Prostate cancer a silent threat: ‘Educate, prevent and empower’

Some men may feel completely well and be unaware that they are living with prostate cancer due to the silent nature of the disease. Prostate cancer typically does not present with symptoms in its early stages. Strikingly, the signs and symptoms are usually manifested when the disease has advanced significantly, making early diagnosis and treatment difficult. Prostate cancer is a type of cancer that originates in the prostate involving the uncontrolled growth of abnormal cells and the formation of a malignant tumour. While normal cells eventually die, cancerous cells are immortal and continuously multiply. As such, they can invade nearby tissues or spread to other parts of the body.The prostate is a small, rubbery gland located between the base of the penis and the rectum. It plays a crucial role in male reproduction by producing a fluid that nourishes sperm and helps to form semen. Some forms of prostate cancer grow slowly and remain confined to the prostate. Other types are more aggressive and rapidly spread to other areas of the body. Prostate cancer is of great concern to Jamaica as epidemiological studies show that Jamaica has a very high incidence of prostate cancer. Additionally, the Caribbean region has one of the highest mortality rates from the disease worldwide. Therefore, it is crucial to understand the risks and symptoms as well as the screening and diagnosis of prostate cancer.

RISK FACTORS

Unfortunately, the cause of prostate cancer remains unknown, but certain risk factors are associated with its development. Prostate cancer predominantly affects older men, and your risk increases significantly after age 50. Additionally, your risk of getting prostate cancer more than doubles if a first degree relative such as your father or brother was diagnosed with prostate cancer. Research shows that your risk is even higher if your first degree relative was diagnosed before age 60. There is also a notable racial disparity in prostate cancer risk as black men are 60 % more likely to be diagnosed with prostate cancer and two to four times more likely to die from the disease compared to their white counterparts. Some men are genetically predisposed to prostate cancer through inheriting gene mutations such as the breast cancer genes BRCA1 and BRCA 2. Men with BRCA mutations are five times more likely to get prostate cancer than men without the gene. Studies have shown that men with BRCA gene mutation have more aggressive forms of prostate cancer and can potentially pass on this gene to their daughters and sons, increasing their risk of other cancers such as breast cancer. Men born to families with a high incidence of breast cancer are also at risk for prostate cancer.

SYMPTOMS

Some of the common symptoms associated with prostate cancer as it progresses are:

• Bloody urine or semen

• Persistent back pain

• Increased urge to urinate at nights

• Difficulty urinating

• Feeling that your bladder has not emptied fully

• Painful ejaculation

• Unexplained weight loss

Prostate Cancer Screening, Diagnosis

Prostate cancer screening involves a blood test that checks for a protein called prostate specific antigen (PSA)that is made only by the prostate. It is important to note that an elevated PSA does not always mean cancer, as it can be elevated in benign conditions such as Benign Prostatic Hyperplasia (BPH) and prostatitis.

Additionally, a digital rectal examination (DRE) is usually done where the doctor feels the prostate gland via the rectum for abnormal changes. If any abnormality is observed by either test, a prostate biopsy is usually done to determine if prostate cancer is present. If cancer cells are detected, your doctor may assign a Gleason score and determine the stage of your cancer. If prostate cancer is diagnosed at stages 1 or 2, the cancer is completely confined to the prostate and has not spread. As such, almost 100% of persons survive for five years or more following diagnosis. At stage 3,cancerous cells have broken through the membrane that encapsulates the prostate gland and may spread to nearby tissues. With suitable treatment, around 95 per cent of men diagnosed with stage 3 prostate cancer will survive for five years or more. At stage 4, the cancer cells have spread to nearby lymph nodes, adjacent organs like the bladder, or distant parts of the body, such as the lungs or liver. Only around 50 per cent of men diagnosed with stage 4 prostate cancer will survive for five years or more. It is important to recognise that overall survival rates depend on many factors and are based on averages, which may not reflect individual outcomes

Since prostate cancer is a silent disease, regular prostate screening is a win-win. Early screening can detect prostate cancer before it spreads allowing for timely treatment. As such high risk cases can be managed more effectively and can improve successful treatment and long-term disease free survival. If you are 40 years and older, you should speak to your health care provider about getting screened for prostate cancer. Additionally, if you are predisposed to prostate cancer or are experiencing symptoms it is essential to consult with your health care provider for evaluation and screening.

Melisa Anderson Cross is a clinical chemistry lecturer in the College of Health Sciences at the University of Technology, Jamaica