Face your prostate cancer fears

BY ANIKA RICHARDS Sunday Observer staff reporter richardsai@jamaicaobserver.com

Sunday, September 28, 2014

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FOR many, prostate cancer is still shrouded in some amount of uncertainty, but one thing is definite, early detection is the key to reducing the death rate associated with the condition that has many men cowering in fear.


According to consultant urologist at the University Hospital of the West Indies and head of urology at the University of the West Indies, Dr Belinda Morrison, prostate cancer is the leading cancer in Jamaica. With a death rate of 63.9 per 100,000 men in the population, and an incidence rate of 78.1 per 100,000 men, according to information obtained from the Jamaica Cancer Society based on a study conducted by the University of the West Indies between 2003 and 2007 for Kingston and St Andrew, the fears of being diagnosed are not entirely unfounded.


However, Dr Morrison told the Jamaica Observer in a recent interview that, with no definitive way of preventing the condition, early detection is key to managing prostate cancer.


"It has been proven that, if a man presents early for prostate cancer, if he is screened, then you can reduce the death rate from the disease," Dr Morrison shared.


Prostate cancer, according to the Mayo Clinic, is "cancer that occurs in the man's prostate -- a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperms". The prostate surrounds the urethra and is located in front of the rectum and under the bladder.


The Jamaica Cancer Society does screening for prostate cancer and charges $2,000 for the blood test, the PSA and the private consultation with the urologist to have the digital rectal examinination done. However in the last three years, the cancer society has averaged an annual screening total of 600 men.


"There are a number of factors that contribute to Jamaica's high incidence and high mortality rate and we have narrowed them down to both psychological and social factors," executive director of the Jamaica Cancer Society Yulit Gordon told the Sunday Observer. "The psychological factor is fear. Fear of knowing that you have prostate cancer, fear of dying, fear of impotence, which is associated with the treatment of the disease, and fear of the actual test, which is the digital rectal examination."


The digital rectal exam involves a doctor using a gloved, lubricated finger to feel the prostate and surrounding tissues from the rectum. The doctor should also be able to say whether the cancer has spread beyond the prostate with this exam.


One man told the Sunday Observer that the first time he did the digital rectal exam, which Gordon described as the gold standard for prostate screening along with the prostate-specific antigen (PSA), he felt assaulted. Another man told this newspaper that the exam felt "unnatural".


"The social factor is cost," Gordon continued. "First and foremost there is an economic factor of cost. There is also in terms of geography, there are a lot of underserved communities out there that don't have access to screening facilities."


Dr Morrison also spoke to the issue of fear among men.


"They fear being told that they have an illness at all," Dr Morrison insisted. "Remember what we are asking is men who perceive themselves to be healthy to come to the doctor, men don't generally go to a doctor when they are well. Some don't want to go when they are sick. So it's a challenge to tell a man, 'okay, I am going to diagnose you with an illness' when, in their mind, they are thinking they are well."


She also said that being diagnosed with an illness also threatens the role of a man as it relates to his family and his being the breadwinner.


"Men feel weak when they are sick, they feel as though they are not fulfilling their role, and that's a major issue," explained Dr Morrison.


But what are the risk factors?


"We can only tell you risk factors and associations, but nobody can actually say this is the exact cause. The risk factor is black men, the risk factor is increasing age, the risk is family history, and also lifestyle," shared Dr Morrison. "As I mentioned unhealthy lifestyle, the things in the diet that are not good, or a lack of exercise. But, nobody can actually say this was my cause. People, for example, can look at you and say a man got lung cancer because he smokes, or a man got bladder cancer because he smokes. It's not as easy with prostate cancer."


The consultant urologist said, of all the cancers that exist in Jamaica, whether it be of the breast, colon, prostate, or cervix, prostate cancer is the number one cause of cancer-related deaths.


"We may not be able to change the incidence of the disease, because of the fact that the men are black, so they are going to be high risk anyway... but if you say, 'okay, we are high risk, why is it that it's the leading cause of cancer-related deaths?' And one way to try and reduce the death rate is to present early, so that is why, no matter what we say we always come back to the same point, we still have to suggest that men screen and get screened early."


And screening, according to Dr Morrison, means picking up the disease before symptoms start. These symptoms include: Frequent urination, especially at nights, painful urination, lower back pain, weak or interrupted flow of urine, blood in the urine or in semen, loss of an erection, as well as constipation or altered bowel habits. Dr Morrison also sad that, based on screening trials done overseas,the results showed that men who got screened early, their death their death rate from prostate cancer is reduced.


"So that is the benefit of it, and that is the challenge," said Dr Morrison. "The challenge is to get men to come out."


"We don't want men to come when they are having back pain, they can't walk, or they have blood in their urine or urinary symptoms," insisted Dr Morrison. "We want them just to come from age 40 and have the test done, every year, instead of waiting on symptoms."


Though a few agents have been proven to prevent prostate cancer, Dr Morrison told the Sunday Observer that they have not been approved by the FDA because they found that, although it did significantly reduce the risk of getting prostate cancer, they also found that there was a slight increased risk of getting higher grade cancer in men who did get it.


"So really, although that issue has been resolved, and they didn't think it was the drug that caused it, just for safety purposes, the FDA does not recommend giving the men this particular drug to prevent prostate cancer," Dr Morrison explained. "In terms of all the herbal substances, dietary supplement, none has been proven yet to be preventative. And, when I say that, I don't mean one man coming to you and saying he took guinea hen weed... and it prevented prostate cancer, we are talking about a clinical trial where you have thousands of men who get the drug daily. And then you have another arm, which is men who do not get the drug (placebo arm) and you follow them over a period of time and you see what happens."


Once detected, treament options are explored and these include radiation, surgery and hormonal therapy.


"It is going to cost in excess of a million dollars per person," Gordon told the Sunday Observer. "When you look at a course of radiation, which is about eight weeks, it is $1.8 million."


"Remember, surgery differs from patient to patient, surgery can run you anywhere from a quarter million to a million dollars." Gordon said.


It is therefore recommended that men get over the different fears associated with prostate cancer, minimise their risk by maintaining a physically active lifestyle and paying close attention to diet and nutrition as well as getting screened on a yearly basis once they get to 40 years old.


"Early detection is the key... There is no way around it," declared Gordon.


 


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