University shares insight on prostate cancer

AS November, or rather ‘Movember’, is Men’s Cancer Awareness Month, the Universtity of Stellenbosch has shared the most common cancers affecting South African men to see who is at risk and look at what they can do to stay healthy.

International statistics suggest that black men have double the risk of developing prostate cancer compared to men from other population groups.

This estimate is based on US statistics for African-American men and is applied locally due to a lack of reliable up-to-date local data. The latest statistics from the South African National Cancer Registry (NCR) are from 2010 and suggest that South African black men have a lower risk of prostate cancer than other population groups. NCR data is collected from diagnoses made in laboratories, but do not consider diagnoses made by doctors (clinical).

Urologist, Dr Kenneth du Toit from Stellenbosch University’s Faculty of Medicine and Health Sciences and Tygerberg Hospital, said until there are good statistics available in South Africa, they should assume that black men have double the incidents and present with far more aggressive cancer than men from other populations groups.

“Doctors have not yet determined the exact cause for this increased risk among black men, but believe genetics and higher levels of testosterone in this population might play a role.

“Although testosterone does not cause prostate cancer, it has a growth-promoting influence on the prostate, and genetic abnormalities need testosterone to be present in order to develop into an aggressive cancer,” explains Du Toit.

This is the most common cancer among South African men, yet few actually die from prostate cancer.

“If they live long enough, most men will develop prostate cancer, but only a small group with a more aggressive variant will end up dying from it – and those are the ones we must find,” he said.

Prostate cancer is a silent disease and does not present with early symptoms. Only when it is quite far advanced and difficult to treat will the patient complain of difficulty to urinate, blood in the urine, erectile dysfunction and back pain.

“By the time you experience these symptoms, the cancer has already spread, which is why screening is so important. If we diagnose the disease early on, there is a greater chance for cure and fewer of the side effects related to treatment.”

Prostate cancer usually presents around the age of 65 but can occur earlier, particularly in high risk groups that include black men or men with family history of the disease. Du Toit recommends that men at average risk for the disease go for screenings from the age of 50 onwards, but that high-risk groups start as early as 40.

Forty might sound young, but that is what they recommend in America. If you pick it up early, the patient can likely be cured and live up to 75 or 80 with few or no side effects. If it is only picked up once it has advanced, many men will die of the disease within four or five years. Screening involves a prostate-specific antigen (PSA) blood test and a digital rectal exam. These tests are affordable and are available in the country’s public and private health care sectors.

Doctors have not identified one particular cause of prostate cancer, but various factors have been linked to an increased risk for the disease. These include certain gene mutations, including BRCA1, which is also associated with breast cancer, inflammation of the prostate, high testosterone levels and even obesity.

“Fat is metabolically active. It converts testosterone to oestrogen, which has a negative effect on the prostate.”

Although there are many anecdotal remedies that claim to guard against prostate cancer, Du Toit said that maintaining a healthy lifestyle and a healthy weight is beneficial for prostate health.

“Many believe that to have a healthy prostate, you need to have a healthy heart. So if you look after your heart by keeping your weight down, following a healthy diet and exercising regularly, your prostate should be relatively healthy too,” added Du Toit.