Prostate cancer - experience from a specialist urological facility in Sri Lanka

Objective: Prostate  cancer(CaP)  is  one of  the  a  commonest  malignancies  in  the  aging  male. Data on this aspect is sparse in Sri Lanka. Following  a initial report, we present 4½  year  review with regard  to  the mode of presentation, stage  and  histological  characteristics & therapeutic options for CaP. Methods: This is a prospective cohort study of 236 CaP patients presented to a specialist urology unit  from 2007 up to May 2012. Results: Out  of 236 CaP diagnosed, mean age was 70.23.The peak incidence was in the age group 71-75 with 75% of patients being diagnosed at this age interval. LUTS(52.5%), Retention of urine(33.5%) & backpain(31%)  were the  commonest presentations. 51% patients had their initial PSA level above 40ng/ml & only  10% were PSA “non secretors”. Majority of patients (56.4%) had Gleasons 7 or higher histological patterns and 77% had advanced disease at  presentation. Androgen ablation therapy was the commonest treatment modality 63%(n=148) used. Out of them a majority of  90%(n=134) underwent bilateral orchidectomy. Only 15.4%(n=36) were suitable for treatment with a curative intent, 9% were treated with radical radiotherapy while 6.4% underwent radical prostatectomy. 17%(n=41) of the patients required a treatment with  combination of above therapies. Conclusions: This study highlights the need  of  higher  awareness  amongst  men  beyond  50  years  regarding prostate  cancer  and  development  of  a  protocol  based  strategy  to  handle  CaP which is  likely  to  be  significant  health  care  burden  in  an  increasingly  aging  population  in Sri  Lanka

Haematuria: a three year experience in a specialist urological facility in Sri Lanka.

Objective: Haematuria  is  an alarm sign which needs exclusion of sinister pathology. Data regarding haematuria  is  sparse  in  Sri  Lanka. Our objective was to identify the age related causes, associated  presentations of benign & malignant conditions and to assess the success of diagnostic tools in achieving the proper diagnosis in patients with haematuria. Methods: We  retrospectively  analyzed  our  database  consisting  of 332 Patients over 3 years. Results: Mean  age  was  56.13 (range 4 – 91), age  related  causes  of  haematuria  are  as  follows.     Cause of haematuria <40 (n=69) Calculi(81.5%) UTI (12.3%) Malignancy(6%) >40 (n=263) Malignancy(41%) Calculi(31%) Vascular prostate(11%)               Majority  were  males (75%).  Overall, 34%(n=113) patients  had  malignancies  and 66%(n=219) had benign disease. LUTS(44%),  pain(45.5%),  retention of urine(14.8%), Fever(7.2%)  were  the  common  associated  presentations. Passage  of  clots(16.6%), particulate matter(11.4%)  pneumaturia,  had  significant  relationship  to  malignancies. 62.7%(n=208) had frank haematuria of which 40.4%(n=84) had malignancies. Of the 37.3%(n=124) with microscopic haematuria, 23.4%(n=29)  were malignant. Of the 54.5%(n=181)  who  had  painless  haematuria, 50.3%(n=91)  were  malignant. Only 14.6% of those with painful haematuria had cancer. Overall, 47.8% were TCC, 34% RCC & 17.4% Prostate Carcinoma.Physical  examination,  urine  analysis  and basic imaging had a diagnostic  yield  of over 80%, uro-endoscopy  was  needed  to  diagnose  further  8%  patients.  3%  patients  would  have missed  the diagnosis  if  not  for  axial  imaging. Conclusions: The high proportion of cancer and overall diagnostic yield in patients with haematuria emphasizes  the   need  for  comprehensive  evaluation. Lack  of  pain,  passage  of clots, particles  &  pneumaturia  had  notable  associations  with  malignancy.