Specialists tackle prostate cancer, a difficult men’s health topic.
November is a very important month for raising awareness around the serious health issues specifically affecting the male half of our population. Movember, as it has become known, sees healthcare professionals, men and some women around the globe joining forces in multiple events and campaigns to highlight what are considered the three vulnerabilities particular to the male sex, namely: prostate cancer, testicular cancer, and clinical depression in men.
Dr Paul Porteous, a urologist at Netcare Olivedale Hospital explained that although SA men have a one in 17 risk for being diagnosed with prostate cancer in their lifetime, prostate cancer is far more common with one in 10 men being diagnosed in areas with widespread screening. “The good news is that many, if not most, prostate cancers are slow growing, meaning that early detection does enable better management and improves the chances of a cure.”
AGE AND PROSTATE CANCER
Urologist, Dr Jan Wilhelmus Aucamp who practises at Netcare Union Hospital, reported that prostate cancer represents the second most common cancer in men and the fifth most common cause of cancer death in men. “Age related demographics do clearly indicate an increase as men age, and it is most often diagnosed in men aged 65-74 years. However, worldwide incidence of prostate cancer has increased in men as young as 15-40 years old, with an average of about 2% per year since 1990. Although rare, these men present with more advanced cancer with a worse prognosis than older individuals.”
Due to the significant role that age plays in the development of prostate cancer, healthcare professionals urge men to take the importance of screening seriously. Dr Stephen Cornish, a urologist at Netcare Sunninghill Hospital suggested: “Any man over the age of forty should consider having himself assessed with regards to the current state of his prostate gland as well as its potential to develop prostate cancer in the future.”
RACE, GENETICS, AND LIFESTYLE INDICATE RISK FACTORS
“Racial disparity in the incidence and mortality rate of prostate cancer is significant, with a two-fold higher mortality in black men than in white. Asian men, in their native countries, have the lowest incidence,” said Dr Aucamp.
“Family history and genetic predisposition are additional risk factors. In men, immediate relatives with breast cancer increase the diagnosis by 21% and mortality by 34%. Similarly, a family history of prostate cancer increases risk by 68%. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, in families also predisposes individuals to a two-fold higher risk.”
Dr Aucamp warns that unhealthy lifestyle factors such as tobacco smoking and increased BMI (body mass index) with other components of metabolic syndrome increase prostate cancer risk.
SYMPTOMS AND SCREENING
According to Dr Aucamp, prostate cancer can be detected with screening before patients experience any symptoms, however local symptoms can include the following. These symptoms, however, usually only present at a more advanced stage:
- Lower urinary tract issues such as frequent, weak, interrupted, or painful urine flow
- Presence of blood in the urine or seminal fluid
- Erectile dysfunction
- Urinary retention
Dr Cornish noted that many of the above symptoms can also indicate benign prostate enlargement, and that a good place to start is often the GP, who should be able to perform a baseline screening for prostate cancer. If there are concerning findings, then a referral to a urologist would be necessary.
Dr Cornish’s recommended frequency of screening
| Screen every three to five years if: | Screen annually if: |
|---|---|
| No symptoms | Family history of prostate disease |
| No family history of prostate cancer | PSA abnormally elevated |
| No family history of breast cancer | Abnormal prostate exam |
| Normal prostate exam | |
| Low PSA level |
Dr Porteous added that a further point to consider is that while many prostate cancers are indolent and may not even need to be treated but should be monitored through ‘watchful waiting’, there are those which are aggressive and certainly do warrant treatment. He asserts that current screening methods cannot distinguish between these cancers and screening programmes run the risk of over diagnosing and over treating some cancers in addition to incurring avoidable risks and costs for the patient, physically, financially, and emotionally. Ultimately, the specialists note that a great deal of consideration should be given at each step of the process as to the management of the condition.
