Doctor's Appointment | Early screening to combat prostate cancer
Prostate cancer is the second most diagnosed cancer in the world and the leading cancer affecting Jamaican men. Still, according to consultant urologist Dr William Aiken, many men seem reluctant to do the necessary tests related to diagnosing the disease, resulting in the cancer being detected too late. This was the discussion on Doctor's Appointment on Sunday featuring Dr Aiken and Dr Audley Betton, himself a cancer survivor.
The show revealed that one of the factors leading to the late diagnosis of this dreaded illness is the apprehension of men to getting screened via the digital rectal exam (DRE). The DRE sees the doctor inserting his or her gloved index finger into the rectum to feel if there are any abnormal swellings on the prostate gland.
Apart from DRE, there is the prostate-specific antigen (PSA) blood test which measures the level of PSA in a man's blood. The higher the count the likelihood of an abnormality.
The prostate gland, located at the base of the bladder, is one of the accessory glands of the male reproductive system. It mainly functions to produce 25 per cent of the seminal fluid which is secreted during ejaculation, as well as it stops the communication of the bladder and the urine passage during ejaculation.
As men age, two predominant conditions affect the prostate - benign prostate enlargement and prostate cancer. A third condition known as prostatitis, an inflammation or swelling of the prostate, normally affects younger men.
It is, therefore, recommended that men above age 40 get annual screening for prostate cancer. However, men with a family history of prostate cancer should begin screening earlier. This, Aiken explained, is one of the main reasons for the high prostate cancer mortality rate locally.
"Jamaican men do not have the habit of preventative health maintenance. Without these preventative measures, chances are that men who show no visible symptoms do not discover the illness until it is at an advanced state where treatment is much more difficult," Aiken told viewers.
Some of these symptoms that might present in the later stages of prostate cancer include:
- Weak or interrupted flow of urine.
- Sudden urges to urinate, yet trouble starting the flow of urine.
- Trouble emptying the bladder completely.
- Frequent urination, especially at night.
- Pain or burning while urinating.
- Blood in the urine or semen.
- Persistent pain in the back, hip or pelvis.
If either the PSA or DRE is abnormal the next step would be to do a biopsy to confirm presence and stage of cancer.
Should the diagnosis be cancer, treatment options may include surgery, radiation therapy, hormone therapy and chemotherapy. The option selected, however, will depend greatly on the stage of the disease.
- For cancer that is confined to the prostate, which is known as early or localised prostate cancer, the treatment includes removal of the prostate, radiotherapy and active surveillance.
- For cancer that is locally advanced, which has not spread to distant sites but has metastasised or spread just outside of the prostate, hormone therapy and radiotherapy are the preferred treatment.
- For advanced prostate cancer or metastatic prostate cancer that has spread outside the local region, the treatment of choice is hormone therapy where the cancer is deprived of testosterone which it needs to grow. This then leads to shrinking or involution of the cancer.
Though erectile dysfunction (ED) and incontinence are two common side effects of treatment, diagnosing the illness early normally allows for one to retain such functions.
Also important, as outlined by Anntonette Cowan-Palmer, National Commercial Bank (NCB) Insurance sales manager, is a financial plan as the cost of treatment varies greatly, based on where one accesses medical care. NCB Insurance critical illness product, ProCare, which cover nine illnesses, including cancer, provides customers $5 million coverage.
Estimating costs, Aiken noted that if a patient chooses to do surgery at any one of the two major public hospitals, there is no cost to the patient. At the University Hospital of the West Indies, which is considered semi-private, patients are required to absorb the remainder of the subsidised fee. However, private care for surgery can range between $1.5 and $2 million. Radiotherapy, which can extend up to two years, could cost the patient about $2 million. Having a critical illness plan in place, like NCB Insurance's ProCare is very important.
Research shows that the following may help to reduce the risk of prostate cancer.
- 'Cleaning the pipes'. It has been found that men who ejaculate more than 21 times for the month have the lowest risk of developing prostate cancer.
- Diets rich in vegetables and fruits, eating soy or tomato-based products, reducing animal fat, processed foods, dairy, and avoiding red meat may go a long way in reducing one's risk for developing prostate cancer.
"As with any other critical illness, once diagnosed, support from friends and family is essential," Dr Betton advised. Concurring, Aiken also made a special appeal to wives, girlfriends, daughters and mothers to encourage the men in their lives to get screened.
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