Prostate Cancer: It’s hard to put a finger on it!

by Drs Kevin Browne and Patho Mandlal

September is Prostate Cancer Awareness Month. Did you know that Afro-Caribbean men have a higher risk of getting prostate cancer than any other population of men in the world? St Vincent and the Grenadines reported a higher mortality rate of 115 men per 100 000 population when compared to 11.5 in the United States.

Early diagnosis of Prostate cancer (where there is no spread to other parts of the body) means the difference between a 95 per cent chance of surviving the next 15 years as opposed to a 32 per cent chance of surviving the next five years, as in a case where there is spread.

The literature also shows that with the advent of Prostate Specific Antigen (PSA) screenings resulting in earlier prostate cancer diagnosis and treatment, the death rate from prostate cancer in the United States has dropped by an amazing 44 per cent according to the National Cancer Institute, since 1992.

Screening modalities

A History and Physical examination should be done by a physician. History can include signs and symptoms e.g: frequent urination especially at night, difficulty urinating, blood in the urine, erectile dysfunction, or painful ejaculation. The most positive physical finding is a firm or hard nodular prostate on Digital Rectal Examination by the doctor.

There may be asymmetry and difference in consistency of the prostate. Prostate cancer that has spread can lead to bone pain, pathological fractures and neurological compromise including paralysis, urinary and bowel incontinence, due to metastasis to spinal cord.

The Prostate Specific Antigen (PSA), a blood test, is a good testing factor to evaluate for Prostate Cancer. An Elevated PSA (> 4 ng/mL) and a positive physical examination gives indication for prostate biopsy which is the confirmatory test for diagnosis.

Most professional organizations suggest screening from age 45 to 75. Unfortunately, the mortality rate in the Caribbean is still high, but why? Typical barriers to screening in the Caribbean include perceived discomfort of the Digital Rectal Examination, taboos about prostate cancer, having a male examining physician, and fear of cancer itself.

Hopefully we can get around these hurdles through education, the elimination of public misinformation and the reversal of cultural stereotypes. An early diagnosis is the BEST weapon we have in the fight against cancer and as such we encourage all males 40 years and older to go out, get tested and take control of their lives.