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Prostate Care and Cancer Prevention

DARYL XUEREB

October

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“Don't keep it to yourself. When the burden becomes too heavy speak out.”


Voicing our opinion, and saying what has to be said is most probably something which we constantly do in our daily lives; at work, at home, with our friends or wherever need be. Yet again, when it comes to matters which might arise concern, many find themselves struggling to open up. The more time passes, the more concerned they get, and the more concern, the more difficult it becomes to speak. It’s time to break the cycle and wait no more. While it is easier said than done, awareness and information can help with the process, wherefore Life on Point has reached out to Dr Daryl Xuereb to shed light upon prostate care and cancer prevention.



How common is prostate cancer?



Prostate cancer ranks as the first most common and second most common cancer in males in the UK and US respectively. According to the Malta National Cancer Registry, the 2017 incidence rate was 77.49/100000.


The majority of prostate cancers grow slowly and are confined to the prostate gland. These tend to cause little harm and may go unnoticed for years. In fact most men diagnosed with prostate cancer will not die from it. Other forms of prostate cancer are rapidly growing and may spread outside of the prostate gland.


About 1 man in 41 will die of prostate cancer in Europe. The crucial aspect of detecting prostate cancer is to detect the rapid spreaders as early as possible. Prostate cancer limited to the prostate, has the best chance for successful treatment.


What are common symptoms?



Prostate cancer in its early stages may be totally asymptomatic. Patients may have prostate cancer for months without being aware of it. As the cancer advances and grows in size a number of symptoms and signs may appear such as:


  • An increased need to pee

  • Excessive straining while peeing

  • Incomplete voiding of the bladder

  • Blood in the urine

  • Weight loss and loss of appetite

  • Bone pain


Not all patients who exhibit one or more of the above symptoms will have prostate cancer. Difficulty in passing urine, especially in older individuals is a common symptom and is attributable to a benign growth of the prostate.

Many men feel uncomfortable to reach out for a check-up even when symptoms are manifested. When and how often should men start checking up?



Early diagnosis is key in prostate cancer. The earlier the diagnosis is made, the better the outcomes. Ideally patients should not wait for symptoms to appear before consulting a professional. Feeling uncomfortable or fear is a common occurrence. Males are embarrassed of getting checked or afraid of having tests carried out. The general consensus is that males having an average risk of prostate cancer should start screening at age 50. High risk individuals with a strong family history should start earlier at age 45.



In my practice the largest hurdle I encounter is clearing misconceptions patients present with when discussing prostate screening. First of all, prostate screening consists of two parts. Most patients believe that taking a yearly blood PSA level is enough. The truth is that while PSA is extensively used, a biomarker health professionals cannot rely solely on it to confirm or rule out a diagnosis. High levels of PSA can be found in other conditions such as prostatitis (inflammation of the prostate secondary to eg infections) or benign prostatic enlargement. Some early prostate cancers may fail to secrete PSA resulting in a low PSA level.


A PSA test should always be combined with a digital rectal examination whereby a trained professional examines and feels the surface of the prostate. The latter test is what puts off the majority of patients, however, careful explanation and reassurance works wonders in such situations. Any patients with abnormal screening tests are then referred to urologists who will conduct further radiological and blood tests to confirm the diagnosis and assess the level of growth. Yearly screening is a must in most patients. Individuals with symptoms mentioned above should immediately consult a doctor.


Apart from checkups, are there any other ways to help prevent prostate cancer?



The exact cause of prostate cancer is still unclear, but like most cancers, a multifactorial aetiology is most plausible. Most of these risk factors, such as age and genetic predisposition cannot be controlled. On the other hand men who are overweight or obese have been found to have a higher risk of developing advanced prostate cancer.


Choosing a healthy diet full of vegetables and fruit, provides abundant anti-oxidants. These have been shown to reduce the incidence of a number of different cancers. Avoiding red and processed meat, sugar-sweetened beverages and processed food also seems to help. Regular exercise also helps in maintaining a healthy weight and indirectly may aid prevention. A number of studies which are still in the preliminary steps are showing promising results when it comes to prostate cancer prevention and soy protein intake.


Physical and mental health are very much related especially when experiencing cancer. What would be your advice to men who find themselves struggling to cope?



Dealing with cancer is never easy. My advice is do not try to beat it alone. Having a support network is paramount. Each individual should be cared for holistically, keeping in mind his physical, mental, social and spiritual wellbeing. Most often we tend to focus only on the medical aspect of a condition but the other aspects are equally important. Relatives, friends and trained professionals can support a patient in different ways.

There are people out there ready to listen and help. Don't keep it to yourself. When the burden becomes too heavy speak out. Try to maintain a routine which includes hobbies and physical activity. In most situations referral to the hospice movement can help in numerous ways from physical to psychological assistance.

In my experience patients who are proactive and seek help immediately have a better convalescence and rehabilitation.

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