THE STATISTICS regarding prostate cancer in Jamaica are quite alarming. Prostate cancer has been the leading cause of cancer diagnosis, as well as cancer death in Jamaican men for several decades. Jamaica has been quoted to have the highest rate of prostate cancer in the world with a report in 1998 suggesting an incidence as high as 304 per 100,000. Though this is five times any report from our local Cancer Registry at the University of the West Indies, we admit that the burden of the disease is great. We are not unique with regard to the high prevalence of the disease. Many other Caribbean and Western countries also have a high disease burden.
One of the confirmed risk factors for prostate cancer is African ethnicity. Black men are disproportionately affected by prostate cancer. In the United States, prostate cancer is 1.6 times more common in the black male than the Caucasian male. Black men tend to present at a younger age, more advanced stage, with a more biologically aggressive disease.
Screening at an early age
Due to the high prevalence of the disease, many countries adopt a policy of screening for prostate cancer. Screening is performed by having a clinical examination of the prostate performed (that is, digital rectal exam, or DRE), as well as a blood test, called prostate specific antigen. The aim of screening is to detect the disease at an early stage, when a cure can be offered. The objective measure of success of screening is a reduction in mortality. A recent large-scale European trial published interim results that suggested that screening reduced prostate cancer mortality by as high as 20 per cent. Locally, the Jamaica Urological Society recommends annual screening for prostate cancer in all men, commencing at age 40. In the United States, due to widespread screening, most cases of prostate cancer diagnosed are at an early stage. Unfortunately, research conducted by the Department of Urology, University of the West Indies confirms that many cases of prostate cancer are still diagnosed at an advanced stage!
Fear of the digital rectal exam
There are several obstacles to the adoption of widespread screening in Jamaica. In 2009, at the Jamaica Cancer Society, the largest screening centre in Jamaica, 7,755 mammograms and 13,168 pap smears were done in women to screen for breast and cervical cancers, respectively. Comparatively, for the same year, 464 men screened for prostate cancer. This data exhibit the discrepancy in screening practices by gender. Of the obstacles, fear of the diagnosis and fear of the DRE are reported by many men. The DRE is a quick, simple and painless exam. Fear of this examination is unsubstantiated and should not hinder screening.
We recognise September as prostate cancer awareness month. Let us use the statistics as a wake-up call. Let us conquer this epidemic affecting our Jamaican men and reduce the mortality and morbidity of this disease.
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