Family history critical to early prostate check
Cancer screening under age 40 has to be personalised, says specialist
DR DEAN Wong, a urologist based at the Hospiten medical facility in St James, is dismissing suggestions to screen men under age 40 for prostate cancer as impractical, as such tests would require specific genetic guidelines and knowledge of a family history of cancer.
Speaking at an online panel discussion about prostate cancer in recognition of Prostate Cancer Awareness Month, Dr Wong said that the current practice of screening men for prostate cancer beginning at age 40, allows for a greater chance of accurately diagnosing the disease.
“For us in Jamaica to bring the age of screening down to 40, instead of age 50 or 55, I think it is a good move, as we should capture 99 per cent of persons (for diagnosis). To screen persons less than 40 years old is going to pick up less than one percent of affected persons,” Dr Wong told the forum.
SPECIAL GENETIC TESTS
“It is not that persons under age 40 are not important, but they would have to be individualised, and it would not be a mass population guideline. So if that person has a strong family history, we would probably engage them doing specific genetic tests that we are looking for in order to assess their risk,” Dr Wong added.
He noted that as far as a family history of prostate cancer is concerned, an individual male may be screened earlier than age 40, depending on whether he had a male relative with the condition, and at what age was that relative diagnosed.
“As a general rule of thumb, for the youngest person with a related cancer that relates to prostate cancer in their family, we start screening the person 10 years prior. If that person’s father or brother was diagnosed with prostate cancer at 45, then there is strong merit to start his screening at age 35. But that is specific to that family or gene,” said Wong.
“One of the first things I ask about is the family history, not just of prostate cancer, but of other cancers, because sometimes they overlap in the genes. So it is not just if the man has a father or brother with prostate cancer, which is significant, but also if they have a mother or sister with breast cancer, because some of the genes are shared, causing cancer,” Dr Wong explained.
Fellow Hospiten-based urologist Dr Jeremy Thomas told the forum that prostate cancer patients need to have a strong support system around them in order to manage the disease and its treatment, including support from family members and prostate cancer survivors.
“Having a very supportive system around you, including your wife, your children, and other family members, it is very important. In terms of the complications surrounding the disease, reproductivity and family planning may be affected; and if you have not started a family, this is something you have to talk about prior to treatment. Certain types of treatment may affect your sexual function, and that is where you need a supportive partner,” said Dr Thomas.
Prostate cancer has been identified as Jamaica’s most prevalent cancer and the leading local cause of cancer-related death in men. Jamaica recorded 1,561 new cases of prostate cancer in 2020, and the Ministry of Health has estimated that 304 out of every 100,000 adult males locally will be diagnosed with the condition.
In early September, the Western Regional Health Authority revealed that 250 prostate cancer cases have been listed for surgical attention among the 590 backlogged, elective surgery cases to be done in western Jamaica. Those backlogged cases are among 6,000 elective surgeries islandwide which had to be delayed from as far back as March 2020 due to COVID-19 cases being treated as higher priority.
“What has been encouraging in recent times is that there have been a few support groups with prostate cancer survivors, and they meet with each other and share stories, and so you do not feel alone,” said Dr Thomas. “But in terms of your immediate family, which comes first, that support is very important.”