The prostate is a small, walnut shaped gland in men, which helps in producing seminal fluid, which nourishes and transports sperm. It is found right below the bladder, along the seminal vesicle, which is the duct that transports sperm from the testes to the urethra, to be passed out via the penis. Tumours and carcinogenic growths in or on this organ are known as prostate cancer.
Prostate cancer is the most common cancer of adult males in Trinidad and Tobago, accounting for 19.5% of all incident cases at the National Radiology Centre (NRC) in 2018 (Annual Cancer Registry Report, 2018, NWRHA). Globally, it is the second leading cause of death from cancers in men (American Cancer Society, 20181), and the American Cancer Society estimates that 1 in 9 men will be diagnosed with this disease in his lifetime, and 1 in 41 men will die from the disease. Prostate cancer affects men of all races and ages, although this risk is not equal for all men (Mayo Clinic2). Major risk factors for this disease are:
- Age: Older men are more at risk for this disease, especially past the age of 50. The global average age of diagnosis is 66 years.
- Race: Men of African origin are more at risk for this disease.
- Family History: Men with a family history of prostate or breast cancer (especially BRCA mutation related to breast cancer) are more at risk for this disease.
- Obesity: Obese men are more at risk for this disease, and are more likely to be diagnosed with aggressive forms of the disease.
- Smoking: Smoking cigarettes increases the risk of developing this disease by around 50%.
Early stages of prostate cancer are usually symptomless, as the cancer is usually slow growing, and many patients will not require treatments for this disease. In more advanced stages, the signs and symptoms of this disease include:
- Problems passing urine- An increase in frequency of passing urine, especially at night, as well as having a weaker urinary stream. Pain or burning on urination is less common, but can occur.
- Hematuria or Hematospermia- Blood in the urine or in the semen.
- Erectile Dysfunction- Problems getting or maintain an erection.
- Pain- Hips, spine, ribs, or other areas may experience unexplained pain, if the cancer has metastasized (spread) from the prostate. Some may experience pain on sitting.
- Loss of Bladder Control- The tumour may press on the spinal cord, and impair function. This may also lead to weakness in the legs or feet.
- Edema- Swelling of the hands and feet due to fluid buildup.
These symptoms are not limited to prostate cancer, and may indicate hyperplasia, or enlargement, of the prostate3. However, they still indicate the need for a medical check if experienced, as the enlargement of the prostate is a condition that should also be treated, and so if you or a family member experiences these, see a doctor as soon as possible. The doctor will do one, or more of the following tests, to determine the exact nature of the disease, as well as the severity:
- Digital Rectal Examination (DRE)- This is a physical examination of the prostate by the physician, which will allow the doctor to determine if the prostate is swollen, and if this is limited to one side of the organ, or both. This alone is not a confirmatory test, and will be followed by other tests.
- Prostate Specific Antigen (PSA) Testing- This is a test for the PSA antigen in the blood. PSA is naturally made by the prostate, and so the levels can indicate if there is an issue with the gland. The PSA test is also not confirmatory, and so must be followed by other tests.
- Transrectal Ultrasound (TRUS)- This uses a small ultrasound probe inserted near to the prostate to create an image of the prostate using sound waves. This will show the size of the prostate, and if it is symmetrical. It is also not a confirmatory test.
- Biopsy- A small sample of the prostate is taken, and examined under a microscope. This will indicate to a pathologist the extent of changes of the cells in the prostate, and so is the only confirmatory test used. It can give information on staging and extent of the disease. It may be guided by TRUS.
- Other tests- X-Rays, MRIs, CTs and lymph node biopsies may also be performed to determine the spread of the tumour through the body
When the stage and extent of the disease is determined, the doctor will decide on the course of treatment for the patient. Major treatments for prostate cancer are:
- Surgery- The carcinogenic growths are cut out of the organ by the surgeon, along with parts around the growths, to remove the growth.
- Radiation Therapy- This uses directed radio waves to kill the cells in the area, especially the cancerous cells, which are more sensitive to the waves as they are rapidly dividing.
- Cryotherapy- This is useful for early stage prostate cancer, where the cells are frozen and killed.
- Hormone Therapy- This reduces the level of male androgen hormones in the body, which prevents them from stimulating the cancer cells to divide.
- Chemotherapy- This uses chemicals which are toxic to the cancerous cells to kill them, and prevent their growth.
- Vaccine Treatments- This vaccine boosts the immune system to fight against the cancer cells.
Often, a single approach is used, although the physician may combine multiple treatment plans based on the individual disease.
Early detection of the disease is important, as early stages of the disease are much easier to treat and cure. International guidelines recommend that men above the age of 55 get screened annually with the PSA or DRE methods, or as directed by their doctor2. New recommendations for screening in Trinidad and Tobago4 indicate that, as a high risk population, screening should begin as young as age 40, especially in higher risk men. Screening is available at NWRHA health centres, hospitals and outreach events. Take your prostate health into your own hands today, and live a healthy, happy, long life with your loved ones.
- American Cancer Society, (2019). “Key Statistics for Prostate Cancer.” Available at: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html Accessed on: July 31st, 2019.
- Mayo Clinic, (2019). “Prostate Cancer.” Available at: https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087 Accessed on: July 31st, 2019.
- American Society of Clinical Oncology, (2019). “Prostate Cancer.” Available at: https://www.cancer.net/cancer-types/prostate-cancer/symptoms-and-signs Accessed on: August 6th, 2019.
- Persaud S & Kawal T, (2019). “Screening for Prostate Cancer.” Trinidad and Tobago Newsday. Date Published: May 22nd, 2019. Available at: https://newsday.co.tt/2019/05/22/screening-for-prostate-cancer/