Prostate cancer, one of the leading causes of cancer deaths in Guyana

By Lakhram Bhagirat

Men are generally reticent when it comes to explaining what they feel and how they are feeling. This self-imposed reserve often translates to every aspect of their life and the consequences can be deadly, especially when it concerns their health.
Quite often, men speak out when it is too late and they are left to deal with the consequences of their silence.
This very silence, according to Dr Rajendra Sukhraj, needs to be addressed, so he is urging men to speak out more since it may save their lives.
Dr Sukhraj, a urologist, recently completed his urology subspecialty training at the San Fernando General Hospital in Trinidad and has since returned to Guyana where he intends to address the urological needs of Guyanese.
Speaking with the Sunday Times Magazine, Dr Sukhraj said over the years, data collected from the Georgetown Public Hospital Corporation (GPHC) has proved that prostate cancer is one of the most common types of cancer in men and one of the leading causes of cancer-related deaths. Against this backdrop, Dr Sukhraj is issuing a challenge to men urging them to take their health into their own hands and speak up and speak out about how they feel.
“One of the biggest challenges we have, based on research we have, is that we are seeing persons coming to us too late. At that point we cannot offer a cure, we can only make them comfortable,” he said.
The prostate is a small walnut-shaped gland in men that produces the seminal fluid which is important to the nourishment and transportation of sperm. The Mayo Clinic explains that “prostate cancer is one of the most common types of cancer in men. Usually, prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.”
If detected in its early stages, prostate cancer can be successfully treated.
The World Health Organisation (WHO), through the International Agency for Research on Cancer (IARC), said that the cancer burden is on the rise with some 18.1 million new cases in 2018. Additionally, some 9.6 million cancer-related deaths have been registered for the same period.
The WHO estimates that one in 5 men and one in 6 women worldwide develop cancer during their lifetime, and one in 8 men and one in 11 women die from the disease. It is believed that some 43.8 million persons are living with cancer.
Lung and breast cancer are the leading types of cancer worldwide accounting for about 11.6 per cent of total cancer cases. That is followed by colorectal cancer and prostate cancer which account for 10.2 per cent and 7.1 per cent of all cancer cases respectively.
“In men, lung cancer ranks first and prostate cancer second in incidence in both developed and developing countries…Lung cancer is the most commonly diagnosed cancer in men (14.5 per cent of the total cases in men and 8.4 per cent in women) and the leading cause of cancer death in men (22.0 per cent — about one in 5 of all cancer deaths). In men, this is followed by prostate cancer (13.5 per cent) and colorectal cancer (10.9 per cent) for incidence and liver cancer (10.2 per cent) and stomach cancer (9.5 per cent) for mortality,” the WHO said in a 2018 news bulletin.
In Guyana, there is a lack of a comprehensive database to track the various cancers so it makes it a mountainous task to be able to determine the various statistics associated, particularly with prostate cancer. However, data shows that it is one of the leading causes of cancer-related deaths in the country.
Moreover, Dr Sukhraj has indicated that the lack of proper screening infrastructure is one of the major contributing factors to late detection.
“We do not have a screening programme where you can detect these diseases early where you can actually cure the patient through surgery or radiation. In fact, for this month (September), I have partnered with the (St Joseph) Mercy Hospital, where we have a screening promotion where the patient can get their PSA blood test as well as a prostate examination for the cost of just the test,” he noted.
Though he has only been back in Guyana for a little over a month, Dr Sukhraj has already committed to educating men more about taking care of their bodies and ensuring that they have the requisite knowledge to lead healthy lives.
The prostate gland is an issue for all men, but prostate cancer predominantly affects men of African descent, and Dr Sukhraj is urging that all men begin checking up on their prostate health at the age of 40. It is between 40 and 45 years that prostate cancer develops for most men, and with very little to no symptoms, detection often happens in the final stages.
“Every man should have a prostate examination at least every two years. Prostate cancer is one of the leading causes of cancer-related deaths. If they come at a late stage, we cannot offer much and it causes a lot of complications. Back pains, spinal cord compressions and these are things you do not see in the developed world because they have structured screening programmes and that is something we need to move towards.
“Unfortunately, the signs will manifest in the late stages and that may be a little too late. In the early stages, there are little to no signs and the only way to know is to do the blood test, examinations and, in some cases, the urologist would advise to do a biopsy and that is how you will detect it. If you are to wait until the symptoms show which would be difficulty passing urine, blood in the urine, back pain, weakness in the legs, then that is already stage four cancer; you don’t want to be presenting to your doctor at that stage,” he explained.
It is believed that much of prostate cancer has to do with genetics, but it also includes a number of other factors which are not limited to environmental issues, exposure to radiation and some industrial chemicals.
“You cannot prevent it, but what you can do is to detect early and cure it. Generally, men are scared of the doctor or just don’t want to go, and men need to be more open about the illnesses and being able to have a proper discussion with our doctors about our health,” Dr Sukhraj advises.
Based on information from Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN), prostate cancer incidence and mortality rates are strongly related to age, with the highest incidence being seen in elderly men over the age of 65. Men of African descent have the highest incidence rates and more aggressive types of prostate cancer compared to other men.
“There is no evidence yet on how to prevent prostate cancer; however, it is possible to lower the risk by limiting high-fat foods, increasing the intake of vegetables and fruits, and performing more exercise. Screening is highly recommended at age 45 for men with familial history and African-American men,” GLOBOCAN notes.