Bladder Cancer

the management of bladder cancer can be considered a real success story with so much finances being invested in the early detection efforts (hemeturia clinics) within the NHS, but are we really treating the disease the properway? though our main effort is to conserve the organs (i.e. the kidney and the bladder) but the approach being persued to controll the disease i.e. telescopic removal of the tumour through the urethra is less than ideal. we are actually many a times removing the tumour in piecemeal fashion raising the possibility of tumour cells being ejected into the bladder and then implanting at other sites in the bladder causing recurrence of disease at some other site in the bladder which can be considered as a failed operation in terms of acieving a cure though I must confess that tumour development can be a field change i.e. the lining of the bladder becoming unstable and producing tumours at various sites simultaniously or sequentially. a standard procedure capable of completely excising the tumours with a clear margin i.e. removing intact tumour is yet to be develped.

Prostate Cancer

The trend towards preventive medicine has led to an emphasis on screening programs. The prostate cancer screening is still a controversial issue with no strong evidence to point to any advantage in persuing this course but the GPs are routinely performing the PSA screening (blood test) in men above fifty years of age. if the PSA is raised then the person goes through the anxiety and tension involved in the process of further investigation. if the prostate biopsy is negative, that by no means is the end of the process and the person has to remain on the razor edge going through the regular PSA evaluation. Newer developments like PCA3 test (urine test) doesnot help for it only gives an indication of probability of cancer i.e. the result interpretation soesnot give a black and white answer whether to do a biopsy or not. various nomograms which again try to use various resk factors to predict the probability of having prostate cancer, this once again only generates a figure the clinician and the patient being left with the responcibility to decide whether to do a biopsy or not knowing that what ever these clinical exams blood test urine test or nomograms might indicate, there will always be a small but significant possibility of missing a patient with significant cancer

Medicine and information

The field of medicine has been a witness to phenomenal advancements. The interesting fact is that the pace of research and development has widened the gap between the health care providers and the recepient i.e. the patient. A patient with symptoms or complaints comes to doctor to seek a solution a remedy and also reassurance. The doctor's main focus usually is to establish a diagnosis and then institute specific treatment, often it involves more than simple tests requiring a trip to the hospitalor referral to specialist department or clinic. Till the time the results are on the table to be discussed the patient and the relatives can be exposed to lots of anxiety and apprihension. the change of perception from being gods dictating the investigations or the treatment to being a businessman selling one's perception of the cause of problem/ symptoms, proposing the investigations or the management should inturn help in taking the barriers down and also would make health professionals more accessable.