Charles Kong Soo

Act­ing chair­man of the Trinidad and To­ba­go Can­cer So­ci­ety (TTCS) Dr George Laquis says T&T has the high­est deaths from prostate can­cer in the world.He was speak­ing at a lec­ture on prostate can­cer ti­tled Lack of Ev­i­dence-based Med­i­cine: Un­der­stand­ing and Im­ple­ment­ing PSA Guide­lines in­to Prac­tice, host­ed by the TTCS and TT Med­ical As­so­ci­a­tion's CME at the Court­yard Mar­riott Ho­tel, In­vaders Bay, Port-of-Spain, last week.

"The high­est mor­tal­i­ty rate from prostate can­cer in the world is T&T, prob­a­bly be­cause we're not screen­ing our pop­u­la­tion who're at risk, so we're los­ing our men at an alarm­ing rate," Laquis said."That da­ta from the can­cer reg­istry of T&T is very dis­turb­ing and it's a wake-up call, we have to get more ac­tive with this and ed­u­cate our health­care providers on the us­es of these tests."A lot of us have a lot of doubts about the PSA test, what is an ag­gres­sive can­cer as op­posed to a non-ag­gres­sive can­cer.

"It's very im­por­tant that we don't want to do any harm by tak­ing a non-ag­gres­sive can­cer and treat­ing it like an ag­gres­sive can­cer and sub­ject the pa­tient to surgery, ra­di­a­tion ther­a­py, when that can­cer would not have harmed the pa­tient, yet we don't want to miss the ag­gres­sive ones."The PSA test mea­sures the blood lev­el of PSA (prostate-spe­cif­ic anti­gen), a pro­tein that is pro­duced by the prostate gland.

Prof Vi­jay Narayns­ingh said T&T had a steady in­crease in the mor­tal­i­ty rate for prostate can­cer since 1970 and an un­re­lent­ing rise in deaths not on­ly in new cas­es but in deaths."Our death-to-in­ci­dence ra­tio is very high, one of the high­est in the world and cer­tain­ly the high­est in Latin Amer­i­ca and the Caribbean," Narayns­ingh said.

"While it is the sec­ond most com­mon cause of death in the US, it is the most com­mon cause of death in T&T, so we have sig­nif­i­cant dif­fer­ences from the da­ta that Dr Slaw­in pre­sent­ed and I think, there­fore, we have to use dif­fer­ent guide­lines, be­cause we're deal­ing with a more ag­gres­sive dis­ease that is af­fect­ing more Afro-Trinida­di­ans and many of them at younger ages as well."

To­ba­go-based Dr Alan Patrick said the preva­lence and in­ci­dence in the mor­tal­i­ty rate from the dis­ease in To­ba­go was sim­i­lar to Bar­ba­dos and was ac­cept­ed as "very high," but not yet pub­lished."Re­gard­ing the US pol­i­cy, whether it would not make sense to pur­sue the is­sue of screen­ing, we in­tend to sub­mit an ar­ti­cle this year to the British Jour­nal of Urol­o­gy In­ter­na­tion­al," Patrick said.

Patrick said prostate can­cer af­fect­ed all races, the most se­vere and most com­mon in mor­tal­i­ty ap­peared to be much high­er in Afro-Trin­bag­o­ni­ans, less so in In­do-Trin­bag­o­ni­ans and least in Cau­casians.Dr Philip Ay­oung-Chee said while PSA was im­por­tant in the di­ag­no­sis of prostate can­cer, it did not equate to can­cer so it had to be used very care­ful­ly in the di­ag­no­sis."We al­so need to look in­to the re­port of the high mor­tal­i­ty rate of prostate can­cer in T&T," Ay­oung-Chee said.

"The in­for­ma­tion is that from the To­ba­go study, there is a high preva­lence of can­cer and this needs to be backed up by ev­i­dence that there is a high mor­tal­i­ty and in­ci­dence rate."Slaw­in's lec­ture will be avail­able on the T&T Can­cer So­ci­ety's Web site short­ly.Al­so present at the event were TTCS chair­man Dr Jacque­line Pereira-Sab­ga and first vice chair Dr Mar­lene Sukhdeo.