COVER STORY: Getting to the bottom of it

2009/10/26

KASMIAH MUSTAPHA and SUZANNA PILLAY

Impotence and prostate problems rank in the top five of the top 10 medical conditions patients find too embarrassing to discuss with their family physicians. KASMIAH MUSTAPHA and SUZANNA PILLAY take a look at both conditions.

IF you are male, and in your fifties or older, you may want to visit your GP or urologist for a digital rectal exam annually to check for prostate cancer. It could save your life.

It is a test, which Dr Peter Ng, consultant urologist and president of the Continence Foundation Malaysia said should be necessary — like breast examination tests are for women — in helping to ensure that patients get the right treatment. “The digital rectal examination (DRE), in addition to other tests like a blood test to check for the PSA (prostatic specific antigen levels) would help in making a correct diagnosis.” In Malaysia, prostate cancer is the sixth most frequent form of cancer and makes up 5.6 per cent of cancer cases in males.

“Very few prostate cancers occur in men under 50. The rate increases sharply with age and is the highest in the oldest age group.” Dr Ng said DRE, which involves inserting a finger into the rectum to feel the size of the prostate gland, is controversial, because men are uncomfortable with the test.

“Even some GPs are uncomfortable about performing it. However, it is one of the best tests in determining whether the urinary problems are caused by an enlarged prostate — which could be either benign prosatic hyperplasia (BHP) or prostate cancer,” said Dr Ng, who conducted a workshop organised by GlaxoSmithKline for the media on Lower Urinary Tract Symptoms (LUTS) recently.

“Upon a DRE, an enlarged gland that is smooth and soft is most likely BPH while a hard and nodular gland might indicate infection (prostatitis) or even cancer.” The prostate is a gland found between the bladder and the urethra, and as men age, it slowly enlarges. Dr Ng said as it becomes bigger, it may press on the urethra and restrict the flow of urine, resulting in a slower, less forceful stream. This condition is normal and is referred to as a BHP. While it is not life-threatening like prostate cancer, BHP is uncomfortable for the patient and could contribute to LUTS. “LUTS are a group or constellation of symptoms often related to the prostate and bladder, and affect storage and voiding. The function of the bladder is to store and release urine, and any disease of organs in the lower half of the body will result in LUTS,” said Dr Ng.

This is a common problem affecting older men and about one third will develop urinary tract (outflow) symptoms. Symptoms can be categorised into filling symptoms which include: frequency, urgency, excessive urination during the night (nocturia) and voiding symptoms: poor stream, hesitancy, dribbling, incomplete voiding, overflow incontinence which occurs in chronic retention).

How common are LUTS in men? Overall, six out of 10 of men worldwide suffer from LUTS and Malaysia is expected to share the same incidence. “In a study done last year in Subang Jaya, eight out of 10 men aged 50 and above experienced LUTS, with 55.6 per cent of the men surveyed suffering from mild LUTS, 24.2 per cent moderate LUTS and 2.4 per cent severe LUTS.

“It is a disease which becomes more common with age and a very common problem in the population, but very few will seek a doctor for consultation. Most men either regard the condition as an embarrassment or as a sign of ageing. This is why public education is important. Anyone who suffers from these symptoms should seek professional help.” Malaysian men are less likely to report the condition because of the shame. Instead, they plan or limit their activities around their condition.

“BPH, for instance, can seriously affect the patient’s daily activities. Overall, 51 per cent of men with BPH reported interference with at least one area of daily life as a result of urinary dysfunction, compared with 28 per cent of men who did not have this condition. In 17 per cent of men of working age (40-64 years) with BPH, this interference occurred most, or all of the time, for at least one activity of daily life.” “Having BPH seriously affects patients’ daily activities. The patients and their families may see the impact on daily living in other respects — for example, these men might avoid places without toilets, drinking too much water and long events like going to the cinema or theatre. Their sleep, too, can be affected because they would be waking up frequently at night to urinate.” Dr Ng said another condition of the prostate with similar signs and symptoms is prostatitis. “It is the inflammation or infection of the prostate gland which causes fever and chills, urinary problems including increased urinary urgency, frequency, excessive urination during the night, difficulty or pain when urinating, inability to completely empty the bladder and blood-tinged urine.” Although BHP and prostatitis have similar symptoms, a DRE, in addition to other tests like a blood test to check for the PSA would help in making the correct diagnosis.

Dr Ng said in Malaysia, the Chinese have the highest incidence of prostate cancer compared with Malays and Indians.

Men who suffer from ED should seek medical treatment.

“A high fat diet also increases one’s risk because it may have an impact on the male hormone testosterone, which controls the growth and function of the prostate.” Apart from a low fat diet, he said the consumption of antioxidants like lignans (found in flaxseeds, sunflower seeds, pumpkin seeds, rye, oats and barley), isoflavenoids (vegetable protein from soy products) and vegetables like cabbage, broccoli and brussel sprouts, was beneficial.