Shunning prostate probe - Fear of anal examination puts Jamaican men at risk

Cultural barriers are preventing scores of Jamaican men from doing a simple test for prostate cancer which could save their lives.

Prostate cancer, which affects only men, is one the most frequently diagnosed cancers in Jamaica, and among the leading causes of cancer-related deaths despite the fact that if it detected early, it is cancer is completely treatable.

"The need to engage our men about the importance of screening for this cancer cannot be overstated," declared Yulit Gordon, executive director of the Jamaica Cancer Society, during an Editors' Forum last Wednesday.

Screening is especially important in Jamaica, where more than 90 per cent of the population is of African descent, a factor which predisposes its male population to getting prostate cancer.

But Jamaican men, 40 years and older, are hurting themselves by refusing, for the most part, to undergo the routine screening procedure, which is a combination of a digital rectal examination and a prostate-specific antigen (PSA) blood test.

During a digital rectal examination, a doctor puts a lubricated, gloved finger into the rectum to check the prostate gland. A tumour in the prostate can often be felt as a hard lump.

However consultant psychiatrist, Professor Wendel Abel, says Jamaican men fear this examination, as they associate it with homosexuality.

"(The thought) of having another person inserting their finger inside their anus can be very stressing for some men and makes them uncomfortable," Abel told The Gleaner in an interview some time ago.

"The other factor," said Abel, "may also be the fear of being diagnosed with prostate cancer or any life-threatening disease".

But consultant urologist, Dr Belinda Morrison, is urging Jamaican men to wake up to the reality that, despite the advances in medical technology, there is not yet any kind of blood, urine or other test that is as effective in detecting prostate cancer than the tried and proved combination of the digital rectal examination and prostate-specific antigen test.

"The gold standard still for screening is doing the PSA and the rectal examination," Morrison stressed during the Editors' Forum.

"Doing the rectal exam is important for us because it gives us an idea of stage, the potential stage of your cancer; (and) how it feels helps us to know, is this just something localised, is it advanced?

"It helps us in determining what we are going to suggest you for treatment. So we can't do away with the physical exam. It's not a painful test, doesn't take a long time and really ought not to be a barrier to screening," added Morrison.

Admitting that her experience has shown that the nature of the test continues to be a psychological barrier for some men, Morrison argued that a little bit of ignorance has gone a long way in hampering the drive against prostate cancer.

"Some men think it's painful, some confuse the rectal exam for a prostate biopsy, and most, when they come for the first time, are afraid, but when I am finished, they often ask if you are done already," said Morrison.

She warned that despite ongoing research, scientists have not yet developed any method to replace routine screening as an effective early-detection tool.

"There is one called the early prostate cancer antigen, various other ones that have come about ... the answer is no. They have come up with blood or urine tests that test for specific antigens and substances in the blood that can help increase or improve your detection rate, but they still have not come to the fore to replace doing the digital rectal examination."

Morrison continued: "Even for us as urologists, we would want to find something that is a little bit easier for the men to come in earlier, because we know that is one of the many barriers to screening. But you want something that has a high pick-up rate, a high sensitivity; something that if it is negative, you can almost, with certainty, say there is no cancer there, but relatively easy to perform.

"And to this date, no matter how much progress has been made, in terms of medical advancement, we have not gotten past doing the physical exam, and doing the PSA. It is just what it is."

 

____________________________________________________________

"African American (black) men are more likely to develop prostate cancer compared with Caucasian men, and are nearly 2.5 times as likely to die from the disease.

"Although scientists do not yet understand prostate cancer, incidence and death rates are higher among African American (black) men. It is widely believed that it is a combination of genetic differences and lifestyle. Nutritional habits and medical care may all play a role in the statistics."

- Prostate Cancer Foundation