Ministry of Health & Environment

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Although it has been tried, tested and proven overtime, that early detection of prostate cancer can save lives, this disease continues to claim the lives of numerous Jamaican men each year.

The March 2008 edition of the West Indian Medical Journal, shows that between 1998 and 2002, there were 873 recorded cases of prostate cancer.

Consultant urologist at the University Hospital of the West Indies, Dr. Belinda Morrison, attributes this grave reality to the continued apprehensive or resistant attitude of many males towards being routinely checked for this disease.

She notes that "though Jamaica is said to have the highest incidence of deaths in the world for prostate cancer, this has not been enough to motivate the men to come in and do the required examination." Pointing to research data from the Jamaica Cancer Registry in the Department of Pathology at the University of the West Indies, Dr. Morrison says the incidence of prostate cancer now stands at 65.5 for every 100,000 of the Jamaican population.

According to a report from the Dr. Elizabeth Quamina Cancer Registry, the National Cancer Registry of Trinidad, men of African descent are said to produce higher levels of testosterone (male hormone) compared to men of other ethnicities. Increased levels, it is said, can cause the development of prostate cancer, which one in every five African men are at risk of having.

Prostate Gland

So what exactly is prostate cancer, what are its causes and why are so many Jamaican men so hesitant to get themselves screened for this chronic disease?
"For one to fully understand what prostate cancer is, knowledge of the prostate gland and its contribution to normal body functions is important," she states.

The prostate gland, she explains, is a walnut-sized gland that forms part of the male reproductive system. This gland is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the tube through which urine passes out of the body. One of its main roles is to squeeze fluid, which helps make up semen, into the urethra as sperm moves through during sexual climax.

Dr. Morrison informs, "It is common for the prostate gland to become enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH), and is a common part of ageing." She explains that with benign prostate disease, the cells are normal prostate gland cells and are not cancerous. "However," she hastily adds, "this condition does not necessarily lead to or cause the disease." prostate cancer, she says may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.

Prostate Cancer

Prostate cancer begins when normal, semen-secreting prostate gland cells mutate into cancer cells and begin to multiply out of control. To date, uncertainty still surrounds its exact causes. As Dr. Morrison states, "The specific causes of prostate cancer remain unknown. However, a man's risk of developing prostate cancer is said to be linked to environmental and dietary factors, as well as the acquired mutation of genes."

She adds, "One of the primary risk factors for prostate cancer is age. Though this disease is largely uncommon in men less than 45, it becomes more common with advancing age. It is extremely important therefore for men over 40 to get regular screening."

Screening

The urologist lists the two methods used to test for prostate cancer as the Digital Rectal Examination (DRE) and the Prostate Specific Antigen (PSA). She admits that the nature of the DRE has contributed to the hesitancy and in some cases outright unwillingness of many males in getting regular screenings. She states, "Jamaican men are apprehensive at the thought of having this procedure done. However, both the Digital Rectal Examination and the PSA are relatively painless methods."

The DRE, she notes, is a clinical procedure where the examiner inserts a gloved-lubricated finger into the rectum to check the size, shape, and texture of the prostate. "We tend to feel for areas which are irregular, hard or lumpy as these will need further evaluation, as they may be cancerous," she informs.

Prostate Specific Antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood through a blood sample. While it is normal for men to have low levels of PSA in their blood, prostate cancer or benign (not cancerous) conditions can increase PSA levels.

For those males who may think of foregoing the DRE, Dr. Morrison advises that "both tests should be conducted as neither are 100 per cent conclusive and ideally there is no substitution for both." She notes that PSA levels alone do not give doctors enough information to distinguish between benign prostate conditions and cancer, though doctors do take the result of the PSA test into account when deciding whether to check for further signs of prostate cancer. "A biopsy of the prostate is only done if there are abnormal results in the testing," she assures. This biopsy involves the removal of cells or tissues from the gland for further examination under a microscope.

Signs and Symptoms

Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland therefore directly affect urinary function and may produce symptoms. "When the cancer starts to manifest itself, then the person may experience lower urinary tract symptoms. The urinary stream may be poor, which encourages hesitancy and leads to this male seldom getting the feeling that he has emptied his bladder," she notes.

Dr. Morrison however warns that the disease is much harder to control when there are visible symptoms. "Oftentimes when they get to this stage," she says, adding, "the cancer has already spread to other parts of the body, such as the bones in the lower back and is much harder to contain."

In fact, there are examples of this with two men, both over 60 years, who have both been diagnosed with prostate cancer. Both told JIS News, that it was only when they began to experience excruciating back pains and what they termed 'stoppage of water' that they went to be screened.

Unfortunately, Dr. Morrison informs, "Prostate cancer can only be cured if it is localised to the point of origin. If it has spread to the lymph nodes and bones, then it cannot be cured." This invasion of other organs, Dr. Morrison notes, is called metastasis. Prostate Cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder. The most common symptom is bone pain, often in the bones of the spine, pelvis or ribs.
Prognosis

Dr. Morrison says that despite these realities, there are a number of treatment options.

But the chances of recovery and treatment options will depend on the stage of the cancer, and whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body. Other determinants include the patient's age and health, and whether the cancer has just been diagnosed or has recurred.

However, she advises, early detection saves lives as this is the best prognosis. She acknowledges the need for increased public education efforts to highlight the importance of these examinations. "Some men are not even aware of the role of the prostate gland in their body functions," she informed.

Information and Fundraising Officer at the Jamaica Cancer Society, Shullian Brown, concedes that the awareness level of Jamaican men about this illness will have to be improved, in order to begin to achieve a marked decrease in its incidence. She noted that while many females have been utilising the services offered by the Jamaica Cancer Society, to have their mammograms done, the figures for the men are unacceptable.

"The level of participation of our men needs to be improved. Until the psyche of male changes and they realize that they need to be screened on an annual basis, this problem will perpetuate. We need to eliminate the apprehension and the fear that is associated with getting tested," she stated.

The Jamaica Cancer Society, Miss Brown informs, operates a screening clinic and encourages men who are not yet members of the clinic to come in and get their cancer screening. "We understand the apprehension that might surround getting it done, but the key is to come in and get it done as early detection can save their lives. To allay some of their fears, there is a female nurse and female doctor to do the examination," she informs.

She also urges the men to think of their families and the possible impact that their deaths due to prostate cancer may have on them. "This disease has left families traumatised, as sometimes it steals away a father who is the sole bread winner of a family, or a single mother with hopes of seeing her children's dream realised."

Dr. Morrison mentions that a man's risk of developing prostate cancer is to be linked to environmental and dietary factors. In a bid to reduce the incidence of chronic diseases, including prostate cancer, the Ministry of Health and Environment, has sought to increase its drive to encourage Jamaicans to adopt healthier lifestyle practices, through several initiatives, such as the Workplace Wellness and Healthy Zone Programmes. The Ministry has also indicated its commitment to having sustainable activities, which promote healthy nutrition, physical activity, and an overall healthy environment, for the Jamaican people.

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