With October closing its doors and opening them to November, it is a time to focus more on men. Movember is an annual event involving the growing of moustaches to raise awareness of men’s health issues, such as prostate can­cer, testicular cancer and men’s suicide. Movember aims to increase early cancer detection, diagnosis and effective treatments, and ultimately reduce the number of preventable deaths. This article will focus on prostate cancer.

The prostate is a gland that forms part of a man’s sexual organs and which is found below the urinary bladder. It is located around the urether, which connects the bladder and the penis. When the prostate grows in size, it affects the urinary function and can even affect sexual activity.

In a large number of cases the prostate cancer grows very slowly and does not cause harm to men. In some cases, treatment of prostate cancer causes more harm than the cancer itself.

Although this is the most common cancer in men in Malta, it usually is the cause of only seven per cent of deaths in men. In 2016, 49 men out of 216 prostate cancer cases passed away. Prostate cancer is more common in men aged over 60. There are some types of prostate cancer which grow and spread quickly, while others grow very slowly, with no symptoms and do not shorten the expected lifespan of a person.

In a large number of cases the prostate cancer grows very slowly and does not cause harm to men

There are several risk factors for prostate cancer, which include men aged over 65 – age is the main risk factor. The chance of getting this type of cancer increases with age and the disease is rare in men aged under 45.

Another risk factor is a family history. A person’s risk is higher if their father, brother or son had prostate cancer. Changes in the prostate are another risk factor. Men with intraepithelial neoplasia of grade prostate may be more prone to getting the disease.

Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may increase. The risk increases with the number of genetic changes that are found. Also, other studies have shown an elevated risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

A man with this type of cancer may not have any symptoms at all. For men who do develop symptoms, these include urinary problems, whereby men start to pass urine more frequently, urinating at night, a burning sensation when passing urine and/or blood with urine. Some develop symptoms of erectile dysfunction. Some feel frequent pain in the back, hips or thighs. The latter symptoms are not specific to prostate cancer, but it is important to investigate this case, especially if the person falls within the risk categories.

The PSA test (prostate specific antigen), which is conducted through a blood test, increases when there is prostate cancer. The higher the level, the more likely there is cancer. However, there are many other causes of high PSA, such as a large prostate or an infection. When there is a high PSA, it must be repeated and further tests are carried out to verify the diagnosis or otherwise. Such tests include a biopsy diagnosis.

The PSA test cannot distinguish bet­ween a rapidly growing cancer and or a type of cancer which is slow-growing. So before a man takes a PSA test, he should talk to his doctor to understand the uses and limitations of this test. For this reason, there are many countries and organi­sations that disagree on whether there should be a screening programme for prostate cancer using a PSA test. Others combine the PSA test with digital rectal exploration of the prostate.

We know that what we eat has an im­pact on our overall health and risks to the development of cancer. There is evidence to show that a diet high in fat, especially fat of animals, may be associa­ted with an increased risk of prostate cancer. Studies also show that a diet high in dairy pro­ducts and calcium may be associated with an increased risk of prostate cancer, although the increase may be small.  Hence, the general recommendation is to follow the Mediterranean diet which can help prevent cancer as well as other non-communicable diseases such as cardiovascular disease.

Tips for a healthy lifestyle

■ Eat regular meals.

■ Base your meals on plant foods such as bread, pasta, rice and potatoes. Eat wholegrain-based food such as wholemeal bread, whole wheat pasta and wholegrain breakfast cereals. These are high in fibre which is necessary for good health.

■ Eat at least five portions of fruits and vegetables every day. Eat a wide range of coloured fruit and vegetables (red, purple, green, orange and yellow). It is also important to include vegetables that belong to the cabbage family, such as broccoli, cauliflower, cabbage and Brussels sprouts.

■ Include some protein, such as fish, lentils, skinless chicken/turkey and tofu. Avoid processed meat and eat less red meat. Add more beans, peas and lentils to your diet.

■ Eat oily fish such as sardines, pilchards, tuna or salmon at least once a week.

■ Adopt a low-fat diet. Choose tomato-based sauces instead of cream sauces. Choose low-fat milk, cheese and yoghurt. To use less fat in cooking, grill, bake, boil or steam food instead of frying or roasting. Replace fatty snacks like crisps and biscuits with fruit.

■ Cut down on salt. Look out for hidden salt in processed foods. Try using herbs and spices to add flavour to dishes.

■ Cut down on sugar. This includes sugar in soft drinks and processed foods such as cakes, biscuits and other sugary foods.

■ Drink plenty of water every day. Try drinking green tea instead of other hot drinks throughout the day.

■ Try to include at least 30 minutes of physical activity as part of your daily routine.

Dr Charmaine Gauci is Superintendent of Public Health.

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