Take Charge of Your Health
An article by Dr. Kirtland Culmer

Prostate Cancer
I believe that September was designated Prostate Cancer Month. By the time that this article is printed, we will unfortunately be into October. I hope that this information will be of interest to you nonetheless. Much of what is contained here was taken from a policy statement of the American College of Preventive Medicine.

Prostate cancer is the most commonly diagnosed cancer in the United States (excluding skin cancers), and is second only to lung cancer as a contributor to cancer deaths in American men. It is the number one cause of death from cancer in older men both in the U.S. and the Bahamas. Mainly because of early detection, the age-adjusted incidence of prostate cancer has been increasing over the past 50 years, and much more so in the past ten years. White men with cancer localized to the prostate have a 94% five-year survival rate, and 31% for those whose cancer has spread to the far reaches of the body. We know that the incidence of cancer of the prostate is higher in black men than in men of other races, and risk factors such as genetic, environmental, social, dietary and hormonal are also believed to play a part in increasing the incidence. The incidence also increases with age.

A thirty eight year old male in my practice insisted on having further investigations when his PSA was only slightly elevated. He was particularly sensitized because his father has cancer of the prostate. It was found that he did have cancer, and because he took charge, the cancer was early and localized. He was immediately treated, and it is expected that he will survive. This is particularly significant when we realize that the younger the prostate cancer patient is, the more aggressive is the disease.

The incidence is also believed to be affected by carcinogens in the environment. The atmosphere, water etc., especially in industrial countries, may possibly contain these risk factors. Smoking, drinking, and a fatty diet are also among the high-risk influences. An enlarged prostate is not directly linked to prostate cancer. Both conditions occur in older men. An unknown number of prostate cancers do not cause problems, and no one can predict with any degree of certainty which cancers will be killers, how fast they will grow and/or spread, and how long which patients will not have symptoms of the disease. “Many men will die with prostate cancer, not because of it”.

The chief screening tests for detection of prostate cancer are the digital rectal examination (the gloved index finger of the doctor is inserted up the rectum to feel the prostate gland), and the prostatic specific antigen (PSA), a blood test. Other tests include transrectal ultrasound, and fine needle biopsies. All these tests may give a percentage of false negatives, and, in the case of the elevated PSA, the diagnosis can be benign prostatic hypertrophy or prostatitis. The skill of the urologist in determining which tests are indicated, and their interpretation, is so greatly important.

When the experts say that there is no direct evidence to indicate that early detection and treatment of prostate cancer reduces the death rate of the disease, they are referring to general available statistics, not individual cases. When they say that the effectiveness of treatment for prostate cancer is uncertain, it is because well-designed controlled trials of surgery, radiation, and other treatment modalities have not been completed. For some cancers, simple observation seems to be the best approach. For others, there seems to be definite benefit from treatment intervention.

The experts also say that screening and treatment can be harmful. They say that a positive digital rectal exam (DRE) and/or PSA requires repeat testing, and may lead to more invasive diagnostic tests, such as needle biopsy, which carries a small risk of infection or bleeding. They say also that radical prostatectomy and radiation therapy can produce serious complications affecting quality of life such as urinary incontinence, erectile dysfunction or strictures and even death.

The American Urological Association and the American College of Radiology recommend annual digital rectal examinations (DRE) and PSA screening beginning at age 50, and annual screening beginning at age 40 for African-American men and other men with a positive family history of prostate cancer. Many of the Bahamian physicians, including myself, recommend this screening in Bahamian men starting at age 35. Technology assessment agencies in Canada, England, Sweden, and Australia have recommended against population screening for prostate cancer. It is interesting to note that all of these countries have elements of socialized medicine.

I have been in the medical arena for a large number of years. Those patients of mine who decided to come for diagnosis only after severe symptoms appeared, those who were diagnosed and decided to wait and see, and those who decided to take bush medicine or “pills” from a non-medical store are unfortunately not with us today. Those who were diagnosed early and were treated have all passed the five-year survival mark. A small percentage succumbed to the disease eventually, but the majority are still alive. I cannot recall one of my patients having complications from treatment as described above. I know that mine is only a small sample of the overall number, but guess what my recommendation to my patients would be, especially if it is their money that they are spending?

Take charge by getting as much educational information on this subject as possible. Then decide if and when you want to do your screening, and what you want to do for your body and mind if those tests turn out to be positive..God forbid!