When was the last time you visited a doctor? A week, a month, maybe a year ago? If you are like most people, it’s been too long. Many people don’t go to the doctor unless there is something ‘seriously’ wrong. For example, many won’t pay a visit to the hospital if they have a common cold or headache or even a stomach ache. However, what many of us are not aware of is that something as simple as a stomach ache can be the sign of a huge health issue.
In a recent interview, 74-year-old Richard (not his real name), said that four years ago he had been experiencing what he thought were stomach aches. It was not until the pain intensified that he finally decided, “Let me go to the hospital and see what happens. They decided to run a couple of tests.”
At the time, he said, he thought it was probably a heart problem and was thus shocked when he received a positive prostate cancer diagnosis. “The urologist did a prostate specific antigen (PSA) test and he suspected right away that it was cancerous.
Then he sent me to the MRI people and they did an MRI, but I don’t think that showed anything,” he said. According to the man, after a biopsy was done and the results came back, he was diagnosed with prostate cancer. “As you know cancer always makes a person think certain things so I nearly dropped dead,” he said. This was in 2013.
While prostate cancer treatments, diagnoses and even survival rates have been gaining momentum in Guyana over the past decade, awareness around the disease is still lacking. For example, when asked if he had ever heard about the disease before being diagnosed, Richard said no.
As with all cancers, an early diagnosis of prostate cancer means less complicated treatment and ultimately saved lives. In an interview last week, Chief Radiation Oncologist Dr Sayan Chakraborty said that fortunately this type of cancer when treated adequately can lead to the patient enjoying a long and healthy life. Thus, he urged men with a family history of the disease to get screened as early as 40 years old.
The oncologist explained that this type of cancer eats on the male hormone, testosterone, hence why it is one of the most popular cancers found in men. As regards detection, he said screening can be done by two tests. “One is a blood test called prostate specific antigen (PSA) and the second is the digital rectal examination (DRE) to see how the prostate feels. These two tests are very specific to diagnose the prostate cancer,” the oncologist said.
He further explained that “one part of the treatment is a hormonal treatment in which we give medicines to stop the testosterone production in the male body, to starve the prostate cancer. … What else can be done is the testes can be removed, either one of them.”
This he said can be done by medical castration by way of medicines or surgical castration which is the removal of the actual testicles. “When patients do not chose to do the surgical castration we can also perform the medical castration,” the oncologist said.
The chief oncologist said that when the PSA results are high and the digital rectal examination feels like it may be cancer, biopsies are then conducted. According to Radiologyinfo.org, a biopsy is a sample of tissue taken from the body in order to examine it more closely. He explained that the concept of a biopsy has changed. “Nowadays we no longer knock out the patient to cut them. We are doing needle biopsies, CT guided or ultrasound guided,” Chakraborty said.
Biopsies are done regularly at the Cancer Institute with an appreciable amount of response. He explained that biopsies are not done for the screening of prostate cancer but to give confirmation of cancer. “The biopsy is done only when the patient has a very high PSA or if the DRE suspects cancer then we only we do the biopsy. This procedure takes a maximum of 15 to 20 minutes and the patient can go home after 15 minutes or so. They can go home the same day,” the oncologist said.
Stages
According to Chakraborty, prostate cancer has various stages and depending on the stage, this will determine the time period for hormonal therapy. He explained, that once the grade is high, the time period for hormonal therapy is long as opposed to a lower grade which he says will normally result in treatment from six to eight months.
Early prostate cancer can be treated with both radiation and surgery and the oncologist said that radiation is the main type of treatment for advanced stages of prostate cancer.
Generally, the radiation therapy is given over a period of six to seven weeks along with the hormonal therapy to cut down the testosterone levels.
The oncologist said that prostate cancer is one of the cancers which has a high propensity to spread to the bones. Most commonly he said, this type of cancer will first spread to the back bone from there it might spread to the brain and other bones of the body. When this happens, short doses of radiation are administered. “Those places where there are bony sites of diseases short doses of radiation is done on those sites to kill the tumour in the bone and we can give chemotherapy as well,” he related.
There are many who are resistant to chemotherapy, while some refuse this type of treatment. Chakraborty explained that in such cases persons can be treated orally; there are tablets, which he said, represents a targeted treatment. He added that these tablets are outsourced by the institute. “They are costly, but yes I have started using them in Guyana,” he said.
As regards Richard, Chakraborty said he had undergone 40 sessions of radiation.
For Richard, the hardest part was when he was advised by the doctor that he could not have a shower for the duration of the sessions which lasted 60 days. “But I bathed every day,” he said, “I put the towel around the area that they were doing the radiation.”
Family support has been tremendous and this is something he thinks is needed by everyone going through the same ordeal. His daughter, he said, spends a lot of time with him. “When I went to the doctor and I came home, she asked me a whole lot of questions and I didn’t answer them. So [the next visit] she went with me,” he said.
Get tested
Since he was diagnosed, Richard has been advising men to get tested. “I tell everyone to get checked from 40 to 50 years. Don’t be like me. Get it tested. I don’t want them to go through what I have gone through because last year; the latter part I went back to the doctor and… we tested it back and the cancer came back. Right now it is back,” he said. “He [the doctor] wants to give me chemotherapy and we had a big argument about it. …I tell he I aint tekkin no chemotherapy. So I didn’t do chemo,” the man said.
He explained that he read about the procedure and it is not a sure thing. When asked how he is going to get rid of the cancer, he replied, “You know I don’t feel nothing wrong. That’s what I told the doctor. I do all my exercises like usual. Riding, go on the seawall and walk. I even take my granddaughter swimming in the morning.
“To tell you the truth I don’t know where I am going from here. I am getting medication but it is very expensive. I might have to revert to the chemotherapy but it is not my first choice. What I read is that it does more harm than good.”
Dr Syed Ghazi, Sonologist, Internist and Director of Outreach at the Cancer Institute of Guyana, in a recent interview with this newspaper stated that apart from prostate cancer there is a condition called chronic prostatitis which is also found in men. This condition, he said, affects men in their late 40s to early 50s and can be treated using antibiotics.
He went on to explain that the symptoms are almost the same as those of prostate cancer, “except when it is chronic prostatitis the person has pain in the lower abdomen or sometimes in the back, also burning in urination.”
According to Ghazi, prostate enlargement does not necessarily mean that it is cancerous. A PSA blood test, he said, is used as a screening test to assess the condition of the prostate. “If it is elevated, the physician, depending on the range, decides what could be the likely diagnosis” he said. “It could be Benign Prostatic Hypertrophy (BOH) or suspicion of prostate cancer correlated with Digital Rectal Examination (DRE) followed by ultrasound if needed. If there is a strong suspicion of cancer, an ultrasound guided biopsy is performed.”
Meanwhile, Ghazi stated that September is Prostate Cancer Awareness month and the institute will be offering a discounted package on PSA, ultrasound and DRE along with free consultation.
What is prostate cancer? According to the American Cancer Society website, prostate cancer begins when cells in the prostate gland start to grow uncontrollably.
The prostate is a gland found only in males. Prostate cancer, is the most common cancer found in men and statistics in Guyana show that it is the third highest occurring cancer, trailing behind breast cancer and cervical cancer. While all men may not experience symptoms when they have prostate cancer, those who have prostate cancer experience symptoms which include burning or pain during urination, blood in the urine or semen, frequent urination especially at nights and sometimes abdominal pain.
