Prostate and cancer are two words that when said together men do not like to discuss.
However, it is vitally important that men discuss prostate cancer with their partner and also with their doctor.
The facts speak for themselves. In the United States, one in six men will develop prostate cancer in their lifetime, meaning a man is more likely to receive a prostate cancer diagnosis than a woman is to get a breast cancer diagnosis.
Prostate cancer is generally a slow growing cancer and many older men have undiagnosed prostate cancer, which in many cases is not presenting with any signs or symptoms.
The most common symptom of prostate cancer is a deviation in the way you urinate e.g. getting up frequently to urinate, blood in the urine, or dribbling.
Ethnic origin is a significant risk factor in developing prostate cancer with men of African descent at greatest risk. In fact some studies cite the Caribbean as the region with the highest incidence of prostate cancer globally and place Jamaican men of African descent at particular risk.
There are limited statistics for Cayman but anecdotally prostate cancer is thought to be one of the more common cancers diagnosed in men and one of the more common causes of death from cancer.
The good news is that prostate cancer is one of the most treatable and beatable cancers particularly if diagnosed and treated at an early stage. Unlike the Pap smear that is a recommended and very effective screening test for cervical cancer in women, there is no recommended routine screening test for prostate cancer.
There are tests that can help a doctor diagnose prostate cancer but these have not been recommended by medical and scientific institutions as screening tests.
Of these tests, the one of choice for men is the PSA blood test. PSA – prostate specific antigen – is a protein produced by the cells in the prostate. The level of PSA can be measured by a blood test. This test is recommended on an annual basis beginning at age 50 but men at greater risk including Afro-Caribbean men should begin having this test by the age of 40.
Men will sometimes talk about their PSA level the way they will quote the level at which their favorite stock is trading or a sports score and a level less than four was considered normal.
Many doctors are changing the norms and saying that a level less than two is normal. Recently a study was published which says that change is the most significant factor with a PSA test. An abnormal increase from one test to another is indicative that additional investigation is needed.
Another test and one not favored by men, especially West Indian men, is the digital rectal exam (DRE) which involves the doctor feeling for changes and abnormalities on the surface of the prostate by inserting a gloved hand into the rectum.
It is believed that a doctor should do both a PSA test and DRE exam as part of a ‘screening’ workup for prostate cancer. The reason for this is that neither test is effective as a stand-alone test.
The DRE can only examine the part of the prostate that a doctor can feel. PSA levels may appear to be normal but abnormalities may subsequently be detected by DRE. PSA levels can also be falsely elevated e.g. if there is a prostate infection or non-cancerous conditions of the prostate or if a man has engaged in sexual activity up to 48 hours before his PSA test.
If a man is diagnosed with prostate cancer there are a number of treatment options available including surgery, radiation and cryosurgery. They all have side effects and it is therefore important that a man sits with his doctor and his partner and discusses the best treatment option.