Last week we completed a 7 part series on breast cancer, the most common cancer affecting women second only to skin cancer. The most common cancer affecting men in many parts of the world is prostate cancer. In fact I can remember back in my medical school days, it was taught that if men lived long enough, most would get prostate cancer.
What is the Prostate Gland? (Notice not prostrate)
Just below the bladder, completely surrounding the first part of the urethra is a small gland the size of a lychee fruit or small apricot. The prostate gland secretes about one third the fluid in semen and provides various substances – like citric acid, zinc and various enzymes. It also has muscles which squeeze out the fluid into the urethra at the time of ejaculation.
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With age it is common for the prostate gland to enlarge, thus causing slowing of urination, increased frequency, dribbling, waking up frequently at night to urinate, and bladder infections or blood in the urine. In most cases this is just benign prostate hypertrophy (enlargement). But these symptoms can also accompany prostate cancer, and are thus good indicators to see your doctor for a check-up. If you have close relatives that have had prostate cancer, you need to start regular prostate check-ups from the age of 40 years.
How common in prostate cancer in South Africa?
Apart from skin cancers, prostate cancer is the second most common cancer amongst men in South Africa. Studies have shown the incidence of prostate cancer here is around 62 per 100,000 men (compared to over 100/100,000 men in the USA and 189/100,000 in Guadeloupe in the Caribbean). According to the Cansa website, in South Africa in 2018, 12,452 men were diagnosed with prostate cancer and 4,400 died from the disease. The lifetime risk of contracting prostate cancer amongst white men is 1:10, and for black men 1:30. However unfortunately the disease seems to be more aggressive amongst black men, who also tend to present later, resulting in a higher mortality. In a 2014 study, the incidence of prostate cancer was found to be highest in South Africa, compared to other African countries (6 times higher than North Africa).
What are some risk factors for prostate cancer?
- Age – the risk of getting prostate cancer rises especially over the age of 50 years
- Family history – brother, father, grandfather – this may suggest either lifestyle or genetic predisposition
- Genetics – BRCA type 1 or 2 gene mutations (the same mutations in women can increase the risk of ovarian and breast cancer)
- Nationality: Prostate cancer is most common in North America, north western Europe, Australia, Africa and Caribbean islands and less common in Asia, Central America, and South America
- Diet: Men who eat a lot of red meat or high-fat dairy products appear to have a higher risk of getting prostate cancer. Ingestion of eggs has recently been shown to increase the risk. (Eating 2,5 or more eggs per week increases the risk of lethal prostate cancer by 81%). Insufficient consumption of fruit, vegetables and legumes also increases the risk
- Diabetes is associated with a higher risk, possibly because of common relationships with obesity and poor diet
- Obesity: Obese men diagnosed with prostate cancer may be more likely to have advanced disease that is more difficult to treat – with specific reference to belly fat
- Use of anabolic steroids: The use of anabolic steroids may have a number of side effects including infertility, testicular atrophy, baldness and increased prostate cancer incidence.
- High alcohol intake – Alcohol was declared a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) in the 1980s
- Use of tobacco products
Fortunately most prostate cancers are slow growing and many men will succumb from other chronic conditions like heart disease and strokes before their prostate cancer takes its toll. The various management options are beyond the scope of this article, but the Cansa fact sheet does provide information on treatments available in South Africa.
Next week we will look at lifestyle options for both preventing and managing slow-growing prostate cancers.
Stay healthy and keep up with social distancing. Sometimes people become emboldened to take risks, when they see the disease not affecting their close acquaintances. Remember Covid-19 is extremely infectious, and you need to become obsessive compulsive about hygiene during this pandemic.
Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.
He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.
An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.
He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.
