A harsh reality facing many Caribbean men is that the region has one of the highest prostate cancer mortality rates compared to developed countries.
While the incidence of prostate cancer varies across Caribbean nations, men in rural areas are disproportionately affected. In contrast, those in urban centers often have greater access to screening programs, better healthcare services, and increased public awareness of the importance of early detection.
According to Prostate Cancer in the Caribbean by Ramesar, et al., “Responsive cancer care in the Caribbean is difficult because there is a broad spread of islands, under-funded medical care systems, and the lack of a unified strategy for cancer control.” The authors point out that not every country has a national program to screen for prostate cancer. Even if they do, how many men actually participate?
Prostate cancer facts: Knowledge is power
It is important to equip men with the correct knowledge about prostate cancer. Knowledge empowers men to take responsibility for their health and not wait for programs to come to them. Here are 3 key points.
First, prostate cancer can be successfully treated when it is caught early. However, early prostate cancer has no symptoms, so how can it be detected? This is where a simple blood test comes in. It is called the PSA test, which stands for Prostate-Specific Antigen. This test measures a surface protein from prostate cells that circulates in the bloodstream. A normal, healthy prostate sheds very little into the blood. However, if something is bothering the prostate, more PSA is shed. Several things, such as an infection, sexual activity, prostate enlargement as a man ages, even riding a bike, or a digital rectal exam by a doctor, can disturb PSA. The same is true for prostate cancer. As a tumor starts to grow, it disturbs PSA.
Therefore, a normal PSA test gives a low number, usually between 2 and 4. If the number is higher, a doctor suspects something unusual, but it might not be cancer. Typically, the doctor will ask the patient to repeat a PSA test in about 6 weeks. This also helps rule out lab error. If the number is still high, or even higher, imaging and/or a biopsy can be done to determine if prostate cancer is present.
Second, if tests are positive for prostate cancer, the test results will determine the treatment strategy. If the prostate cancer is still contained within the gland, here are 4 general choices with brief descriptions:
- Prostatectomy – A surgical operation to remove the whole gland and nearby lymph nodes. Taking out the gland removes the cancer. Common side effects: incontinence (leaking urine) and erectile dysfunction (ED), but they will usually improve. Treatments for them can help.
- Radiation – There are two basic types: either beam radiation (daily treatment over a period of weeks) or radioactive seed implants that stay in the patient’s prostate. Since radiation does not immediately kill all cancer cells, the tumor must be exposed to radiation over time. Cancer cells are more damaged by radiation than healthy cells, so they gradually die off. Common side effects: fatigue, urinary or bowel irritation, and possible ED. These improve over time.
- Focal treatment – This is a precise, image-guided treatment that targets and destroys the tumor while sparing healthy cells. It is an outpatient treatment that immediately and accurately destroys the tumor. Imaging is used to monitor the treatment and confirm the result. An example is Focal Laser Ablation, in which a laser fiber is inserted into the tumor; when activated, it applies heat. There are very low rates of side effects, which usually clear up quickly.
- Active Surveillance – This is an alternative to immediate treatment and is recommended for men with early, low-risk prostate cancer. It allows the patient to hold off on treatment while being monitored with PSA tests and MRI. Patients must follow the doctor’s schedule for monitoring. There are no side effects. Any sign that the cancer is growing or becoming more aggressive will trigger treatment using one of the methods described above.
No treatment is 100% successful with every patient. So, which one is the right choice? It depends on everything the doctor knows from the diagnostic tests, plus the patient’s lifestyle—but most important is matching the treatment to the disease. The more aggressive the prostate cancer, the more aggressive the treatment. The doctor should carefully explain to the patient how each treatment choice works, what the side effects might be, and what the recovery will be like. Patients should not be afraid to ask questions. It’s important that they feel good about their choice.
Finally, a special type of MRI (magnetic resonance imaging) called multiparametric MRI (mpMRI) is a game-changer when it comes to detecting, diagnosing, and treating prostate cancer. It’s the preferred imaging for getting the most accurate portrait of each man’s prostate cancer, since no two cases are identical. While a needle biopsy (tissue samples) is still the only way to see the actual prostate cancer cells, mpMRI supplements the diagnosis by showing the location, shape, and size of the tumor. This information is necessary for the doctor to determine if a patient can have a focal treatment or go on Active Surveillance. However, the equipment is very expensive, and not every Caribbean country may have it in many centers. Usually, large hospitals and academic medical institutions are equipped with it, but it is the new standard in prostate cancer care.
Remember: Every man should have an annual PSA test to screen for prostate cancer. The earlier it is found, the more treatment choices he will have, and the higher the chances for success. An unusual PSA is no cause for alarm, since a repeat blood test and a follow-up mpMRI will reveal what’s really happening.
The Caribbean region can be a health paradise for men who live there if they participate in annual prostate cancer screening as part of their commitment to live long and enjoy life among the islands.
