Men, do you know where your prostate is?

Prostate cancer is the second most common cancer to affect men globally.

The Movember movement, celebrated annually in November – the month where a certain portion of men (called the Mo Bros) decide to sprout and groom their facial hair to form moustaches of all shapes and sizes.

The purpose? To change the face of men’s health by acting as a walking, talking advocate for prostate cancer, and encouraging men to get screened for the disease.

Ignorance, fear and all sorts of preconceived myths play a big role in this hesitance to get tested. So here, we sit down with Dr George Eng Lee, consultant urologist and Star Online columnist to give us an honest gist about the disease, as well as the tests and treatments that are available today.

Let’s start with the big L, location. Do you know where your prostate is? If you do, bonus brownie points for you.

The prostate is part of the male reproductive system, and refers to the walnut-sized exocrine gland located below the urinary bladder, which surrounds part of the urethra. Its main function is to produce seminal fluids. It is influenced by testosterones, which are the hormones found in males.

Prostate cancer is a common cancer amongst Malaysian men, with increasing number of cases diagnosed since 2007. Globally, prostate cancer is the second most frequently diagnosed cancer in men, and the fifth leading cause of death from cancer in men.

Who’s at risk?

Amongst Malaysian men, statistics from the 2007 National Cancer Registry Report suggest that Chinese men are more at risk for prostate cancer, compared to Malay and Indian men.

Susceptibility to prostate cancer can be due to a family history of carrying the BRCA gene, which is the same gene that is responsible for the susceptibility to breast cancer, which so famously led Angelina Jolie to her decision of getting her preventive double mastectomy procedure.

Apart from that, those in the at-risk group include:
· Men over the age of 50
· Men who have immediate family member (father or brother) who suffers from prostate cancer
· Men whom consumer high animal fat or meat
· Men whom have had repeated cases of sexually transmitted infections (STI)

Getting checked

The bad news is, prostate cancer usually does not come with any warning signs. Early symptoms do not exist, and there is no self-examination that can be performed, which is why it is so important for men to get screened regularly.

A simple blood test can act as screening for prostate cancer.

The test is simple and non-invasive. It measures the levels of prostate specific antigen (PSA) through a commonly performed blood test to determine the state of the prostate.

Men with a PSA level lower than 4.0 may have less risk of prostate cancer. However, the elevation at the blood test may also be due to other benign conditions such as infection and natural enlargement. Digital rectal examination (DRE), which involves a medical practitioner inserting a lubricated gloved finger into the rectum, is necessary to identify abnormality of prostate through the rectal wall.

A biopsy is a procedure that involves collecting tissue samples with a needle under local anaesthetic and is necessary to determine the presence of cancerous cells in the prostate9. However, Dr Lee reveals that this method can produce false negative results, where the cancer might exist, but was missed by the needle picking up the sample tissue.

Treatment: Not always aggressive

The good news is, certain prostate cancers may have slow progression.

Not all forms of prostate cancer require aggressive treatment. In fact, some urologist believes there is the real issue of overtreatment in prostate cancer.

Thus in a portion of cases, the treatment option for prostate cancer is simply to take a passive stance and closely monitor the progression of the cancer – an approach which is called watchful waiting or active surveillance.

With active surveillance, the patient’s cancer will be carefully monitored through PSA blood tests and DRE every three to six months. Prostate biopsies may be necessary if indicated.

The other treatment options available are surgery, radiotherapy, and hormonal therapy.

Surgery: There are several options such as the traditional open operation, keyhole (laparoscopic) surgery and robotic radical prostatectomy. The keyhole surgery is done via small incisions, and with the use digital camera and minimal invasive instruments to remove the prostate. The robotic surgery has better advantages such as tissue preservation and faster recovery.

Radiotherapy: The new generation of radiotherapy has the advantage of radiation targeted to the prostate through computer generated images, with minimal side radiation affecting other tissues. It can aim accurately to perform by brachytherapy, which are little rice-grain sized pallets inserted inside the prostate, to enhance the high dose of radiation eliminating cancerous tissues.

Hormonal therapy: Hormonal therapy is necessary especially in patients who need treatment for metastatic cancer. The elimination of testosterone through medical or surgical castrations will suppress the cancer growth temporarily.

Palliative care: When the cancer is no longer controllable by hormonal treatment, patients will require supportive therapy to ensure comfort and dignity with minimal suffering and pain.

The different types of therapies are necessary for different stages and age of the patient. In fact, many doctors determine treatment options not just based on the stage and grade, but on a man’s life expectancy. For stage 1, where the cancer is organ confined, active surveillance may be recommended or patients might opt for surgery to remove the prostate. However for stage 2 and stage 3, a combination of radiotherapy and hormonal therapy might be appropriate.

However, for stage 4 of prostate cancer, no cure is possible, but it can be controlled by lowering the level of testosterone with hormone therapy or surgical castration.

Conclusion

“Although there are many layers of the unknown (when it comes to prostate cancer diagnoses and treatment modality), there is one thing that is for certain, and that is men should get tested,” says Dr Lee. “It is a very simple test, and it is very affordable.”

Dr Lee added that although imperfections may be present in the system of diagnosing prostate cancer, getting tested regularly for the disease is crucial as it allows doctors and patients to monitor the PSA levels and early intervention.

If you’re a male above 40 years of age, make an appointment with your doctor for a regular check-up.