The Tribune

By DR GREGGORY PINTO

The World Health Organisation (WHO) has registered that 200 Bahamian men were diagnosed with prostate cancer in 2019, and that number is likely underestimated, as several Bahamians seek prostate cancer screening and treatment abroad and are therefore often not captured in local statistics. WHO data showed that 249 men died of cancer in the Bahamas in 2019 and 80 of those men died of prostate cancer.

Bahamian men in general have many of the high-risk factors for prostate cancer, including being predominantly of African ancestry and having a high rate of obesity, which places them at a higher risk of developing high-grade prostate cancer.

There is a highly suspected genetic predisposition for men of African ancestry to develop a more aggressive form of prostate cancer and to have prostate cancer six to seven years younger than their other male racial counterparts. There is a recognised increased risk association between the gene mutations for the BRCA 1 and 2 genes, particularly in the case of BRCA2 gene mutation. Studies in the Bahamas related to women with BRCA mutations have shown a relatively high cancer incidence in the Bahamas.

One in six Bahamian men will develop prostate cancer in their lifetime.

The occurrence of prostate cancer does not need to be inevitable, as there are several lifestyle changes, behavioural modifications, dietary changes and medications that reduce the likelihood of developing prostate cancer.

• Finasteride can safely lower prostate cancer risk

According to The Prostate Cancer Prevention Trial (PCPT), Finasteride, a five alpha reductase inhibitor medication, can safely lower the chances of developing low risk prostate cancer. The Prostate Cancer Prevention Trial enrolled about 19,000 men between 1993 and 1997. In 2003, trial results were published that concluded that Finasteride reduced the incidence of low risk prostate cancer by about 25 percent, but slightly increased the risk of developing high-risk prostate cancer. Newly released trial results have continued to show the effectiveness of Finasteride reducing the chances of low-risk prostate cancer, with less than 100 men in the trial dying of prostate cancer. Most importantly, newly released trial data has shown that there is no statistically relevant increased risk of developing higher risk prostate cancer with taking Finasteride.

Finasteride is also known as Proscar, or in a lower dose it is marketed as Propecia, a male pattern baldness blocking drug. Finasteride and Dutasteride are widely prescribed to potentially reduce the size of obstructive prostates that often lead to numerous urinary issues, such as a weak stream, frequent urination and incomplete bladder emptying.

Bahamian men and men worldwide can safely take Finasteride or Dutasteride and effectively reduce the chance of lower risk prostate cancer by approximately 25 percent.

Finasteride (Proscar) and Dutasteride ( Avodart ) artificially reduce the prostate specific antigen (PSA) blood value in half. After taking one of these medications for a minimum of five months, a PSA value, for example, of 2.5 ng/ml is in reality 5.0 ng/ml.

Prostate cancer screening using PSA values must take into account Finasteride and Dutasteride in calculating the true PSA value, otherwise many early prostate cancers could potentially be missed.

• Twenty-one ejaculations per month

An Australian study involving 2,338 men showed that men who ejaculated five or more times a week had were 34 percent less likely of developing prostate cancer by the age of 70. Self-love or with a partner, the act of ejaculating can lower your prostate cancer risk.

• Spice up your diet

New York researchers at the Center for Holistic Urology at Columbia Presbyterian Medical Center recently determined that a herb blend of rosemary, green tea, ginger and oregano, reduced prostate cancer cell growth in their laboratories by seventy eight 78 percent. The herbal mix is sold as Zyflamend and it is believed to inhibit the activity of COX-2, a protein linked to prostate cancer progression. Future studies are needed regarding these promising findings.

• High blood pressure medication

Researchers at the Institute for Stem Cell and Regenerative Medicine Research at Albert Einstein College of Medicine in New York City found that the high blood pressure medication Atenolol reduced the risk of intermediate and high grade prostate cancer by nearly half. These results were recently presented at the 2019 American Urological Association annual meeting.

Atenolol is a beta blocker antihypertensive medication that blocks the effects of the hormone adrenaline, so that the heart beats slower and with less strength and it relaxes blood vessels and improves blood flow. Other beta blocker medications such as Metoprolol/Lopressor and Carvedilol/Coreg did not provide the same reduction in prostate cancer as Atenolol.

The results of this study appear promising but it is too early to categorically promote the use of atenolol as a prostate cancer risk reducing medication.

• Use a condom

There is a recognised higher risk between having gonorrhea and human papillomavirus-16 and developing prostate cancer.

• Diet and lifestyle modifications

There are several dietary advices related to reducing the risk of developing prostate cancer but the evidence is weak. There is a weak correlation between a high intake of protein from dairy products and the risk of prostate cancer, according to the European Association of Urology (EAU), but the EAU provides no specific preventative or dietary advice to reduce the risk of developing prostate cancer.

Also, according to the EAU, cigarette smoking was associated with an increased risk of prostate cancer.

Bahamian men must have a healthy balanced diet with routine exercise at least three times a week. Obesity is a risk factor for high-grade prostate cancer.

Prostate cancer screening for Bahamian men starting at the age 40 is imperative, as an early prostate cancer diagnosis can lead to 99 percent survival rate at five years and 97 to 98 percent at ten years.

Seek confidential, compassionate and comprehensive prostate cancer screening and management.

• Dr Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon. He has trained in Germany, South Africa and France, and is a member of the European Association of Urology. He can be reached at the OakTree Medical Center, #2 Fifth Terrace and Mount Royal Avenue. Call (242) 322-1145-7, e-mail welcome@urologycarebahamas.com or visit the website www.urologycarebahamas.com.