What you need to know about prostate cancer |22 September 2017

Between 2012 and 2016, the Seychelles National Cancer Registry recorded 176 cases of prostate cancer, making it the most common cancer in Seychelles during this period as well as the most common type of cancer among men during the same period. To commemorate Prostate Cancer Awareness Month in September, the Ministry of Health (M.O.H) in collaboration with NARS (Nurses Association of the Republic of Seychelles) and the Cancer Concern Association (CCA) as well as Dr Raphael of the M.O.H’s Department of Urology share their knowledge and advice in an attempt to help in the fight against prostate cancer.

What is the prostate?

The prostate is a gland found only in men. It is part of the male reproductive system that makes the fluid that carries sperm. The prostate is located in front of the rectum and just below the bladder. The urethra (the tube that carries urine from the bladder to the outside of the body) runs through the center of the prostate. As men age, the prostate tends to increase in size and this can cause the urethra to narrow and decrease urine flow.

What is prostate cancer?

Prostate cancer is made up of cells in the prostate gland that do not grow normally. The cells divide and create new cells that the body does not need, forming a mass of tissue called a tumor. These abnormal cells sometimes spread to other parts of the body, multiply and cause death.

What causes prostate cancer?  

As with many types of cancers, medical experts do not know the exact reason why cells become cancerous. It is thought that sometimes damages in the cell can alter certain genes, making the cell abnormal and it multiplies ‘out of control’.  Although the exact cause is unclear, certain ‘risk factors’ increase the chance that prostate cancer may develop.

Who is at increased risk for prostate cancer?  

All men are at risk for prostate cancer. Other factors that increase risk include:

• Age: The older you are, the greater the risk for getting prostate cancer
• Family history: Men with a father or brother who has had prostate cancer are at greater risk for developing it themselves
• Race: Prostate cancer is more common in some racial and ethnic groups than in others. It is for example, more common in men of black descendant than in white men
• Diet: Diet is possibly a risk factor. As with other cancers, a diet high in fats and low in fruits and vegetables may increase the risk.

What are the symptoms of prostate cancer?

Many men with prostate cancer often have no symptoms, however, Dr. Raphael from the Ministry of Health’s Department of Urology states that if symptoms appear, they can include:

✓      Blood in the urine

✓      The need to urinate frequently, especially at night

✓      Weak or interrupted urine flow

✓      Pain or burning feeling while urinating

✓      The inability to urinate

✓      Constant pain in the lower back, pelvis or upper thighs

If you have any of these symptoms, see your doctor as soon as possible. Keep in mind that these symptoms are also caused by other prostate problems that are not cancer, such as an infection or an enlarged prostate.

Dr Raphael strongly emphasises on the importance of an early diagnosis and ensuring that you follow all protocols in place in the clinics. He reiterates that this particular cancer is common among men above 40 years of age and to ensure that a Prostate-Specific Antigen (PSA) test is carried out for those who are at risk and/or are having symptoms. This test is available to all those who wish to have it carried out and can be done in any clinic locally.

Is prostate cancer serious?

Some prostate cancers become a serious threat to health by growing quickly, spreading beyond the prostate gland to other parts of the body, and causing death. However, other prostate cancers grow slowly and never become a serious threat to health or affect how long a man lives.

Statistics relating to prostate cancer from the Seychelles National Cancer Registry

Can prostate cancer be prevented?

Adopting the following practices can help reduce your prostate cancer risk and contribute to overall good health:

✓      Not smoking

✓      Maintaining a healthy diet

✓      Staying physically active

✓      Seeing your doctor regularly

Prostate cancer screening

Finding and treating prostate cancer early may save lives. Men who are over 45 years should annually be offered tests to check the health of the prostate. The main screening for prostate cancer is the digital rectal examination (DRE) and the prostate-specific antigen (PSA) test. The DRE and PSA tests alone cannot tell if you have cancer; they can only suggest the need for further tests. Biopsy of prostate confirms the cancer.

What is the DRE examination? 

The DRE or digital (finger) rectal examination is a quick exam for checking the health of the prostate. For this test, the doctor inserts a gloved and lubricated finger into the rectum.  This allows the doctor to feel the back portion of the prostate for size and any irregular or abnormally firm areas.

What is the PSA test?

PSA stands for “prostate-specific antigen.” PSA is a substance produced by cells from the prostate gland which circulates around the body. A small amount of blood is drawn from the arm and sent to the laboratory for this test. The higher the level of PSA in the blood, the more likely you have cancer of the prostate.

Follow-Up Testing   

If your PSA test or DRE suggests a problem, your doctor most likely will refer you to a Urologist (a doctor who has special training in prostate-related problems).

If the Urologist suspects cancer, tiny samples of the prostate may be removed with a needle. This is called a biopsy which is usually performed in an operating theatre. The samples are then examined under a microscope in the laboratory to determine if cancer cells are present.

Treating Prostate Cancer

When prostate cancer has been found in its early stages and has not spread beyond the prostate, a doctor and his patient may decide upon:

✓      Watchful waiting: monitoring the patient’s prostate cancer by performing the PSA test and DRE regularly, and treating it only if and when the prostate cancer causes symptoms or shows signs of growing

✓      Radical prostatectomy: Surgery to remove the prostate

✓      Orchidectomy:  Surgical removal of both testes to limit production of male hormone

✓      Hormone therapy: Giving certain hormones to keep prostate cancer cells from growing

✓      Radiotherapy: the use of radiation, usually X-rays to treat diseases

✓      Cryotherapy: The application of ice to treat diseases (done only overseas)

More advanced prostate cancers that have spread beyond the prostate is complex to treat and is incurable. Palliative care (treatment to relieve, rather than cure symptoms) is the only option.

Side effects of treatment

Almost all prostate cancer treatments have unwanted effects caused by the treatment. These may include pain, discomfort and other mild to severe effects that may be temporary or may last a long time. It is important that you discuss any problems or concerns with your doctor or nurse. They can help you ease, manage or even prevent some side effects:

✓      Impotence: Inability to achieve or maintain an erection

✓      Incontinence: Inability to hold urine

✓      Development of secondary female characteristics due to hormone treatment

Your doctor may also perform surgery or prescribe medication to relieve some side effects.

For more information, please talk to your doctor or nurse, who will be more than willing to help you out or contact the Cancer Concern Association on 2 522 440.