From Kidney Stones to Prostate Cancer, with Dr. Cyril Natarajan (UCSI Hospital)

Introduction and Background of Dr. Cyril

Host: Today I am joined by Dr. Cyril Natarajan, a consultant urologist at UCSI. Welcome to the show. Could you tell us more about what you practice and what your specializations are?

Dr. Cyril: Thank you. I am a consultant urologist here. Essentially, we deal with urological problems that people have — from kidney disease to bladder disease and prostate conditions. It is quite a broad specialty.

My first particular interest is functional urology, which involves managing functional problems that people experience when urinating. My second interest is uro-oncology, where we manage urological cancers. I also manage stone disease, because stones are very common in this part of the world, and most urologists in this region need to perform stone-related procedures.

Functional Urology: What Is It and Who Does It Affect?

Dr. Cyril: Functional urology deals with problems of holding and passing — or releasing — urine, which can be related to various underlying conditions. For example, neurological disease: people who have had a stroke, or people who have had an accident and sustained a spinal cord injury, have urinary problems and need to be properly assessed.

This is important because if they are urinating at high pressure, the upper urinary tract can be at risk and they may develop kidney failure. Additionally, people with incontinence — who cannot control their urine — are also among the aspects of functional urology that we manage.

In terms of age, functional urological problems can affect anyone: elderly people with dementia or cerebrovascular disease, younger people with a slipped disc affecting the nerves, and even children who wet the bed. However, I personally deal more with the adult population, as there is a separate sub-specialization called pediatric urology.

The Patient Diagnostic Journey at UCSI

Host: Could you walk us through the journey of how you diagnose and manage patients?

Dr. Cyril: Patients generally come through referral pathways — from general practitioners, or from colleagues who refer patients to UCSI because we have the specialization here.

They will be assessed with a basic blood profile, including a full blood count and kidney function tests, along with various other parameters. We then perform imaging investigations. We typically start with an ultrasound because it is non-invasive and can provide a great deal of information about the genitourinary tract. From there, we progress to other investigations based on need — for example, a CT scan if there is a suspected kidney mass or tumor.

For patients with prostate problems, we assess them with urodynamics if necessary, to study the function of the bladder and the urinary outlet. We also use symptom scores to determine whether a patient requires medication or surgery. Urology is a unique specialty because much of its management remains medical through drug therapy, and does not always require a surgical procedure.

Prostate Cancer: Early Detection and Warning Signs

Dr. Cyril: Prostate cancer is one of my core interests. It is very common now and the numbers are increasing, partly due to improved early detection.

One of the main tests we use is PSA (Prostate-Specific Antigen), which is an indicator of prostate cancer risk. We also perform a digital rectal examination to assess whether there are any suspicious nodules on the prostate, and if necessary, we proceed to an MRI scan for further evaluation.

Unfortunately, the symptoms and signs of prostate cancer are generally very non-specific. In fact, most patients with prostate cancer are detected incidentally through a PSA test. At an advanced stage, when the cancer has spread beyond the prostate, patients may experience pelvic pain, blood in the urine, or even urinary retention — the inability to urinate.

"Most patients with prostate cancer are detected incidentally through a PSA test."

If the cancer has spread to the bones — which represents the late stage — patients will experience bone pain.

"Sometimes the presenting symptom may be nothing more than a spinal fracture from a minor fall, because the cancer has already spread there and weakened the bone. Unfortunately, this is the late stage."

Although there is no formal screening program for prostate cancer as there is for breast cancer or colorectal cancer, we carry out opportunistic screening: men who present with lower urinary tract symptoms (LUTS) in certain risk categories will be advised to have a PSA test.

Rising Prostate Cancer in Asia: Lifestyle and Dietary Factors

Host: You mentioned that prostate cancer is rising in Asia. Are there reasons for that, and are there any lifestyle changes you would recommend?

Dr. Cyril: The answer is not entirely clear. However, I believe that the diet of Asian people has changed significantly over the past 30 or more years, with much greater Western influence. This is an association that is still somewhat weak, but it is what is frequently linked to the rise in prostate cancer in Asia.

The highest rates of prostate cancer are actually found in African American men. In Japan, for example, it was found that the incidence of prostate cancer increased after the war, coinciding with the entry of Western dietary influences. So I believe that the type of food we eat plays a major role in many diseases, including prostate cancer.

"The type of food we eat plays a major role in many diseases, including prostate cancer."

Indonesian Patients at UCSI

Host: Are there many Indonesian patients coming to UCSI, and what conditions do they come for?

Dr. Cyril: Since I joined here — about one to one and a half years ago — I have not had too many Indonesian patients. However, most of them come because of stone disease, or what we call urolithiasis — kidney stones causing pain.

Some come for prostate cancer assessment. One of them was already at an advanced stage and came here for assessment and hormonal therapy. Another common type is benign prostatic hyperplasia (BPH) — a non-cancerous enlargement of the prostate — which causes difficulty urinating and other related problems.

Closing

Dr. Cyril: I enjoy my visits to Indonesia, and Indonesian patients are very warm and welcoming. Urology is quite a broad specialty, and we hope to be able to help people who have urological problems.

"Urology is quite a broad specialty, and we hope to be of help to people with urological problems."

Dr. Cyril Natarajan is a Consultant Urologist at UCSI, Malaysia.