Prostate Cancer Awareness

Creating initiatives for the well-being of menfolk

By Earl D.C. Bracamonte

Prostate cancer is the most common type of cancer in men. According to the World Health Organization (WHO) data, it is the 9^th cause of cancer deaths in the Philippines in 2010. This condition develops when cells in the prostate gland start to grow in an uncontrolled manner. Usually a very slow-growing type of cancer, it often causes no symptoms until it is in an advanced stage. Once it begins to metastasize, grow quickly, or spreads outside the prostate, it becomes very dangerous.

The prostate is a part of the male reproductive system and is about the size of a walnut located below the bladder and in front of the rectum. It works to produce fluid that forms part of the semen. When the prostate is enlarged, it can cause the urethra to narrow and makes urinating difficult.

The strongest risk factor for the disease is age, and the risk skyrockets with the passing of time. Men with one or more first-degree relatives (like a father, brother or son) diagnosed with prostate cancer have an increased risk of having it. As to ethnicity, Afro-American men (mulattos) are affected more than any other race as they have a double to triple increased risk when compared to white men. And although the risks are lower for Asian men, caution should never be thrown to the wind.

“Culture, too, can be a risk factor. In the Philippines, the mentality of prevention is not yet something that’s part of mainstream consciousness. That’s why we extend and expand our programs by involving as many organizations in the oncologic fields as well as partner with relevant clinics, doctors and like-minded societies,” intoned oncologist Dr. Josephine C. Tolentino, prime mover of the ‘Fight for Your Man’ campaign, a prostate cancer advocacy spearheaded by pharmaceutical company Janssen and clinics chain HealthWay.

“Fight for Your Man is our way of reaching out to families to encourage the men in their lives, aged 40 and above, to have themselves screened for prostate cancer. We believe that we can address this public health issue by getting everyone involved, especially the families who may be affected when a breadwinner becomes sick,” she added.

The National Kidney and Transplant Institute estimated that prostate cancer develops in 19.3 out of every 100,000 Filipino men. Unfortunately, most cases remain undiagnosed unless they are already in the advanced stage. In addition, nine out of 10 adults are unaware that cancer of the prostate can develop slowly.

Dubbed as a ‘silent killer,’ prostate cancer is estimated to kill at least one Filipino male every hour. Data from the Dept. of Health (DoH) in 2010 showed that around six million men over the age of 50 were at risk of developing the disease. It also estimated that half of the men aged 50 and above will most likely develop urinary and prostate problems that will progress as they grow older.

Mrs. Sonia Roco, whose husband, former senator Raul Roco, died of complications from prostate cancer in 2009, was present during the launching ceremonies at Edsa Shagri-la Hotel to express her support for the nationwide campaign. 

“It is important for families to get involved in the fight against prostate cancer because when a man in the family gets sick, it is life-changing not only for him but also for everyone he leaves behind. Our role as wives and children is to encourage the men in our lives to take responsibility for their prostate health. If we are able to do this, we stand a better fighting chance to prevent this disease from affecting our households,” she intimated.

“There’s a lack of statistics in Philippine records as to the exact number of cases. Our record systems are poor and fragmented data remains scattered. Not one institution collates all these data,” laments Dr. Josephine C. Tolentino, who also works as Therapeutic Area Lead with Janssen Philippines.

Prostate cancer can be asymptomatic during its early stage. However, a patient may start experiencing blood in the urine or painful urination and lower back pain when the condition has worsened. “Cancers want to be autonomous. It becomes bloody because it has created blood vessels to support itself. In later stages, the invasion becomes bloody and painful as the urethra is now encased by the prostate itself,” informed Dr. Tolentino, herself a member of the Philippine Society of Medical Oncology and the Philippine Urological Association.

Early symptoms of prostate cancer include a weak and reduced urine flow, the need to urinate more often (especially at night), a feeling that the bladder has not emptied properly, difficulty starting to pass urine, and the need to rush to the toilet.

In the early stages, no symptoms are felt. Blood in the urine or painful urination is a sign of lower urinary tract symptoms. In advanced stages, low back pains are usually experienced.

Treatments for prostate cancer include surgery, radiation therapy, hormonal procedures, chemotherapy as well as immunotherapy. Other modern options include robotic surgery, new oral anti-androgens, dendritic cell vaccine and new molecules.

“The risks for developing cancer become greater with ageing. The key to preventing it is through early detection. Unfortunately, only a few adult men submit themselves for screening unless they already feel the symptoms,” remarked noted urologist Dr. Jaime Songco, during the media launch colloquy.

“The survival rate for prostate cancer has increased because of advances in medical science wherein multiple treatment options are already made available. On one end of the spectrum is radical prostatectomy or radiation therapy with the potential side effects including erectile dysfunction, urinary incontinence (or the non-control of bladder functions), or rectal bleeding. Somewhere in the middle there is hormonal therapy, brachytherapy (a form of radiation directly targeting cancer cells thru an instrument), cryotherapy (as the extreme temperature sloughs off cells due to ‘melting’), and high-intensity focused ultrasound therapy. On the other end of the spectrum is active surveillance, where aggressive treatment is deferred and patients are carefully monitored for disease progression,” elucidated Dr. Songco.

“Undergoing regular screening enables early detection. Common tools used to help diagnose the disease are urine tests, ultrasound (which can show the size of the prostate or whether the bladder is emptying properly), and prostate specific antigen (PSA) tests.

“PSA is a protein produced by the prostate gland and it is normal to have it in the blood. PSA levels rise as men get older,” he continued.

Aside from prostate cancer, the other causes of cancer deaths in the country (based on the WHO’s 2010 record) are (in descending order) mammary carcinoma, emphysema, cirrhosis, cervical cancer, colon cancer, thyroid cancer, rectal cancer, ovarian cancer, and Non-Hodgkin’s lymphoma.

“We at the ‘Fight for Your Man’ campaign forefront encourage screening as we go on massive awareness drives for the disease’s prevention. For those on very advanced stages, they can continuously contain the pain with the help of Abiraterone, an androgen synthesis inhibitor that inhibits androgen production. Patients must take this medication four times a day without fail,” Dr. Tolentino concluded.