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June 18, 2013

Do not wait for symptoms to test for prostate cancer!

It’s amazing that after weeks of writing about prostate cancer, I still meet men who continue to ask: “Doc, how do I know that I have prostate cancer?” In addition, in the past month, I have seen no fewer than four men whose PSA was more than 500ng/ml. These men obviously have advanced prostate cancer and they all had symptoms.{{more}} In other words, they waited until they “felt something”. This, I tell men, is the crux of the issue.

If you wait until you feel something, then it’s too late. For prostate cancer, we screen “at risk” groups before they start feeling something. Black men are at risk for prostate cancer and should be screened. Even though some international health bodies, like PAHO, do not advocate screening for prostate cancer, this advice does not include black men, who are two to three times more likely to be affected by prostate cancer and when they are affected, they also tend to have more advanced and aggressive disease on presentation. So, the simple answer to “How do you know you have prostate cancer” is: YOU DO NOT KNOW UNTIL IT’S TOO LATE! So, please do not wait until you have symptoms. You should get tested, using first the blood test and starting at age 40 for black men.

You should also memorize your PSA value. It’s not unusual for a man to come to my office and say that he has been tested for prostate cancer and not remember the value of his PSA. The value is also not “hard and fast”. The value of 4ng/ml is a guide for patients and non-urologist doctors. Urologists, however, know you can have prostate cancer with a PSA less than 4ng/ml.

Finally, on the issue of testing for prostate cancer, most men come to the office thinking that the test always includes the finger test. The finger test is advised, but I use it only when needed. I generally do it in all men over 50; even for men over this age, whose PSAs are less than 1ng/ml, whose prostates are small on ultrasound and who have no urinary symptoms, they can be excluded safely from the finger test. Besides, I generally do not do a finger test in men under 50 whose PSA value is less than 1ng/ml.

Now, I’ll discuss some non-prostate issues. Every day, I have people who come to my office who say things like, I didn’t know there was a urologist in the country or I didn’t know you treat women, or I didn’t know I can get this operation or that procedure done here in this country. It’s amazing that simple operations that we do every day at the hospital are being sought overseas, with patients saying things like “I didn’t know I could have done it in St Vincent”.

I think I can give thumbs up and “big up” all the doctors who labour at the Milton Cato Memorial Hospital, especially those of us who cut. We, with limited facilities, do so much, for so many, for so long, with minimal recognition. We do it without pomp and circumstance, at strange hours and usually with little or no additional financial remuneration. Compared with our colleagues in neighbouring islands, with whom we went to school, they charge exorbitantly more than we do for the same or similar service.

I think Vincentians need to realize that GOOD DOCTORING IS NOT DEPENDENT ON THE NUMBER OF INSTRUMENTS YOU HAVE. They help, as icing is to cake, but it is not the cake. Good doctoring is about being kind, caring, empathetic, detailed and professional. Taking time to listen to your patients, ask appropriate questions, examine the patient and using simple tools like a stethoscope and basic blood tests will help us to diagnose 95 per cent of our patients. Without these basic steps, fancy and expensive tests done by even more fancier and expensive machines can be more confusing than helpful. Next week, I will start looking at the other things a urologist does, like treating conditions affecting the kidneys, ureters and bladder in men, women and children.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com