DR. WILLIAM AIKEN
ALTHOUGH STATISTICS from the Jamaica Cancer Registry clearly indicate that prostate cancer is the most common cancer in men and the leading cause of male cancer-related deaths in the Kingston and St. Andrew, there is an ambivalent attitude towards the disease by many men, including health professionals.
It is not uncommon to hear men say that they don't want to know if they have prostate cancer or that, if they have it, they will most likely not die from the disease.
The fact is that prostate cancer kills, and the younger a man is when diagnosed with the disease, the more likely he is to die from it, if no treatment is received. This is sad indeed, as prostate cancer is imminently curable if discovered and treated early, and the pain and suffering associated with advanced disease is readily avoidable.
Confusion concerning prostate cancer arises because not many men realise that prostate cancer is generally a relatively slow growing cancer which takes between 10 and 13 years from the time of early detection to the time of death, if no treatment is received. Therefore, for Jamaican men, with an average life expectancy of 74 years, it is true that men with no symptoms in their early 70s would probably not benefit from detection and treatment of prostate cancer, whereas men in their early 40s to mid 60s certainly would.
RECTAL EXAMINATION
Early detection of prostate cancer involves doing a yearly rectal examination and a blood test called prostate specific antigen (PSA), either of which if abnormal would result in a prostate biopsy being performed with the aid of an ultrasound machine.
Early prostate cancer generally produces no symptoms whatsoever and therefore waiting for symptoms to develop before having these tests done may jeopardise the chance of early detection and, consequently, the chance of cure.
The Jamaica Urological Society and the Jamaica Cancer Society currently recommend that Jamaican men start these tests at age 40 years. This is especially important if there is a family history of prostate cancer and even moreso if a first degree relative (father or brother) developed it below the age of 55 years.
An ultrasound test alone, no matter how skilled the ultrasonographer, cannot reliably diagnose or exclude prostate cancer and is a practice that should be severely frowned upon.
AFTER DIAGNOSIS
Once a diagnosis of prostate cancer is confirmed by biopsy, the next step is to determine the extent of spread or stage of the disease as this will partly determine the best treatment option as well as the likely prognosis. Sometimes special tests, such as bone scans and CT scans, may be necessary to stage the cancer but most times the findings on rectal examination, the level of the PSA and the biopsy report are sufficient to give a good approximation of how extensive the disease is likely to be, and specific treatment may be recommended solely based on these parameters.
Can prostate cancer be prevented or slowed down? There is evidence that it may be to some extent but this is not absolute. A diet rich in green tea, soy products, processed tomato products, omega-3 fatty acids (salmon, mackerel, sardines, tuna, and so on), fruits and vegetables, vitamin E and selenium may offer some degree of protection along with enough Vitamin D from sunlight, while red meats, saturated fats, dairy products and excess caloric intake may promote its development and growth.
As these recommendations are not absolute in that there is no guarantee of prevention, it remains very important to have a yearly rectal examination and PSA blood test regardless of diet.
Dr. William Aiken is the Head of Urology at the University Hospital of the West Indies and President of the Jamaica Urological Society; email: yourhealth@gleanerjm.com.