Growing awareness on men’s health

Contributed by Dr Ravi Sekhar Patnaik, Consultant Medical Oncologist, The Brunei Cancer Centre of Pantai Jerudong Specialist Centre

Movember, named after a combination of the words ‘moustache’ and ‘November’, is an annual event of growing a moustache in the month of November in support of fathers, brothers, sons and male friends to raise awareness on prostate and testicular cancer as well as men’s mental health. It was formed in 2003 by a group of friends in Australia.

The goal of Movember is to change the face of men’s health. Using the moustache as the driving symbol of the movement, Movember focusses on the three key areas of prostate cancer, testicular cancer as well as mental health and suicide prevention.

The Brunei Cancer Centre (TBCC) of Pantai Jerudong Specialist Centre (PJSC) is the referral centre for cancer treatment in Brunei Darussalam.

CANCER BURDEN IN BRUNEI

Nine hundred and eighty-seven new cancer cases were diagnosed in 2020 with 448 of them being new male cancer patients, accounting for 45 per cent of the total number of cases. One in four males in Brunei is at risk of developing cancer in their lifetime.

Cancer cases are projected to rise by 108 per cent from 2020 to 2040, compared to 22.8 per cent from 2010 to 2019.

The steep projected rise can be attributed to an increase in population growth, life expectancy, ageing population, change in lifestyle (obesity, smoking, drinking alcohol and adapting a Western diet), better screening and diagnostic intervention.

More alarming is the projected increase in cancer-related deaths 434 cases in 2020by 160 per cent to 1,123 cases in 2040.

Males account for 54 per cent (236) of all cancer deaths in 2020.

Common cancers among males in Brunei are colorectal, lung, prostate, liver and stomach.

Other male specific cancers are testicular and penile as well as uncommon breast cancer.

MALE C ANCERS –WHAT IS PROSTATE CANCER?

The prostate is a gland. It is usually the size and shape of a walnut and grows bigger as you get older. It sits underneath the bladder and surrounds the urethra, which is the tube that carries urine out of the body. The prostate’s main job is to help make semen – the fluid that carries sperm.

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. Some prostate cancers grow too slowly to cause any problems or affect how long you live. Because of this, many men with prostate cancer will never need any treatment.

But some prostate cancers grow quickly and are more likely to spread. This is more likely to cause problems and needs treatment to stop it from spreading.

Common symptoms of prostate cancer are: difficulty starting to urinate or emptying the bladder; weak flow when urinating; feeling of bladder not emptied properly; dribbling of urine after urinating; needing to urinate more often than usual, especially at night; sudden need to urinate – may sometimes leak urine before getting to the toilet; back, hip or pelvic pain; problems getting or keeping an erection; blood in the urine or semen; and unexplainable weight loss.

In terms of those who are at risk of prostate cancer, factors include: age (over 50 years old); race; family history of prostate cancer; germline (BRAC2) mutation; and modifiable risks such as obesity, smoking and diet.

BURDEN OF PROSTATE CANCER IN BRUNEI

One in 27 Brunei males are at risk of developing prostate cancer and it accounts for one per cent of total deaths. Prostate cancer accounted for 40 out of 448 (8.9 per cent) new male cancer diagnosed in 2021.

It is the third most common male cancer after colorectal cancer (20.3 per cent) and lung cancer (15.2 per cent).

TBCC of PJSC saw more than 300 odd cases of prostate cancer in the Out Patient Department (OPD) from January to October 2021.

HOW CAN PROSTATE CANCER BE PREVENTED?

Assessing risk factors and symptoms and checking with the doctor for screening with prostate-specific antigen (PSA) for men above 50 years old. Maintaining normal weight, regular exercise, a more plant-based diet as well as avoiding alcohol and smoking in any form.

DIAGNOSTICS AND TREATMENT FOR PROSTATE CANCER

Blood test in the form of PSA and a digital rectal examination by the doctor would be done ideally at the beginning. Upon suspicion of being diagnosed with cancer, transrectal ultrasound (TRUS) biopsy or magnetic resonance imaging (MRI) template biopsy will be carried out.

New modalities of diagnosis like prostate-specific membrane antigen-positron emission tomography (PSMA-PET), magnetic resonance imaging (MRI), computed tomography (CT) scan and bone scan would be done upon confirmation for staging.

Prostate cancer is treated with surgery (radical prostatectomy or orchidectomy), radiation, hormonal or chemotherapy agents and recently novel agents.

MALE CANCERS – WHAT IS TESTICULAR CANCER?

Abnormal growth of cells in the tissue of the testis causes testicular cancer. Typical symptoms are a painless lump or swelling in one of the testicles or any change in shape, texture and appearance of the testicles.

Dull aching pain or sharp pain and associated dragging sensation in scrotum all these need to be examined by doctors for further investigation.

It is the most common male cancer in the age group of 15-40 although older males also get different variants of testicular cancer. Testicular cancer accounts for 1.4 per cent of all male cancers. A total of eight cases were recorded by TBCC in 2020. Risk factors for testicular cancer include: undescended testes; family history; and abnormal development of testes.

TREATMENT FOR TESTICULAR CANCER

Trimodality treatment is offered with surgery and chemotherapy reserved for advanced stage. Testicular cancer has 99 per cent survival rate at five years for localised disease and 75 per cent for advanced stage.

MALE CANCERS – WHAT IS PENILE CANCER?

It accounts for less than one per cent of male cancers. A total of three cases were seen in Brunei in the year 2020-2021. Penile cancer is associated with HPV, non-circumcision, poor hygiene and smoking. Treatment involves penectomy, radiation and chemotherapy.

OTHER CANCERS

Colorectal cancer and lung cancer are two other common cancers which have high association with modifiable risk factors like smoking and obesity.

With newer diagnostics and treatment modalities, death rate has shown a decline. Although breast cancer is uncommon in men, it usually presents signs at a more advanced stage.

HOW CAN THE COMMON CANCERS BE PREVENTED?

Smoking (30-40 per cent) and obesity (40 per cent) are the two most important attributable risks to most of the cancers.

In Brunei, 20 per cent of cases with men comprising 36 per cent. Reduction in those two risk factors could help to prevent it.

Nearly 14 per cent of Brunei’s population is obese, thus a healthy diet and an active lifestyle are crucial.

Accessibility to HPV vaccination for high-risk group, education on safe sex practices, proper hygiene care and awarness of signs and symptoms of common male cancers are also important.

In this Movember, let’s grow a moustache to raise awareness on men’s health and pledge to stand for all men and support them in their fight against cancers.