With an unusually high prevalence of prostate cancer showing up among Caribbean men, the Cayman Islands and similar countries need to instill a culture of regular check ups for their male populations. This comes according to Dr. Avelino A Piñon, a urologist from Miami who recently visited Cayman to update the community on this common form of cancer.
The prostate gland, which is found only in men, sits just below the bladder and in front of the rectum, partially surrounding the urethra, which carries urine from the bladder out of the body. Forming part of the male reproductive system, the prostate is responsible for the production of part of the seminal fluid used to carry and protect the male sperm during intercourse.
Although the Cayman Islands does not have statistic on the prevalence or mortality rate of prostate cancer sufferers, neighbouring Jamaica has statistics that are worrying: prostate cancer is the leading cancer among Jamaican males (30.3 per cent) and the leading cause of cancer mortality (16.5 per cent of total cancer deaths) according to Jamaica’s cancer mortality statistics, 1999. Dr. Avelino A Piñon, a urologist from Miami’s Urology Centre of South Florida says the prevalence is especially high among those of Afro American race.
“We do not know what causes prostate cancer, but studies have shown that diet, exercise, environmental factors and a genetic pre-disposition all play their part,” Piñon explains. “Basically, what’s good for the heart (i.e. a diet rich in fruit, vegetables and whole grains and low in salt, exercise, well maintained blood pressure and cholesterol levels) is good for the prostate.”
Doctors sometimes associate the development of prostate cancer with the natural aging process and Piñon says that there are different approaches to treating the disease depending on the age and life expectancy of the patient. Younger men tend to develop more virulent, faster growing cancers, while older men develop slow growing tumours.
“We tend to treat younger men far more aggressively,” he explains. “An older patient might only undergo observation whereas a younger patient would often undergo surgery to remove the prostate, possibly followed by radiation treatment.”
Screening is vital
Like breasts, the prostate comes in all shapes and sizes; however unlike breasts, its location makes it impossible for men to check themselves for any changes or abnormalities, Piñon advises.
There are two pillars to the screening process – a blood test known as a PSA test and a digital rectal examination. Prostate-specific antigen is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. Normally men have a low level of PSA in their blood; however, prostate cancer or benign (not cancerous) conditions can increase a man’s PSA level. As men age, both benign prostate conditions and prostate cancer become more common. The most frequent benign prostate conditions are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (enlargement of the prostate). There is no evidence that prostatitis or BPH causes cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well. Therefore, a man’s PSA level alone does not give doctors enough information to distinguish between benign prostate conditions and cancer, and thus Piñon recommends a digital rectal examination be performed as well.
Dr. Sook Yin, Cayman Islands medical practitioner and Cancer Society board member says that she recommends to her patients that they receive such check-ups from the relatively young age of 45 and annually thereafter because of the high prevalence of the disease among men from the Caribbean.
“Regular check ups are vital because it’s the change in the prostate over time that helps the doctor decide if there is a problem,” Piñon explains. “It’s much like a woman’s annual Pap smear. The doctor looks for any change in the norm to help them identify any problems down the line.”
As with Pap smears for women, the procedure isn’t particularly comfortable, but Piñon says that a cultural shift is vital if the Caribbean is to get to grips with reducing the prevalence and the mortality rates associated with prostate cancer.
“A couple of decades ago the US began to change the mindset of Americans when it came to smoking. Nowadays it’s seen as anti-social behaviour. The Marlborough-smoking cowboy heroes are now long gone. Likewise I’d like to see a shift in attitude to prostate cancer check ups in men and have them ingrained as a regular and routine act annually,” he confirms.
Doctors are worried, however, that there has been an increase of late in men obtaining products that contain testosterone to improve their sexual performance.
“An over use of testosterone has been shown to fuel cancers such as those of the prostate and should only be used if prescribed by a doctor. They should never be purchased over the Internet as this is not regulated and can be dangerous,” Yin says.
Side effects of treatment
Piñon believes that men are also often afraid to seek help if they believe they have a problem with their prostate because the treatment might lead to impotence.
“If caught early there is a good chance that their sexual function will not be affected by the treatment,” he says. “And even if they may need some assistance initially, medication and prosthesis are already more acceptable in our culture. The side effects of catching prostate cancer late include impotence, pain due to bone fractures, kidney failure, rectal infections and possibly even death, so it is extremely important for men to get checked regularly.”
Hosted by the Cayman Islands Cancer Society in conjunction with the Lions Club of Grand Cayman and the Movember movement, the public lecture given by Dr. Piñon at the Seafarers Hall was extremely well attended. Dr. Yin says she is extremely pleased at the turn out and stating that their public awareness campaign has finally paid off.
“The high turn out shows that men in our community have accepted finally that they need regular check ups for prostate cancer.”