Prostate Cancer
Prostate cancer is the #1 most common cancer among men aside from skin cancer. Every year more than 1 million men are diagnosed with prostate cancer worldwide (accounting for 15% of all new cancers diagnosed in men), and 300,000 men die from the disease.
Jamaica has one of the highest rates of newly diagnosed cases in the world ( 78.1/100 000/ year) ¹, which easily makes it the leading cancer affecting men in Jamaica. It is also the leading cause of male cancer-related deaths here at 53. 9 deaths/ 100 000/year ².
Jamaica has one of the highest rates of newly diagnosed cases in the world ( 78.1/100 000/ year) ¹, which easily makes it the leading cancer affecting men in Jamaica. It is also the leading cause of male cancer-related deaths here at 53. 9 deaths/ 100 000/year ².
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In general, the earlier the cancer is caught, the more likely it is for the patient be cured. Approximately 90% of all prostate cancers are detected in the early stages, before they cause symptoms, and so the cure rate for prostate cancer is very high. Some 70% to 100% of men diagnosed at this early stage will be disease-free five years after a curative procedure.
The purpose of screening for prostate cancer is to detect the disease before symptoms develop (that is, at an early, curable stage), and to give the patient the best chance at cure. The two components used in screening for prostate cancer are the Digital rectal exam (DRE) and a blood test called the PSA. They have played an integral role in decreasing the number of men diagnosed with advanced, non-curable prostate cancer in the past few decades since their implementation, by detecting the disease at an early curable stage.
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1. Aiken WD, Tulloch T, Freeman V, Bennett F, Coard K, Panton B et al. Differences in patient characteristics in black men with prostate cancer from Jamaica and Chicago. In: Proc Am Soc Clin Oncol 2003; 22: (abstr 1764).
2. Blake G, Hanchard B, Mitchell K, Waugh N, Wolff C, Samuels E. Jamaica Cancer Mortality Statistics, 1999. West Indian Med J 2002; 51: 64−7.
In general, the earlier the cancer is caught, the more likely it is for the patient be cured. Approximately 90% of all prostate cancers are detected in the early stages, before they cause symptoms, and so the cure rate for prostate cancer is very high. Some 70% to 100% of men diagnosed at this early stage will be disease-free five years after a curative procedure.
The purpose of screening for prostate cancer is to detect the disease before symptoms develop (that is, at an early, curable stage), and to give the patient the best chance at cure. The two components used in screening for prostate cancer are the Digital rectal exam (DRE) and a blood test called the PSA. They have played an integral role in decreasing the number of men diagnosed with advanced, non-curable prostate cancer in the past few decades since their implementation, by detecting the disease at an early curable stage.
Click here for Patient Instructions
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1. Aiken WD, Tulloch T, Freeman V, Bennett F, Coard K, Panton B et al. Differences in patient characteristics in black men with prostate cancer from Jamaica and Chicago. In: Proc Am Soc Clin Oncol 2003; 22: (abstr 1764).
2. Blake G, Hanchard B, Mitchell K, Waugh N, Wolff C, Samuels E. Jamaica Cancer Mortality Statistics, 1999. West Indian Med J 2002; 51: 64−7.
Digital rectal exam (DRE)
A DRE is a physical exam by a doctor using a lubricated, gloved finger placed into the rectum, so that the doctor can feel the surface of the prostate. The area of the prostate next to the rectum is where tumors often grow. A hard lump may be a sign of prostate cancer. It is an essential part of early detection of prostate cancer while it is still in a curable stage.
Prostate-specific antigen (PSA) test
The PSA blood test should be performed first at age 40, then routinely thereafter. For men with a close relative with prostate cancer (a brother or a father), the risk is two-fold higher, so screening should be considered as early as age 35. The PSA test is a routine blood test; no preparation is necessary, except you may be asked to avoid ejaculation for 48 hours prior. Elevated levels of PSA are often (but not always) an early indicator of prostate cancer, as well as other disorders of the prostate. For that reason, an elevated PSA is not a confirmation of prostate cancer. If there is sufficient degree of suspicion for prostate cancer based on either the DRE or the PSA, a prostate biopsy is performed to confirm the diagnosis.
A DRE is a physical exam by a doctor using a lubricated, gloved finger placed into the rectum, so that the doctor can feel the surface of the prostate. The area of the prostate next to the rectum is where tumors often grow. A hard lump may be a sign of prostate cancer. It is an essential part of early detection of prostate cancer while it is still in a curable stage.
Prostate-specific antigen (PSA) test
The PSA blood test should be performed first at age 40, then routinely thereafter. For men with a close relative with prostate cancer (a brother or a father), the risk is two-fold higher, so screening should be considered as early as age 35. The PSA test is a routine blood test; no preparation is necessary, except you may be asked to avoid ejaculation for 48 hours prior. Elevated levels of PSA are often (but not always) an early indicator of prostate cancer, as well as other disorders of the prostate. For that reason, an elevated PSA is not a confirmation of prostate cancer. If there is sufficient degree of suspicion for prostate cancer based on either the DRE or the PSA, a prostate biopsy is performed to confirm the diagnosis.
PROSTATE BIOPSY
The confirmatory test for prostate cancer is performed as an office procedure; it takes approximately 20 minutes, after which you can go home. We advise that you arrange for someone to drive you. There is no need for anesthesia as a local injection is given into the prostate prior to starting, in order to numb the area. Most men feel no pain during or after the test. An ultrasound probe is then placed in the rectum and, under ultrasound guidance, a needle is passed into the prostate 12-14 times to take tiny samples from various parts of the gland. The samples taken are sent to the pathologist who interprets the tissue under a microscope; within a week or less the results are ready. If prostate cancer is diagnosed, an in-depth discussion is arranged with you to discuss all of the available treatment options for cure or management of the disease.
The confirmatory test for prostate cancer is performed as an office procedure; it takes approximately 20 minutes, after which you can go home. We advise that you arrange for someone to drive you. There is no need for anesthesia as a local injection is given into the prostate prior to starting, in order to numb the area. Most men feel no pain during or after the test. An ultrasound probe is then placed in the rectum and, under ultrasound guidance, a needle is passed into the prostate 12-14 times to take tiny samples from various parts of the gland. The samples taken are sent to the pathologist who interprets the tissue under a microscope; within a week or less the results are ready. If prostate cancer is diagnosed, an in-depth discussion is arranged with you to discuss all of the available treatment options for cure or management of the disease.
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There is an inherent 2% risk of a urine or systemic infection after biopsy. We check your urine prior to performing the test and give you antibiotics to reduce the risk of infection. If you experience fever, chills or rigors after a biopsy, you must seek medical attention immediately. You will notice blood in the urine, semen and stool for a few days; there is no need for alarm as this will resolve on its own. Rarely, the bleeding is moderate and requires treatment. If you are on blood thinners (for example, clopidogrel), you must stop this a week before presenting for your test. Uncommonly, you may have difficulty passing urine after the test, requiring the temporary placement of a bladder drainage device (catheter).
The prostate biopsy is performed in-office for your comfort, without needing hospital admission. We arrange transportation of the sample to the pathologist for you, and see you back in about one week with your results. Many men are quite anxious about having a prostate biopsy done, but we are here to guide you through it comfortably and safely.
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