Prostate screening

Dr Chris Jooste,
Somerset West

I would like to respond to the letter by Chad Anthony Williams (“Yo bro, check your prostate”, Bolander, November 20) regarding the importance of prostate and testicular cancer screening.

His letter helps raising awareness about men’s health because it is a topic which is often avoided in our mostly patriarchal society.

I agree whole-heartedly with the sentiment about the importance of regular screening, not only during N(M)ovember, but actually every month of the year. Early detection, leads to earlier diagnosis, earlier treatment and better prognosis. However, in his piece, which was sourced from CANSA, there are a number of factual inaccuracies:

a digital rectal examination (yes, the dreaded finger), is still regarded as an integral part of the screening and diagnosis of prostate cancer. It was not replaced by a blood test (PSA), but the blood test is an add-on to help guide the diagnosis. Often we see patients with a normal PSA level, but high grade prostate cancer. It is estimated that about 20% of cancers are missed when only relying on a PSA test .

the red flags mentioned are not necessarily typical of prostate cancer, but rather of benign prostatic hyperplasia (nocturia, straining, leaking urine), urinary tract infection, prostatitis or bladder cancer (blood in urine/burning urine). Blood in semen could also be benign. Most often the patient with prostate cancer is totally asymptomatic.

Regular screening (yearly) is thus very important, especially in high risk patients (positive family history of prostate cancer and certain races: blacks, coloureds). Screening in these high risk patients should start at 40 years old, and for the rest at 50 years.

Dr Jooste is a general practitioner in Gordon’s Bay.

He has a special interest in cancer care and palliative care.