muscles in your eye become unable to bend the stiffening lens enough to produce the near point focus. The near point moves further away, until you have run out of arms, as described previously. We call this condition ‘Presbyopia’.

Unfortunately there is yet another result of aging that occurs in the lens of the eye. This is a gradual cloudiness which lowers the visual acuity, and eventually brings on blindness. This is called a cataract. So not only can you not see well enough to read the magazines, but you also begin to lose your distance vision. Welcome to the wonderful world of white sticks and Labrador dogs. Even the World Health Organization says there are currently between 12 and 15 million people blind from cataracts.

The initial method of treating this was by removal of the now optically inefficient natural lens, and attempting to return some usable vision through the introduction of very thick and heavy spectacles placed before the eye. These glasses looked as if the lenses were made from the bottom of Coca-Cola bottles (registered trade mark and all), and were just as heavy. The patient could see again, but reading required even thicker lenses, or hand-held magnifying glasses. Not all that comfortable, but beats the alternative.

So we come to the latest development in intra-ocular lenses (IOLs), where the hardened lenses are replaced by other, very special lenses. These can be focusable lenses, under the control of the patient’s own intra-ocular muscles, or multi-focal lenses, with the brain picking the necessary focus as required. This is SuperSight Surgery and with these lenses you can read your golf scorecard with your near vision, focus on the ball on the tee with your intermediate vision and then using your distance vision watch it gently arcing into the water hazard. (These new IOLs can improve your sight, but not your golf.)

If you want to know more, contact Dr Somchai and reduce your dependence on contact lenses or glasses. You will be amazed.

HEADLINES [click on headline to view story]

Will you die from cancer of the prostate?

SuperSight Surgery - Read all about it! Without glasses!