Prostate cancer: How to prevent it? When will you need a screening?

Most of the prostate cancer cases in Malaysia are diagnosed at the advanced stage, which is very difficult to cure. The silent nature of prostate cancer could be the main reason for late diagnosis, other than irregular screening habits among Malaysian men. Here's what you need to know about the disease:

THE SITUATION IN MALAYSIA

• Prostate cancer is ranked as the third most common cancer among men in the country.

• According to National Cancer Registry’s report, 60 percent of prostate cancer diagnosis in Malaysia were at stage III and IV (advanced stage) while 40 per cent were caught early at stage I and II.

• Not all men in Malaysia go for their regular health check-ups or opt for the prostate-specific antigen (PSA) test to examine their prostate health.

• The silent nature of the disease could be the main reason for late diagnosis, other than irregular screening habits among Malaysian men.

WHAT IS PROSTATE CANCER?

• The prostate is a gland that is found only in males. Prostate cancer begins when cells in the prostate gland start to grow out of control. It makes some of the fluid that is part of semen.

• The prostate is below the bladder and in front of the rectum.

• In some cases, they may have slow urine flow as the prostate enlarges.

• The size of the prostate can change as a man age. In younger men, it is about the size of a walnut, but it can be much larger in older men.

CAUSES AND RISK FACTOR

Though the causes of prostate cancer are still not known, there are several risk factors associated with the disease:

• Family history

• Genetic factors

• Age

• Race

• Dietary habits

• Obesity

• Lifestyle

• Smoking

• Chemical exposure

DEFEAT THE CANCER

There is no proven prostate cancer prevention strategy. But there are ways to reduce the risk of prostate cancer by making healthy choices, such as exercising and eating a healthy diet.

Choose a healthy diet - Low-fat diet that includes fruits, vegetables and whole grains.

Maintain a healthy weight – Obesity may increase the risk of prostate cancer.

Exercise most days of the week – Exercise can help maintain weight, good health and reduce risk of heart disease and other cancers too.

Talk to your doctor about your risk - For those with a very high risk of prostate cancer, there may be other options for risk reduction, such as medications.

EARLY DETECTION, DIAGNOSIS AND STAGING

• The best way to detect prostate cancer early is through regular health screening.

• Prostate cancer diagnosis is often done through a digital rectal examination to see the consistency of the prostate.

• This will be followed by a standard blood test to check the PSA score which is the main determinant of prostate cancer.

• If the PSA test raises any suspicions, the patient will then be ordered to do a prostate biopsy for further investigation.

• A staging scan to determine the severity of the cancer.

TREATING PROSTATE CANCER

The treatment options are based on the severity of the disease.

• For locally advanced cases, there are curative treatments such as radiotherapy or surgery to the patients with stage III prostate cancer.

• Active surveillance on the other hand is an option to monitor and treat later to avoid the possible side effects but this is only applicable to those with a tiny tumour or low-grade cancer.

• The core treatment used for the elderly or frail patients would be androgen deprivation therapy (ADT) to reduce testosterone and eventually keep the growth of prostate cancer under control, to remove the testicles in a procedure called an orchiectomy.

• Those who do not want to remove the testes will have to inject hormones every three months, which would cost them about RM1,000 for every jab.

POST-TREATMENT

Follow-up Care

Even if a person has completed treatment, the doctors will still want to watch closely. It is very important to go to all of the follow-up appointments.

Doctor Visits and Tests

If the prostate hasn’t been removed, then the visits will usually include PSA blood tests, possibly with digital rectal exams (DREs). These will probably begin within a few months of finishing treatment.

CANCER, SEX AND SEXUALITY

• When someone is diagnosed with cancer, they may wonder how ‘normal’ life can and will be if they need to go through surgery or treatment, or as they adjust to living as a survivor.

• Ejaculating frequently may reduce the risk of prostate cancer.

• A research by Boston University of Public Health, found that men between the ages 20 to 29, who ejaculated 21 times or more each month were 19 per cent less likely to be diagnosed with prostate cancer than those who ejaculated less often, between 4 and 7 times per month.

• Nevertheless, a person's sex organs, sexual desire, sexual function, well-being, and body image can be affected by having cancer and cancer treatment.

• Sexuality and intimacy have been shown to help people face cancer by helping them deal with feelings of distress and when going through treatment.