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Understanding cancer in elderly men: Diagnosis, management and treatment  
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Understanding cancer in elderly men: Diagnosis, management and treatment  

Examining the prevalent types, risk factors, screening guidelines, and advancements in treatment modalities could make way for effective treatment of the cancer
Experts say that as men age, they become more susceptible to health conditions, especially cancer.
King Charles III has been advised by doctors to postpone public duties. (Photo by AFP)

Earlier this week, a statement released by Buckingham Palace said that the 75-year-old King Charles III was diagnosed with cancer. While the form of cancer was not revealed, it was said that the cancer was found during his recent hospital procedure for Benign Prostate Enlargement following subsequent tests. Now that King Charles III is undergoing treatment, experts throw light on various forms of cancer that can be of concern to men as they get older.

Experts say that as men age, they become more susceptible to health conditions, especially cancer. Increase in age decreases the body’s ability to repair damaged cells leading to accumulation or build-up of damaged cells which increases the likelihood of cancer or tumour development. Individuals are posed with challenges in tackling the cancer in terms of detection, management, and treatment, especially older men. However, early diagnosis can help in preventing most cancers to an extent, say experts.

Forms of cancer in men

Prevalent types of Cancer in older men around the globe include:

Prostate Cancer: Prostate cancer is the most common malignancy among elderly men, says Dr Ravi Chandran K, uro-oncology surgeon, Apollo Hospital, Bangalore. The risk of developing prostate cancer increases with age, with most cases diagnosed in men over the age of 65. “In India, although prostate cancer is quite common, it goes under-reported until symptoms start to show up,” added Dr Raghunath S K, uro-oncologist and robotic surgeon, director & head of Urological Oncology and Robotic Surgery, HCG Cancer Hospital, Bangalore.

Bladder Cancer: Bladder cancer is another form that is common in older men too. Dr Raghunath says, “Blood in the urine is a common symptom of bladder cancer and is often seen among smokers and individuals who had exposure to certain chemicals like hair dye.”

Colorectal Cancer: Colorectal cancer is quite common,” says Dr Raghunath. Colorectal cancer incidence increases steadily with age, making it an important concern for older men. Regular screening is essential for early detection and improved outcomes.

Lung Cancer: Lung cancer is one of the most difficult cancers to manage and treat, said Dr Sandeep Nayak P, director – department of surgical oncology & robotic & laparoscopic surgery, Fortis Hospitals, Bangalore. Older men remain at significant risk, especially if they have a history of smoking.

Testicular Cancer: Though quite uncommon in older men, testicular cancer may run through generations and is usually seen in undescended testis (a condition called cryptorchidism). “In this case, the testicles during the birth of a baby may not come down to the testicular sac or scrotum. This is when testicular cancer develops,” explains Dr Raghunath.  Adding to it, Dr Chandran said, testicular cancer is predominant in young and middle-aged group primarily indicated by swelling in the testis.

Penile Cancer: Penile cancers are a result of unhealthy and unhygienic sexual practices, says Dr Raghunath. They usually remain undetected within Indian scenario and the signs include lesion and growth over the external genital area.

Skin Cancer: Older men often have a higher likelihood of developing skin cancer due to cumulative sun exposure over their lifetime. Regular skin checks and sun protection measures are crucial. Dr Raghunath adds, “Although skin cancer is relatively less common in India, it is seen more frequently in America and Australia.”

Oral Cancer: As of today, among any age group among men, oral cancer is common. “A person can look within his mouth and if they find anything that is abnormal, like a white, reddish or black patch, then they can get tests done for oral cancer,” shares Dr Nayak.

Breast Cancer: While breast cancer in men is a rare condition, according to Centre of Disease Control (CDC), 1 in 100 breast cancer cases diagnosed in the USA are occurring in men. Though the number of cases reported are less, late diagnosis often ends in fatality. Men are not aware that they have breasts and often ignore the lumps in their chest, says Dr Rakesh S Ramesh, head of the department, surgical oncology, St. John’s Medical College Hospital, Bangalore.

He says breast cancer in men can be as severe as in women and since they are often diagnosed in late stages, it is difficult for doctors to cure them.

Check for these symptoms

Dr Chandran says, “When men have any subtle warning signs, those must be taken seriously and dealt upon by consulting the experts”. Signs like difficulty in passing urine or increased frequency of urination, blood in stool, sudden constipation, diarrhea, weight loss and loss of appetite or any deviation from normal routine should be discussed with a specialist when experienced by any individual.

Early Diagnosis

Screening for cancer in older men is critical for early detection. This aids in improved treatment outcomes. Dr Nayak says, “If cancers are detected in their initial stages, i.e., their first or second stage, the first treatment that is conducted is surgery to remove the cancerous tumour and the individual is out of danger. This can be accompanied by radiotherapy.” However, when they come in their third or fourth stages, then comes the role of chemotherapy, says the doctor.

The testing guidelines depend on the signs of cancer usually detected by the specialists. Certain cancers can be genetic, like prostrate—hence a record of family health history can help the doctors take the right decision. Common screening methods include:

  • Prostate-Specific Antigen (PSA) test: Dr Nayak says, performing a PSA test every year after the age of forty-five is crucial for prostate cancer screening. High abnormal numbers in the PSA test might require a biopsy for cancer confirmation.
  • Colonoscopy test: Undergoing a stool test once every year and colonoscopies every 10 years can help detect if there is anything suspicious, followed by an initial treatment, shares Dr Nayak.
  • Screening for Lung Cancer: While going for an X-ray is good for general health check-ups, Dr Nayak says that it can easily miss detecting lung cancer. Therefore, for men above 50 who are at high risk, i.e., with a history of smoking, a low dose computed tomography (LDCT) can help in diagnosing lung cancer.
  • Skin Examination: Routine examination of skin by a dermatologist can help detect skin cancer at the earliest.
  • Urine examination: Routine urine tests for the presence of proteins, sugar and blood (especially in smokers at elevated risk for bladder cancer) in urine samples should be conducted, which could help to indicate kidney diseases, among other conditions.

Besides, an overall health checkup once a year is advised by experts.

Chemotherapy, surgery and other treatments

Experts say that cancer chemotherapy is a commonly used treatment option in several cancers where drugs are used to kill or slow down the fast-progressing cancer cells. However, the process of chemotherapy can be very exhaustive since some of the healthy cells might also be killed in this process leading to side effects.

On the other hand, surgeries address cancer by removing the tumors from affected areas, slowing down, or preventing their spread to other parts of the body. Often, the only way to prevent or limit the spread of the disease to other organs of the body is surgery as reviewed in Annals of Surgical Oncology Journal (2023).

Dr Chandran adds, “Age should not be seen as a barrier to seeking treatment. Recent advancements in medical techniques have allowed for successful surgeries even in individuals aged over 80 years, known as octogenarians.” He said that the approach to treating elderly patients has been refined, leading to positive outcomes. Interestingly, they (men) have shown good recovery rates after surgery.

Lifestyle and diet improvisation

Though cancer in its late stages is unmanageable, early detection can provide the option to manage the symptoms through natural ways. Dr Raghunath suggests having a diet rich in fiber, fruits and vegetables which can play a significant role in preventing cancer to some extent. Additionally, Dr Nayak advises to exercise regularly, maintain your body weight, avoid smoking and alcohol abuse, and lead a healthy lifestyle.

Trends in cancer treatments and techniques

Dr Chandran stated, “Today, advancements in cancer treatment in terms of diagnosis as well as treatment options have revolutionized healthcare for older men, and results are extremely good.”

Robotic-assisted surgery (Minimally invasive surgical technique) has become the preferred method for treating prostate cancer due to its effectiveness than laparoscopy. Precision medicine, using techniques like genomic detection and nanotechnology, offers promising results in cancer treatment with fewer side effects. Palliative care, sometimes in combination with radiation therapy helps manage symptoms and improve the quality of life for older men with cancer. Looking ahead, artificial intelligence combined with smart devices in healthcare aims to revolutionize cancer diagnosis, potentially eliminating the need for the ‘Wait and Watch’ approach.

Takeaways

Age, lifestyle habits such as unhealthy diet, smoking and alcohol intake, biological predisposition can all contribute to the development of cancer in elderly men. Some of the most common types of cancer among older men are prostate, bladder, and testicular cancer, as well as colorectal cancer, penile cancer, lung cancer, and skin cancer. Early diagnosis, PSA testing, low-dose CT scans, colonoscopies, stool tests, routine examinations, and lifestyle modifications such as exercise and a balanced diet can help reduce the risk of cancer.

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