Tackling the around prostate cancer
The prostate gland is an accessory reproductive gland found in men. It is located in the pelvis, in front of the bladder, and its normal size is that of a walnut.
This gland contributes roughly 20 to 25% towards the male’s ejaculation and is crucial for a man’s normal reproductive function.
Through this gland runs a small pipe, called the urethra, that carries urine from the bladder to the outside world. Any growth in the prostate can, therefore, put pressure on this pipe and disturb the normal flow of urine.
Prostate cancer is now among the leading causes of cancer-related deaths in men. To be specific, it is the second most common cause of death in male patients diagnosed with any form of cancer, eclipsed only by lung cancer.
The main risk factors associated with this disease are age (over 50), a family history of prostate or breast cancer, and being a man of African descent (black ethnicity).
There are other risk factors, such as smoking, obesity and living a sedentary lifestyle, but their overall contribution is still being investigated.
Symptoms can be divided into 'storage symptoms', which means they occur when the bladder is full and when someone is not voiding (passing urine), as well as voiding symptoms, which occur when urine is being passed.
The most common storage symptoms to look out for are waking up frequently at night to pass urine (nocturia); increased frequency of urination, which can happen both during the day and night, as well as urgency, which is the inability to postpone voiding.
These patients often need to go 'immediately' or risk wetting themselves.
Voiding symptoms to look out for include difficulty initiating a urine stream (patients describe this as 'having to wait' before they can go). Once voiding has commenced, the urine stream is poor or slow ('has no power'), and the person has to strain to achieve a strong stream.
Sometimes the stream gets interrupted during the voiding process (intermittency) and even when they have finished voiding, they feel as if there is some urine left in the bladder (incomplete voiding).
Other symptoms to look out for, which can be associated but are not specific to prostate cancer, are blood in the urine or semen, and painful urination and ejaculation.
Many patients will develop prostate cancer without experiencing any of these symptoms, which is why screening is so important, as it enhances early detection.
The screening and diagnosis of prostate cancer has come a long way, and has become easier in recent years. While most men still dread the infamous digital rectal examination (finger test), that has long been associated with screening for this type of cancer, most of them will find comfort in knowing that this type of exam is rarely done these days unless absolutely necessary.
Screening has become as simple as doing a blood test (PSA) at your local clinic or general practitioner who will then refer you to a urologist if your result comes back as abnormal.
The test is readily available and inexpensive.
The urologist then carries out a clinical examination. Further tests, such as an ultrasound scan, urine and additional blood tests, form part of the clinical evaluation. These are followed by a prostate biopsy, which is tissue sampling of the prostate gland, using a special needle.
These tissue sample results confirm whether or not the patient has prostate cancer, as cancer is a tissue diagnosis.
Although the procedure may sound scary, in reality it is a simple day procedure that can be done in an outpatient setting.
Once the diagnosis is confirmed, the correct staging of the disease is determined using scans such as a bone scan or, more recently, a PET scan, which is more accurate. Other staging modalities include a CT scan and MRI scan, depending on the patient’s disease profile and accessibility.
Once the correct staging has been obtained, usually a multi-disciplinary discussion is held with the patient, the family, the treating urologist, and an oncologist to discuss the best possible treatment plan for the patient.
Fortunately, prostate cancer treatment has become easy, with many treatment options, especially for early disease. For most of these patients, it is possible to achieve a 100% cure, which is why it is important to screen early to achieve early detection.
Early disease treatment options include hormonal therapy, surgery and radiotherapy, which can be delivered from outside the body or directly into the prostate using radioactive seeds.
Even in patients with advanced disease, there are treatment options aplenty nowadays, and include hormonal therapy combined with systemic therapies like chemotherapy and anti-androgens, among others.
These have been successful in providing symptomatic relief and prolonging survival, even if the disease is at an advanced stage. Prostate cancer treatment is well tolerated nowadays and often the treatment with the best outcome and the lfewer side-effects is chosen.
There are numerous support groups for patients already diagnosed with the disease, including the Cancer Association of South Africa (Cansa) and the Prostate Cancer Foundation of South Africa, where patients can get free support from professionals and other patients who have had the disease.
Screening ensures early detection which often means a 100% cure
Prostate cancer screening has become as simple as doing a blood test (PSA)
The take home message is that all men over the age of 50 should screen for prostate cancer because of their higher genetic risk.
Men of African descent are recommended to screen from the age of
45.
Patients who are at an even higher risk, i.e. those who have a family history of breast or prostate cancer, are recommended to screen from the age of
40. One annual PSA test is recommended. Screening ensures early detection, which often means a 100% cure.
We need more awareness about the disease from the media, healthcare professionals, and, most importantly, fellow patients who have had the disease, to remove the stigma and fears associated with it.
Working together, we can beat prostate cancer.