60th Courier Anniversary Issue
     
60th Anniversary Issue
 
Supplement Articles
:: Mayoralty Candidates & their vision for Baguio
:: What have we done to our city?
:: Leadership a
la Sudcordillera
:: If I could vote,
I would vote for...
:: A look at the northern youth vote
:: Shanty Town: rethinking
our mountains' development
:: Ma Fok's Secret
:: Ibaloi in international media
:: Preventing cervical cancer
:: Prostate cancer:
a brief perspective
:: Baguio Midland Courier goes online
:: Courier in the '60s
:: Baguio media notes and anecdotes
:: When headline writers become headline makers
:: The History of Baguio City National High School
:: 60 things to do and places to see in Cordi
:: How to make Baguio a child-friendly city
:: Election Cartoons
 
trisha Prostate cancer: a brief perspective
Dr. Andy Marrero
 

A significant number of our adult male population are diagnosed annually with prostate cancer. Most of these men will eventually succumb to the disease regardless of the form of treatment instituted. The reason is that majority of them would harbor an advanced form of the cancer at the time of diagnosis. Prostate cancer is curable only in its early stage or when the disease has not spread beyond the confines of the organ.

In the developed countries in Europe including the United States, prostate cancer has already overtaken lung and colon cancers as the most common form of malignancy involving males 50 years old and above. It has become the most common type of cancer and the second most common cause of cancer death in this age group.  In the Philippines, according to the Philippine Cancer Society, prostate cancer ranks third. This figure, however, is based on statistics taken in the previous decade. It would not be surprising if newer data taken today would simulate the trend in western countries.

Based on admissions at the Baguio General Hospital and data from clinic consultations, only about two out of 10 patients diagnosed with prostate cancer have a localized form of the disease. The rest would have cancer that has spread to the bones or lungs, or that has multi-organ complications like kidney failure or paralysis of the lower extremities. This is one of the many urgent health-related problems confronting our society today. Despite the availability of effective forms of treatment, we are still faced with patients seeking the help of their doctor only when their symptoms are severe and their disease has spread systemically. There remains a need to swing the balance towards earlier diagnosis, with the hope of decreasing its morbi-dity and mortality rates.

Why does this trend persist? The primary reason is due to the natural history of the disease itself. Prostate cancer does not produce definite symptoms during its early stage. If there were any, they would most likely be minor and non-specific and would often be disregarded by the person involved.

Minimal symptoms associated with the urinary tract such as frequent urination during day and night, straining during voiding, or an interrupted urinary stream are often interpreted as part of normal aging or commonly associated with other benign diseases like urinary tract infection.

Misinformation on the part of the populace and the influence of traditional logic and beliefs also impact on the attitude of men towards seeking medical help. A healthy 50-year-old man for instance would find it difficult to seek consult especially since it involves a sensitive aspect of his sexuality.

The presence of symptoms seemingly unrelated to the urinary tract such as back pains, which may be due to bone metastasis, may be misconstrued as arthritis or other benign conditions of the spine. The coexistence of more apparent or urgent medical problems, especially those involving the heart and lungs, often shifts the focus away from the cancer.

There is a need to properly educate our men regarding the prostate and change their attitude towards the issue. The following basic facts are quite simple and easy to understand:

The prostate gland is a small organ located at the base of the urinary bladder, encircling the uppermost urethra (the tubular structure that transports urine from the bladder during voiding). In an adult, it normally weighs about 20 grams, has a  dimension of about 4 x 3 x 3 cm, and resembles the shape of an almond. It is an accessory sexual organ that produces fluids, which facilitate sperm transport. There are several conditions that may  affect the prostate. Among younger and sexually active men, prostatitis or inflammation of the prostate is a common occurrence. This, however, is an entirely benign condition that can be treated by oral medications. The simple enlargement of the prostate called Benign Prostatic Hyperplasia normally occurs beginning at around age 50. Again, this enlargement can be treated with oral  medications or minimally invasive forms of surgery. When the enlargement is caused by a malignant tumor, it is called prostate cancer.

There remains no exact or clear-cut cause of this type of cancer but several risk factors have been identified. Foremost is a family history of prostate cancer. An individual whose father or sibling is affected has a risk twice that of a person without any history. Age is another factor. The older the  individual is, the higher the risk. Environmental and dietary factors such as consuming a high fat diet and coffee drinking have also been implicated but there are no well-controlled studies to substantiate a definite link.

Inasmuch as a cure is possible only when prostate cancer is localized, screening or early diagnosis plays an important role. The Philippine Urological Association, together with the Department of Health, has been conducting free prostate consultations or digital rectal  examinations nationwide since the early ‘90s.

This is held annually during Father’s Day in various medical centers in the country. All men at least 45 years old, or 40 years old if with family history of prostate cancer, are encouraged to undergo this examination. A free DRE is also being held at Notre Dame de Chartres Hospital on the last Saturday of each month or at the Baguio General Hospital Urology out patient section every Saturday morning. DRE is a simple procedure in which the examiner inserts his finger into the rectum palpating whether the prostate is normal or not.

After a DRE, the doctor would then determine whether further tests like serum Prostate Specific Antigen would be necessary. PSA is a form of blood test that aids in the diagnosis of prostate cancer. There are some men who undergo PSA testing without medical consultation. It should be emphasized that blood testing for PSA alone is not enough. A normal PSA does not necessarily mean the absence of cancer and an abnormally high PSA does not always necessarily mean that cancer is present. The PSA test should always be correlated with DRE findings. The embarrassment of letting someone poke into one’s rectum is much outweighed by the benefit that is gained especially if the DRE result proves to be abnormal.

Unlike malignancies in other organs, prostate cancer is slow-growing. Even without treatment, patients with a localized form of the disease may still survive an average of 10 years since the time of diagnosis. Those with low grade and indolent tumors may outlive their cancer and die from other causes. On the other hand, those with metastatic cancer may be able to survive for several years with supportive or antihormonal therapy.  This, however, implies a long-term process, which the patient has to endure. Bone metastasis is a painful and debilitating experience. The physical effects often lead to major disruption in the social functions of the patient and may cause psychological trauma to family members. The financial burden of expensive medications and cost of hospitalizations may stretch out over a period of years.

Prostate cancer may hardly be preventable but there are simple ways to increase its chance for being cured. As previously mentioned, men are encouraged to undergo routine DRE at the age of 45 even in the absence of any symptoms. Urinary disturbances, no matter how mild, should be considered with utmost urgency. Chronic back pains, particularly those which do not respond to the usual analgesics, and the persistence of non-specific signs and symptoms like anemia, pallor, weakness, or edema of the lower extremities should be regarded with a  certain amount of suspicion especially if they coexist with voiding disturbances. A brief visit to a urologist does not involve much effort.


Dr. Andy Marrero is a graduate of the SLU College of Medicine and had his residency training at the National Kidney Institute in Manila. He is a diplomate and fellow of the Philippine Urological Association. He is currently affiliated with several hospitals and holds his clinic at the Notre Dame de Chartres Hospital in Baguio City

 
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