Being aware can save your life

HEALTH experts here are still unsure about whether men 50 or older should be screened for Prostate-Specific Antigen blood test (PSA), especially with the nation likely to reach an ageing nation status by 2035 with the number of people above 60 making up 15 per cent of the population.

Although the American Cancer Society recommends that the test be done annually for men 50 and older, it is a controversial issue in many countries with most claiming that the incidence of prostate cancer was not high compared to some western countries.

"Prostate cancer is very common in the west. The National Cancer Registry statistics in 2008 revealed that it is the fourth most common cancer among local men," says consultant clinical oncologist Dr John Low Seng Hooi.

However, it is the second most common form of cancer among Indian men after colorectal cancer. In Chinese and Malays, it is the fourth most common cause of cancer.

"I think there is a need for awareness among healthcare professionals and the public. We need to educate them not only on prostate cancer and its symptoms but also update them on the latest development and treatment," says Dr Low who is head of the Pantai Hospital Cancer Institute.

He says that although there is no guideline for screening, doctors and patients are requesting for tests for early detection of prostate cancer.

A high level of PSA in the bloodstream may indicate the presence of prostate cancer. But since other kinds of prostate disease can also cause high PSA levels, PSA testing alone cannot confirm the presence of prostate cancer.

Dr Low says additional evaluation is needed to detect this type of cancer. Conversely, a low PSA level does not always mean that prostate cancer is not present.

A possible cause of a high PSA level could be due to a non-cancerous enlargement of the prostate called benign prostatic hyperplasia.

Improved overall prognosis

Pantai Hospital recently held a symposium on prostate cancer to update healthcare professionals and the public on the latest developments, especially about screening and treatment.

Dr Low says there have been recommendations for a digital rectal examination (DRE). If the DRE is abnormal, a biopsy was recommended regardless of the PSA levels.

The American Cancer Society recommends men 50 or older (as well as younger men with high prostate cancer risk) to undergo a DRE as part of their annual physical check-up.

Transrectal Ultrasound (TRUS) is useful when the PSA or DRE indicates an abnormality, to guide the biopsy needle into the exact area of the prostate. But TRUS is not recommended as a routine test for early detection of prostate cancer.

According to Dr Low, the overall prognosis for prostate cancer patients has improved. Over the past 20 years, the overall survival rates for all stages of prostate cancer have increased from 67 per cent to 97 per cent. This means more men are living longer after diagnosis.

This could be due to public awareness and early detection.


How can prostate cancer be treated?

Dr Low says treatment options for prostate cancer includes surgery, Trilogy Image Guided Intensity Modulated Radiotherapy, Trilogy Image Guided Conformal Radiotherapy, Trilogy Image Guided External Beam Radiotherapy, hormonal therapy and chemotherapy.

Prostate cancer is a malignant (cancerous) tumour (growth) that consists of cells from the prostate gland. The tumour usually grows slowly and remains confined to the gland for many years.

During this time, the tumour produces little or no symptoms or outward signs (abnormalities on physical examination). As the cancer advances it can spread beyond the prostate into the surrounding tissues (local spread).

The cancer also can metastasise (spread further) to other parts of the body such as the bones, lungs and liver.

Four stages of prostate cancer PROSTATE cancer often doesn't show any symptoms in the early stages. It's first hint is if there's an abnormality in the blood test or a hard nodule (lump) in the prostate gland, says Professor Dr Azad Hassan Abdul Razak, head and consultant urologist of surgery, University Malaya Medical Centre.

A doctor will first feel the nodule during a routine digital rectal examination (done with the finger). The prostate gland is in front of the rectum.

"As the tumour grows and presses on the urethra, the patient will find it difficult to pass urine. He may experience a burning sensation or pass blood in the urine," says Dr Azad.

"As the tumour continues to grow, it can completely block the flow of urine, resulting in a painful and enlarged bladder."

Men above 40 and those whose father or brother had prostate cancer, have a higher risk of getting the disease.

"Even those whose diet is high in saturated animal fat and low in fruits and vegetables have an increased risk," says Dr Azad.


Symptoms of prostate cancer

He adds that some patients may also experience pain in the lower back, hips, upper thighs, shoulders or other parts of the bone, or pass urine frequently, especially at night.

Other symptoms include difficulty starting or holding back urine flow, and flow that repeatedly stops and starts.

There are four stages of prostate cancer, according to the Malaysian Urological Association.

Stage One has no symptoms. A small amount of cancerous cells is present within the prostate gland. It is often diagnosed "by surprise" after an examination of prostatic tissue following transurethral prostate surgery (to improve urination). More recently, this can be diagnosed through needle biopsy of the prostate gland. This stage cannot be detected by digital rectal examination. Chances of recovery are good.

Stage Two refers to a more easily detected tumour (still within the prostate). There may still be no symptoms, but the tumour is big enough to be detected by digital rectal examination. Patients at this stage also stand a good chance of recovery.

In Stage Three, the tumour would have spread to the area just outside the prostate. Symptoms include difficulty in passing urine. Patients at this stage have less chance of complete recovery, but treatment can effectively slow its spread and relieve most symptoms.

Stage Four is an advanced stage and refers to spread far beyond the prostate, including lymph nodes and bones. Symptoms include difficulty in passing urine, bone pain, weight loss and fatigue. Treatment is targeted to relieve symptoms and slow the cancer's growth.

At UMMC, Prostatic Specific Antigen, or PSA, is used to diagnose prostate cancer.

"Not all men diagnosed with the disease need immediate treatment. Some cancer cells grow slowly and may take 10 years or more to spread. The doctor will monitor the progress and conduct regular examinations to check cancer growth by performing DRE and PSA tests," says Dr Azad.

A surgery to remove the prostate is recommended only if the tumour is localised at the prostate and there is a good margin of certainty that it won't recur, he adds.

Side effects may include urinary incontinence (loss of bladder control), impotence, swelling and change in penis length. But some of these can be treated. Dr Azad suggests men who reach 50 to go for screening as prostate cancer is easier to treat when it is detected early.

He says good nutrition may reduce the risk of prostate cancer. He suggests eating tomatoes as they contain lycopene, which helps prevent prostate cancer, and Vitamin E and Omega 3.

In fact, tomato and broccoli are recognised for their cancer-fighting capabilities and work best when taken together daily, according to a study published in Cancer Research.