Garth Rattray | September is prostate cancer awareness month

All males are born with a prostate gland. The name of the gland gets its origin from the Greek language. “Pro” means “before”, and “states” means “the one who stands”. This gland ‘stands’ before and surrounds the urethra (the tube by which urine and/or semen leaves the body).

The prostate gland plays an essential role in human reproduction. It, along with 2 other glands, produces semen, the fluid that nourishes and protects sperm. However, several things can go wrong with the prostate. It commonly grows larger with age, it may become inflamed or infected, and it may become cancerous.

If the gland malfunctions, one or several things may be experienced. Inflammation can cause frequent urination or burning whenever urine is passed. It can also cause a feeling of fullness in the lower abdomen. Sometimes a bad inflammation may result in some amount of blood in the urine or semen. Sometimes this blood is seen or only detectable in a urine or semen test.

Infection of the prostate gland can feel like an inflammation, but sometimes an infection produces a fever. An infected prostate gland should not be taken lightly. An infection in the prostate can find its way into the blood stream and result in a [potentially fatal] sepsis.

BIG WORRY

But the big worry is prostate cancer. Whereas a non-cancerous and enlarged prostate, Benign Prostatic Hyperplasia (BPH) may result in frequent urination (especially at nights), the urgent need to get to the bathroom when you want to pass urine, the possibility that the urine will come down before you get to the toilet, hesitation when the urine is supposed to come out, a weak flow, and incomplete bladder emptying, prostate cancer usually produces no symptoms whatsoever until it is spreading.

When I just graduated, the tumour marker (the blood test) for prostate cancer was the acid phosphatase test. Unfortunately, that blood test could only tell us if the prostate cancer had already spread to the bone(s). When the Prostate Specific Antigen (PSA) blood test became available, we were all elated.

The PSA blood test was approved by the FDA in 1986, and became widely available in the early 1990’s. But an elevated PSA test can either mean that there is an inflamed prostate, or and infected prostate, or a cancerous prostate. The Urologists used to be wary of how some doctors were over diagnosing prostate cancer because of an elevated PSA, so they said that the PSA was an acronym for “Produces Stress and Anxiety” in some instances.

Nevertheless, it has been found that the best way to screen for prostate cancer is to have an annual PSA combined with an annual digital rectal examination (DRE). Many men abhor the digital rectal examination, but those individuals should, at the very least, get an annual PSA done. The Jamaica Cancer Society does DRE’s, and the National Health Fund (NHF) subsidises the PSA blood test. Therefore, any and every male can have these tests done annually.

This month is dedicated to raising awareness of prostate cancer and to encourage men to get screened. Screening should begin at 40 years of age. Prostate cancer is not preventable, and it tends to run in families. So early detection is your best weapon against this disease.

Those most at risk are the elderly men, a family history of prostate cancer, and men of African descent. Jamaica’s prostate cancer ranking is 14th globally. We have an age-standardised rate of 85.7 per 100,000 population annually. As common as breast cancer is, Jamaica’s incidence is 71.1 per 100,000 population annually, and cervical cancer is about 26 per 100,000 population annually. About 1 in 8 Jamaican men will get prostate cancer during his lifetime.

REDUCE THEIR RISK

Whereas there is no zero risk, there are things that men can do to reduce their risk of developing prostate cancer. No one can change their gender, age, race, or family history, however, eating more natural foods, and less processed foods and animal products helps to reduce the risk of prostate cancer. Keeping active and trying to maintain a reasonable body weight is always good. It is also suggested that men who ejaculate often (21 times per month or more) tend to be at a lower risk of prostate cancer.

If someone is strongly suspected of having prostate cancer, there must be tissue diagnosis before treatment can be initiated. If available, an MRI of the prostate usually proves very helpful. A biopsy will often tell if there is a cancer and how aggressive it is.

Some prostate cancers are indolent (sluggish, very slow growing). In those cases, the Urologist does active surveillance … ‘watchful waiting’. The PSA and symptoms are closely monitored and sometimes medications are prescribed to reduce testosterone levels. It is a very fluid state of affairs where intervention can change over time.

Surgery is sometimes an option. Radical prostate removal may be done by opening the abdomen or robotically (to minimise trauma and reduce recovery time). Other intervention modalities include external beam radiation (which is the only one available in Jamaica at this time), brachytherapy (where perhaps hundreds of radioactive seeds are implanted into the gland), high intensity focussed ultrasound to heat and destroy cancer cells (not currently available here). Some places do cryotherapy, and others use radiofrequency ablation.

Advanced prostate cancer requires chemical management – hormone therapy, chemotherapy, and immunotherapy. Sometimes a combination of different types of therapies is utilised.

In places where the outcome of prostate cancer is much better than ours, the deciding factor is screening aimed at early detection.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com