Poor health-seeking behavior and a low awareness of prostate cancer prevention may explain why the disease is the top killer of male Filipinos above the age of 65, said a urologist.
According to Dr. Aristotle Bernard M. Roque, president of the Philippine Urological Association (PUA), six in 10 cases of those diagnosed with prostate cancer are men aged 65 or older.
Patients are asymptomatic early on in the disease, but may present with symptoms such as bone pain and hip pain in the late stages.
“Since there are no symptoms, we rely more on risk factors,” said Dr. Roque in a Sept. 29 Zoom call with BusinessWorld.
Risk factors include age (men 65 years old and above are susceptible), a family history of the cancer, a high-fat diet, and prostatism (an enlarged prostate, which affects the way the bladder empties).
To catch the disease early, men are advised to undergo a digital rectal exam (DRE).
Patients expect some form of digital equipment when they hear the term “DRE,” Dr. Roque said, and opt out when they find out that “digit” is the medical term for finger.
“When we do surgical missions, a lot of people would go and ask for DREs. When they learn what a digit is, about 40% of the audience would get scared and go away,” he said. “You could save lives with a DRE.”
Other screening tools include prostate magnetic resonance imaging (MRI), which shows a three-dimensional image of the gland and pinpoints which nodules have a high incidence of cancer; and a prostate-specific antigen test, which requires a blood sample.
Prostate cancer is cancer of the prostate, the walnut-sized part of the male reproductive system — right below the bladder — that produces fluid that makes up a part of semen. An enlarged prostate may or may not be cancer.
Dr. Erwin G. Benedicto, Southeast Asia portfolio medical director of Johnson and Johnson (J&J), noted that Filipino men have poor health-seeking behavior compared to women.
“A man would endure pain unless it’s very severe — unlike women,” he said, adding that this is why the blue ribbon campaign, which raises awareness for prostate cancer, hasn’t gained the same traction as the pink ribbon campaign for breast cancer.
“Prostate cancer is already prevalent. We know how serious it is,” Dr. Benedicto said. “We want it to be equally recognized … so awareness would be high on prevention and treatment among patients.”
To boost awareness, the blue ribbon campaign also targets women, who can persuade their male partners or relatives to see a doctor.
“Let’s not forget our dads who protect us. Let’s also protect our dads,” Dr. Roque said.
Prostate cancer is the fifth leading cancer site and third leading cause of cancer deaths among Filipino males, per 2020 data from the Global Cancer Observatory.
The DoH said the average age at the time of diagnosis is 66 years old. — Patricia B. Mirasol
Treated prostate cancer with active surveillance
Benign cases of an enlarged prostate can be treated early on with medical management and active surveillance, said Dr. Aristotle Bernard M. Roque, president of the Philippine Urological Association (PUA).
The latter refers to regular monitoring through prostate-specific antigen tests and biopsies. If the problem persists, surgeries such as a transurethral resection of the prostate (TURP) or a laser prostatectomy can be performed to remove excess prostate tissue that blocks urine flow.
The male hormone testosterone feeds on prostate cancer cells, said Dr. Roque.
He added that today’s novel treatments attack the tumor that produces the testosterone instead of removing the primary source of the hormone (the testicles) — as was done in the past.
Advanced prostate cancer that is localized, meanwhile, can be taken out with radical prostatectomy, or the surgical removal of the prostate.
Even then, active surveillance is still needed post-surgery because cancer cells are recalcitrant.
“There are a lot of people who survive prostate cancer who are treated only with active surveillance and anti-testosterone treatments,” Dr. Roque added. — Patricia B. Mirasol