SEPTEMBER is Prostate Cancer Awareness Month. In the USA prostate cancer is a recognised major health challenge and represents the second commonest cancer, the commonest being skin cancer. In Jamaica and in the Caribbean prostate cancer is the commonest of all cancers and unfortunately has the highest mortality rate.
Globocan, an online cancer database, showed that in Jamaica prostate cancer accounted for 21 per cent of all cancers, ahead of breast cancer at 16 per cent. Amongst cancers in males, it accounted for 42 per cent of cancers ahead of colorectal cancer at 13 per cent. There were over 1,500 new cases and in terms of deaths it also accounted for the highest from cancer at 18.4 per cent, translating to over 800 deaths in 2020.
However, when detected early and treated, the survival/cancer-free rate stands pretty good at over 90 per cent (in fact as high as 96 per cent in some studies). So, although it is a major health challenge that is not totally preventable, increased knowledge leading to the right attitudes and dispelling some of the unfounded fears will lead to a marked improvement with regards to mortality and morbidity in our society. Early screening saves lives.
'Doc I feel fine, still passing urine as usual and no problems with my sex lifeâ€¦I have no symptoms, so I don't have prostate cancer.'
Early prostate cancer which is curable has no symptoms. Symptoms which are often mistaken for prostate cancer are usually related to another common condition affecting the prostate as men get older which is benign prostatic hyperplasia. Some of these symptoms include urinating more frequently, a slower stream, burning on urinating and even blood in the urine. If these symptoms are as a result of prostate cancer, then it usually signifies advanced disease that has spread beyond or is on the verge of spreading beyond the prostate. So don't wait for symptoms. The Jamaica Cancer and the Jamaica Urological societies recommend for our high-risk population that screening should start at age 40 and be done annually thereafter once life expectancy is 10 years or more in asymptomatic males.
'Prostate cancer is an old man's problem. I'll check on that when I'm retired.'
The established risk factors for prostate cancer are unfortunately non-modifiable. Age, race and genetics are the major ones. Yes, there is an increased risk of prostate cancer as you get older. However, these factors vary for all individuals. An approximate risk of one in 500 men in their 40s, to one in 50 men in their 50s represents a significant increase. Also studies worldwide have shown that men of African descent are more likely to develop prostate cancer, and this represents a large percentage of our population.
1) First degree relative being diagnosed with prostate cancer doubles your risk.
2) First degree relatives with prostate cancer increases that risk to five times. Most prostate cancers are sporadic, meaning that they are diagnosed in men who have had no family history of prostate cancer. So no relatives with prostate cancer is not a reason to throw caution to the wind. As much as we would all love a society where retirement age is 40 years with a large retirement cheque, it isn't and 40 isn't old either. So go take interest in yourself to improve your chances of living a long healthy life for not only yourself but for your family and friends.
'PSA is a cancer test. Doc said it wasn't too bad so I'm OK.'
PSA stands for prostatic specific antigen. It's a protein that is produced by the glandular epithelial cells of the prostate. A small amount usually ends up in the blood stream from normal cells. From malignant or cancerous cells more usually ends up in the blood stream and from a simple blood test the PSA levels are used to help determine if you are at risk for prostate cancer. It is referred to as a tumour marker, but it is not a 'cancer test'. Although a very high PSA may indicate the strong likelihood that prostate cancer is present, a biopsy is needed to confirm this. Think of PSA as a smoke detector, when the alarm goes off it doesn't necessarily mean that there is fire, but you are alerted to the possibility of fire. PSA levels may be affected by other things such as the size of the prostate, and infection involving the prostate or urinary system, or recent surgery or instrumentation. A PSA level of four or less is generally considered normal.
'Sexual activity increases your risk of developing prostate cancer.'
This was once a rumour. Interestingly though, several studies have associated frequent ejaculation (21 times per month versus four to seven times) with a decreased risk of developing prostate cancer. Men will be happy to tell their partners this. Ejaculation is not linked to prostate cancer.
'Vasectomies cause prostate cancer.'
A very effective form of birth control that's not widely practised due to many misconceptions including this one. This has been extensively studied and there has been absolutely no link found between the two. A vasectomy is quite safe if you're certain you've completed your family.
Just a few of the many myths and rumours surrounding prostate cancer. The take home message is that we in Jamaica and the Caribbean are high risk populations. Black men and those with a family history of prostate cancer may be at an increased risk. Although it isn't entirely preventable, early screening saves lives.
Dr Jeremy Thomas is a consultant urologist. He works privately in Montego Bay, Savanna-la-Mar, and Kingston and publicly at Cornwall Regional Hospital. He may be contacted on Facebook and Instagram: @jthomasurology or by e-mail: firstname.lastname@example.org