Approximately one in every six men in Canada will have a diagnosis of prostate cancer in their lifetime. It’s the second-leading cause of male cancer deaths behind lung cancer, with a fatality rate of about 25 per cent
While South Asians living abroad suffer from a much higher rate of diabetes than their European counterparts, their risk of prostate cancer evens out the longer they live abroad.
While their initial risk of developing it might be lower, if they have lived in the West for any length of time, their overall risk becomes just as high as those of other groups, says Dr Alan So, uro-oncologist and research scientist at the Vancouver Prostate Centre.
"European data shows that with immigrants who migrate to the UK, their risk increases the longer they stay there," he says. “I truly think that it’s due to the changes in their diet - coming from a very strong vegetarian background, and then becoming introduced to more red meats when they come here, increasing levels of inflammation and fats in their bodies."
"In my approach to a South Asian patient, I don't think of them as having a higher or lower risk; I wouldn’t counsel them any differently and their treatment outcomes are the same."
Dr. So explains further saying "Instead, we would look at the big risk factors: African descent, family history, previous problems with an abnormal prostate biopsy, and a high or rising PSA (Prostate-Specific Antigen) test result.”
In addition to diet and lifestyle changes made over time, increasing rates of prostate cancer diagnosis in the west may also be a function of better screening and diagnosis.
This is likely due to less frequent general screening medical visits in eastern countries, says Dr. Shirin Peters, who practices in New York. She adds that in the past three years, she has seen an increase in South Asian men over 45 who come in for annual physicals.
"I believe with each year that passes, a larger number of older South Asian men are learning of the need to screen yearly for prostate cancer, and coming to me for a screening check-up before they have any unusual symptoms. This is the key to early detection and stronger treatment outcomes,” says Dr. Peters.
"I think this is also the reason I have seen a much higher incidence of microscopic hematuria (blood seen on a urine screen) and slight elevations in PSA in asymptomatic male patients. I would say the South Asian men who find early signs of prostate cancer on screening tests are a little more reluctant than the general population to follow up with an urologist for further diagnosis and treatment. I think this stems from general fear of the unknown, and reluctance to speak about genitourinary issues with a physician to get questions answered and their fears alleviated.”
While their initial risk of developing it might be lower, if they have lived in the West for any length of time, their overall risk becomes just as high as those of other groups, says Dr Alan So, uro-oncologist and research scientist at the Vancouver Prostate Centre
Approximately one in every six men in Canada will have a diagnosis of prostate cancer in their lifetime. It’s the second-leading cause of male cancer deaths behind lung cancer, with a fatality rate of about 25 per cent.
As a silent disease with no obvious signs, causes or symptoms, the best chance for a complete cure is through early detection and treatment. The Prostate Cancer Foundation of British Columbia recommends that every man over the age of 40, particularly those with a family history of the disease, begin examinations and tests for prostate cancer, which typically include a digital rectal exam in conjunction with a PSA test.
PSA tests, which measure the blood level of a protein produced by prostate cells, are not covered by the Medical Services Plan in BC, unless patients have a family history of prostate cancer. It is currently considered to be the single best blood test available for detecting tumours, and should be used as part of a personalized approach where men are tested to establish a baseline number.
If any changes to the baseline are detected in subsequent tests, the patient could undergo additional diagnostic procedures such as a biopsy, transrectal ultrasound or even an MRI. While the PSA test is useful, it is not enough on its own, say some researchers, who point out that even when used in conjunction with a biopsy, the results are not conclusive.
Prostate cancer is not always fatal, but the side effects associated with removal of the gland are potentially devastating, including erectile dysfunction and inability to control flow of urine. Researchers are currently working to determine which prostate cancers, once diagnosed, are most likely to spread and metastasize rapidly.
One of them is Dr. Morley Hollenberg, an award-winning biomedical scientist and professor in the department of physiology and pharmacology at the University of Calgary. He and his team of researchers are currently developing more reliable tests to distinguish the severity of prostate cancer.
"It takes a certain cell chemistry to drive a cancerous cell from a non invasive to an invasive state," says Dr. Hollenberg. "We are trying to identify the steps that drive the cell through this process; the dream would be to throw a monkey wrench into the process, to stop it and hold it in check forever."
“We need more tools in addition to the PSA. With a biopsy, you can't always tell just looking at it whether the cancer is aggressive or not. If we can find the right biomarker for this kind of cancer, then we could have our colleagues looking for the same compound in a semen analysis instead," Dr. Hollenberg states.
For many men, this would mean not having to struggle with the decision of whether to remove the prostate gland, or having to undergo a painful biopsy. They would be able to know positively whether they were at risk of the cancer spreading, or whether it was more likely to remain dormant in their prostate gland.
For Dr. Peters, the wives and partners of her South Asian male patients seem to be the major driving force for getting them into her office for a screening physical/check up visit.
"This is definitely a positive influence," she says. "Unfortunately I am not at liberty to discuss abnormal results from the testing I do with partners - only with the patient himself. For this reason, I cannot rely on them to influence my male patients to follow up with an urologist for care when needed."
As in Canada, there is no culturally-specific support programming available for men and their spouses, whose relationships are undoubtedly affected, says Dr. Peters. "For counselling services, there is not much available before a man is given a prostate cancer diagnosis. After diagnosis at the urologist’s office, they can be directed to support groups."
"I could offer psychotherapy services to my patients who are overly anxious about seeking follow-up care, but middle-aged men are generally reluctant to engage in talk therapy and South Asian men are even less inclined because of the social and community stigma that surround mental illness," she says.
Dr. So says there is a definite need to increase the profile of the need for more culturally specific counselling and support. "We have general support groups in place in the local cancer centre of every city, but we don't know the impact of prostate cancer on spouses in the South Asian community. In my experience, the South Asian wives are not as active in terms of asking questions, and usually leave it to the husband to make decisions."
