Consultant Urologist | Urology Surgeon
Medical Associates Hospital
With World cup in the air, many of us are focussed on which team is winning, who is scoring and who has the best moves! However, to be at ‘World cup level’ fitness, paying attention to one’s physical health is crucial.
During the pandemic many would have neglected routine health check-ups. Now that life is normalizing, let’s ensure we pay attention to those essential check-ups.
Why is this important?
Prostate Cancer is the MOST common cancer among men in our twin republic. It accounts for 18% of all cancer deaths and has the highest mortality of 14.7%. Simply put – 1 in 5 men will be diagnosed with prostate cancer and 1 in 7 men will die from prostate cancer.
What, where and why do men have a prostate?
The prostate is a walnut-sized gland located at the base of the bladder. It is about 20 grams. There are numerous functions, but its main function is to help the production of the supporting fluid for sperm. In other words, it gives your sperm the required nutrients and supplies needed to swim and make babies.
What causes prostate cancer (PCA)?
PCA develops when normal prostate cells DNA mutate. These abnormal cells grow forming the tumor and some stay within the prostate gland whilst others break away invading other tissues. The exact cause of PCA is still a mystery but we have identified numerous risk that can increase your chances:
• Older age – It is more common after 50 years and increases as you get older.
• Race – Afro-Trinidadians have a higher incidence for reasons unknown and it tends to be more aggressive and advanced.
• Family History – if your dad, uncles, brothers have been diagnosed then your risk is 2-3 times higher. Also if you have the BRCA1/2 or HOXB13 genes, your at an increased risk.
• Obesity – being obese put you at an increased risk of advanced disease and dying from prostate cancer.
How do I get tested? Can I get checked out please?
Getting checked out for PCA is called screening. There are many tests but the two commonly used are the PSA and rectal examination.
1) PSA Blood test – Checking the Prostate Specific Antigen (PSA) level in the blood can help identify men who are at risk. But keep in mind, that an elevated PSA is not only seen in Prostate cancer but in men with an enlarged prostate, infections and those who had certain medical procedures.
2) Digital Rectal Examination – this is where your doctor examines your prostate by inserting a lubricated finger in the rectum. This should last only a few seconds as he is checking the surface consistency of your prostate. A hard or nodular prostate can signify cancer.
Why should I get tested?
The goal of early detection if to identify the presence of prostate cancer. Effective early detection is a win-win. Prostate Cancer is undetectable and has no symptoms if caught in an early stage, it can be cured and treated with minimal side effects. Even if it is detected at a later stage, personalized plans are available for successful treatment. Some symptoms include, pelvic and bone pain, loss of weight or appetite, bloody urine, frequent urination or even trouble urinating.
My PSA is elevated? What’s next?
Remember an elevated PSA can be a result of prostate cancer, an enlarged prostate, an infection or due to medical procedures. You may be sent for a urine culture to check for an infection and imaging tests. One commonly used test is an mpMRI. The mpMRI is a special MRI that maps out the prostate looking for any suspicious lesions/growth, the same way a metal detector may find gold in your yard. A newer technology is on the horizon called PSMA- PET Scan which involves the use of a special radioactive dye that can detect prostate cancer throughout the body.
A suspicious area is detected, what next?
The identification of a suspicious area warrants a prostate biopsy. This is a simple painless office procedure where pieces of tissue are taken and sent to the pathologist. The pathologist then uses dyes/stains and examines the tissue under a microscope to check for prostate cancer. At this point, a Gleason’s score will be assigned to the tissue. This is very important as different scores will determine your prostate cancer risk.
What are the treatment options?
Prior to any treatment, the disease must be staged. This can be done using a CT-scan, bone scan or using a PSMA PET scan. Prostate Cancer treatment is dependent on your health and the spread of disease as well as the benefits and side effects of each treatment option.
Options include surgery, radiotherapy, hormonal therapy, chemotherapy, immunotherapy.
One size does NOT fit all, therefore selection of a proper treatment plan is critical and instrumental in ensuring a successful outcome.
Men: Don’t Delay your Check-Up
Prostate cancer is rampant throughout our sweet country, and we need our MEN to get checked out. Its simple, its easy and it can save your life. Don’t delay, as every 45 minutes one man dies from prostate cancer in the UK.
About the Author
Dr. Adrian Ramkissoon graduated as a medical doctor from University of West Indies in 2007. Following his passion of surgery, he specialized and completed his Doctor of Medicine in Urology to become a Specialist Urologist in 2017. In 2018 he attended the Prostate Cancer Academy in California.
He is a member of the American Urological Association, Caribbean Urological Association and Trinidad and Tobago Urological Association and a fellow of the Caribbean College of Surgeons. He is the secretariat for the Trinidad and Tobago Urological Association.
Dr. Ramkissoon has the keen interest in oncology, endourology and reconstructive surgery. He works in a high-volume center performing numerous oncologic surgeries for prostate, bladder, ureteric and kidney cancer. He has the largest series in the Caribbean for Laser Prostate Surgery (HoLEP) and is intent on offering surgical standards on par with first world countries.