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Prostate cancer: Men’s silent killer

by Admin-Phmp

Text by Henrylito D. Tacio

Photos: cancer.org and Mayo Clinic

After lung cancer, prostate cancer is the most common cancer for men. The 2010 statistics from the Department of Health (DOH) showed about 6 million Filipino men over the age of 50 are susceptible to developing the disease.

According to the National Kidney and Transplant Institute (NKTI), prostate cancer develops in 19.3 out of every 100,000 Filipino men. “About six cases in 10 are diagnosed in men aged 65 and older, and it is rare before age 40,” Philippine Cancer Society, Inc. (PCSI) said. “The average age at the time of diagnosis is about 66.”

One out of 100 Filipino men would have died from prostate cancer before age 75, according to the PCSI. “Prostate cancer occurs mainly in older men,” the cancer society pointed out.

Movie actor Nestor de Villa was 75 when he died of prostate cancer in 2004. Davao photojournalist Rene Lumawag was also 75 when he died. Rod Navarro was 73 when doctors pronounced him dead in 2003. Ross Rival was 62 when he succumbed to the disease in 2007. 

The prostate gland lies just under the bladder and surrounds the urethra. It produces the fluid in the semen that nourishes sperm.  Pili nut-sized in young men, the prostate gland enlarges with age.  

“Prostate cancer is a malignant growth that originates in the prostate, a small gland that lies under the urinary bladder and surrounds the initial part of the urethra and whose secretion forms part of semen,” explains Dr. Eduardo Gonzales in his Manila Bulletin column.

The Department of Health (DOH) urges Filipino men who are 40 years old and above to see a urologist ensure that all is well “down there.” 

“A man should have a digital rectal exam (DRE) at age 45 if he has no family history of prostate cancer, or earlier at age 40 if some members of the family have it,” suggested Dr. Michael Jonathan Latayan, a urology consultant at Metro Davao Medical and Research Center in Davao City.

Older men should see a doctor even if there are no symptoms of prostate cancer. This kind of cancer “usually grows very slowly and may take decades to produce symptoms,” says The Merck Manual of Medical Information. “Thus, far more men have prostate cancer than die from it. Many men with prostate cancer die without ever knowing that the cancer was present.”

The bad news is that “one out of 5 prostate cancers will result in death within five years.” That’s according to Dr. Jason Letran, a urologist at the Cardinal Santos Medical Center, University of Santo Tomas, and Chinese General Hospital.

What most Filipino men don’t know is that prostate cancer is among the most curable cancers – when it is detected early. Among those who survived the disease because they discovered cancer early include: Harry Belafonte, Warren Buffett, Robert De Niro, Rudy Giuliani, John Kerry, Ian McKellen, Ryan O’Neal, Colin Powell, and Ben Stiller.

But unlike those in the Western countries, most Asian men with prostate cancer “come for treatment very late,” observes Dr. Sahabudin Raja Mohamed, consultant urologist at the Hospital Kuala Lumpur, “when little can be done to help them.”

In the Philippines, it has been observed that men generally don’t seek exams or treatment until they start having symptoms of pain, urinating blood, or not urinating at all. By that time, the disease may be too late to be cured.

“Prostate cancer usually causes no symptoms until it reaches an advanced stage,” the Merck manual points out. Among the symptoms commonly associated with prostate cancer are the following: urinary problems; inability to urinate, or difficulty starting or stopping the urine flow; the need to urinate frequently, especially at night; a weak or interrupted flow of urine; pain or burning during urination; difficulty having an erection or decrease in the amount of semen ejaculated; blood in the urine or semen; and frequent pain in the lower back, hips, or upper thighs.

These are just symptoms, and only a doctor can know for sure whether a person really has prostate cancer. “If you are suffering from any of these symptoms, go and see your doctor immediately so that the cause can be diagnosed and any relevant treatment administered,” recommends Professor Peter Lim Huat Chye, senior consultant and advisor of the Department of Urology at the Changi General Hospital in Singapore.

In some men, symptoms develop after it spreads (metastasizes). “The areas most often affected by cancer spread are bone (typically the pelvis, ribs, or vertebrae), and the kidneys,” the Merck manual states. “Bone cancer tends to be painful and may weaken the bone enough for it to easily fracture.”

The Merck manual adds: “Prostate cancer can also spread to the brain, which eventually causes seizures, confusion, headaches, weakness, or other neurologic symptoms. Spread to the spinal cord, which is also common, can cause pain, numbness, weakness, or incontinence. After the cancer spreads, anemia is common.”

“To diagnose prostate problems – including prostate cancer – doctors usually perform a digital rectal exam (DRE), which is the insertion of a gloved finger inside the rectum to assess the size of the prostate,” informs Dr. Willie T. Ong, an internist, and cardiologist who serves as a consultant at the Manila Doctors Hospital and Makati Medical Center. “A PSA (prostate specific antigen) blood test, a urinalysis, and a special ultrasound of the prostate are often requested, too.”

If the results of either one of these tests are abnormal, “ultrasound of the prostate and biopsy are needed to see if there is cancer,” PCSI stated. “If prostate cancer is found as a result of screening with the PSA test or DRE confirmed by ultrasound and biopsy, it will probably be at an earlier, more treatable stage than if no screening were done.”

But the question is: should all men undergo any of the aforementioned tests? “There are many factors to take into account, including your age and health,” the PCSI explained. “If you are young and develop prostate cancer, it may shorten your life if it is not caught early. 

“Screening men who are older or in poor health in order to find early prostate cancer is less likely to help them live longer,” the PCSI continued. “This is because most prostate cancers are slow-growing, and men who are older or sicker are likely to die from other causes before their prostate cancer grows enough to cause problems.”

Filipino men should discuss with their doctors the options to make. After testing and prostate cancer has been diagnosed and staged, the doctor may present a treatment plan for the patient.

There are several ways of treating prostate cancer. “Choosing among treatment options can be complicated and often depends on the man’s lifestyle preference,” the Merck manual says.

The Merck manual lists six treatment options: curative treatment (a common strategy for men with cancers confined to the prostate that are likely to cause troublesome symptoms), palliative therapy (treating the symptoms rather than the cancer itself), radiation therapy (to kill cancer and preserve healthy tissue), hormonal therapy (commonly used to delay the spread of the cancer or to treat widespread), and watchful waiting (forego all treatment until symptoms develop if they develop at all).

“Speaking with doctors who specialize in different kinds of treatment helps the patient sort through his options,” the PCSI said, adding the patient should “weigh the benefits of each treatment against its possible outcomes, side effects, and risks.”

Like most cancer, no one knows what causes prostate cancer. “The causes of prostate cancer are not well understood,” says the U.S. National Cancer Institute (NCI). “Doctors cannot explain why one man gets prostate cancer and another does not.”

Researchers are studying factors that may increase the risk of the disease. Having one or more close relatives with prostate cancer increases a man’s risk of developing the disease. A diet high in animal fat is another factor (fats increase levels of testosterone, a male hormone).

Obesity is also a contributing factor. Two studies, which appeared in the Journal of Clinical Oncology, said that maintaining normal weight throughout your lifetime reduces your risk of developing prostate cancer.

So far, no proven link exists between prostate cancer and active sex life, masturbation, use of alcohol or tobacco, circumcision, infertility, and infection of the prostate. The theory that men who have vasectomies are at slightly increased risk for prostate cancer remains unproven.

Evidence from some studies shows that vitamin B6, selenium, vitamin E, soy foods, and lycopene (found in tomatoes) can reduce the risk of prostate cancer. In addition, circumcised men may have a slightly lower risk of developing prostate cancer than those who still have their foreskin, according to an American study.

Now, you know!

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