The prostate is a walnut-sized gland located below the bladder in front of the rectum. It produces semen, the fluid that carries sperm from the testicles. It wraps around the urethra, the tube that carries urine from the bladder out through the penis.

As a normal part of aging, the prostate often increases in size in men over 40 years of age. The non-cancerous enlargement is called Benign Prostatic Hypertrophy (BPH) and may only need treatment if the prostate enlarges enough to press on the urethra, making the flow of urine slow and difficult.

As a normal part of aging, the prostate often increases in size in men over 40 years of age.

Jamaica has highest incidence of prostate cancer

Cancerous growth of the prostate is now the most common type of cancer in men over 50. The American Cancer Society estimates that 189,000 new cases of prostate cancer will be diagnosed this year and close to 50,000 men will die of the disease. Jamaica has the highest incidence of the disease in the world.

This may be related to ethnicity, social predispositions and diet. The risk is higher for a man if his father or brother has prostate cancer.

In most men, prostate cancer is usually slow growing and does not spread beyond the prostate itself. Most men who develop this slow-growing type of prostate cancer have no symptoms.

Prostate cancer can also be an aggressive, fast-growing tumour that in some case spreads beyond the prostate to lymph nodes, lungs, bones and other parts of the body.

What to expect during prostate screening

The screening for prostate cancer involves a digital rectal examination and/or the PSA (prostate specific antigen). Screening should be done on all men 50 years and older with a life expectancy of greater than 10 years; and a baseline PSA on 40 year-old men with a strong family history. The higher the PSA, the higher the probability of prostate cancer.

The digital rectal examination is done by your doctor, who inserts a lubricated, gloved finger in the rectum to check for prostate enlargement. Many men consider this taboo and many who are symptomatic will not see their doctor because they either fear the needle (that will extract blood) to test for the PSA, or they just do not want anything inserted into their anus.

The procedure is mostly painless and may even be pleasurable, and no, this does not mean you are a homosexual in hiding (a concern that has been expressed by a few patients).

This may be normal as the entrance to the rectum has a large quantity of nerves that can be stimulated when touched. You may feel the urge to pass urine or have a bowel movement. Any discomfort is minor and brief.

The PSA can be elevated in prostate problems other than cancer and can be normal in the presence of prostate cancer. It can also identify a slow-growing prostate cancer that does not cause symptoms, hence the need for yearly screening. Early detection means early treatment that saves lives.

Those individuals with a high PSA along with an enlarged prostate may need a biopsy (removing a small portion of the gland for testing) to confirm the diagnosis.

In Jamaica there is not an institutionalised protocol for PC screening but persons who wish to do so may go to their family physician or to their nearest health centre, if there are economic difficulties.

Treatment options

For people who have already been diagnosed with prostate cancer, there are various treatment options.

. Watchful waiting: For those who are in the early stages or have a slow-growing tumour, "watchful waiting" therapy may be used where progression of the disease is monitored while the patient is fully advised of all treatment options.

. Radical prostatectomy: Complete removal of the cancerous gland that is curative if the tumour is limited to the prostate. In addition, a possible cancer-carrying lymph node near the prostate is removed for testing.

. Radiation therapy: Targeted energy rays to kill cancerous prostate cells, shrink tumour or prevent cancer cells from dividing and spreading.

. Brachytherapy (Interstitial Radiation Therapy): Rays coming from tiny radioactive seeds inserted in the prostate.

. Hormonal therapy: The aim is to diminish the effect of testosterone. This can be achieved by chemically inhibiting the function of the testicles or having them surgically removed. Other options include chemotherapy.

The effects of surgical treatments are now greatly decreased with the use of nerve-sparing techniques in combination with drugs such as Viagra, hence effects on quality of life and function can be kept to a minimum.

Sandra Knight is a medical officer at the Community Health Centre of the University of the West Indies.

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