June is Prostate Cancer Awareness month in the Philippines, and Father’s Day has been another reason to raise awareness in the UK.


In the UK 1/8 men develop prostate cancer in their lifetime, the same proportion as women developing breast cancer. It is much commoner in black African / Caribbean men ; less common in Asians. Over 40,000 are diagnosed – causing 10,000 deaths - each year in the UK. Far fewer are diagnosed in the Philippines ( true frequency unknown ), but it is still thought to be the third commonest male cancer, after lung and liver.


The prostate is a male pelvic gland ( " walnut sized " ) surrounding the urethra ( the tube taking urine from bladder to penis ), which helps production of semen.


Symptoms arise if the prostate affects urine flow through the urethra – passing urine more frequently, with poor flow – but even these are commonly due to benign ( non cancerous ) enlargement, which may be treated by drugs / fairly minor surgery.



Apart from race, age is a risk factor – most occur after 50. Family history is the third most important factor. As with breast cancer, 5-10% of prostate cancer cases are thought to be due to genetic factors. For example, men carrying " faulty " genes ( also linked to female breast cancer ) BRCA1 or BRCA2 have several times higher risk of prostate cancer.



Other factors are less clearly linked to risk – vasectomy probably doesn’t increase risk, while coffee and " superfoods " ( fruit and vegetables containing anti-oxidants ) may lower risk. As with so many diseases, other dietary factors ( fat ), lack of exercise, obesity, and smoking may increase risk.



If breast cancer screening is controversial, prostate cancer screening is more so ! PSA ( prostate specific antigen ) is a protein produced normally in this gland, but with cancer it may be measurably raised in the blood. Unfortunately the test is neither specific ( false positives occur in inflammation and " benign enlargement " ), or sensitive ( false negatives occur in true cancer ). Middle aged men with very high levels are thought to be at increased risk in future years.



As with breast cancer, however, there is a chance of unnecessary further tests and treatment of many, in order to prevent lethal cancer in relatively few. In the Philippines the cost of PSA testing ( at least P 600 ) is another disincentive. Other " markers ", such as PCA3 in urine, are now being tested.



Doctors also commonly use DRE ( digital rectal examination; " thumb up the bum " ) to feel prostate enlargement. This is uncomfortable; not itself a diagnosis of cancer ; and accepted less well in the Philippines than UK !


Biopsy of tissue " cores " from various parts of the prostate – taken with hollow needles across the rectal wall – which are examined by microscopy - can not only diagnose cancer, but also grade its " severity / aggressiveness ". But the procedure is painful and carries risks like bleeding / infection. Scanning ( MRI, ultrasound ) – if available - would allow more accurate biopsies.


Early stage cancer, confined to prostate, if it’s low grade, may simply be monitored by " watchful waiting " / " active surveillance ". This is because (over) treatment, to lower testosterone, on which the cancer depends - either with drugs or castration - are drastic and reserved for aggressive cancers. In the UK around 2/5 have drug treatment or radiotherapy. 1/10 have surgery ( with risks such as urine incontinence and erection problems ). Smaller proportions are diagnosed and treated in the Philippines.


In many cases this cancer is slow-growing and will not be lethal. Only if has spread to other parts of the body ( such as bones of pelvis ) is it incurable.



While it mainly affects older men, all of us should be aware of it – whether directly, or as a partner / relative – stand by your man !


http://www.nhs.uk/Conditions/Cancer-...roduction.aspx

http://www.nhs.uk/Conditions/Cancer-.../Symptoms.aspx

http://www.bansalan.com/henry/prostate.htm

http://www.bmj.com/content/346/bmj.f2023