Friday, July 25, 2008

Shying away from prostate check-ups

Attitudes among middle-aged Malaysian men towards prostatic problems have changed little over the years - most are still reluctant to see a doctor about hesitant, drip-drop urination but the quality of life need not be reduced too much in these modern ICT times - plus a medical test just a phone call away

IT’S one of the hard facts most men must face within their lifetime.

By the age of 50, their ever growing prostates will have caused urination problems to some degree. Not a whole lot of preventive measures like exercise and a balance diet seem able to stop the prostate’s steady enlargement.

The organ — a sperm nutrient producer located just under the bladder — holds about 20cc at young adulthood but can grow up to five times its healthy size before death.

The cause of this enlargement is not really clear. And most men remain unaware of the problem until the prostate is large enough to cause symptoms — the first of which is a reduction in the speed of urine flow.

In fact, doctors say all men, as long as they live long enough, will suffer from Benign Prostatic Hyperplasia (BPH). It’s the main culprit behind agonising moments of hesitant, drip-drop urination.

Left untreated, the prostate will compress the urethra, making the tube narrower while the bladder wall becomes thicker with muscles. It results in sudden desires to urinate, the need to “push” and at worst, being completely unable to urinate without a catheter.

BPH is the most prevalent disease to affect men beyond middle age.

While conventional wisdom congeals such inconveniences as “part and parcel of old age” rather than treatable symptoms, doctors disagree.

They believe quality of life need not be reduced too much in these modern ICT times (see list of prostate health websites) and with check-ups just a phone call away.

Malaysians, in particular, also enjoy cheap healthcare at public hospitals where 98 per cent of expenses are government subsidised. Doctors often joke that, for the end user, transportation costs more than medical fees. And yet millions of aging men voluntarily give up hope. What gives?

“Malaysian men are shy. In my eight years practising at Sarawak General Hospital (SGH), I have not observed much change in attitudes,” said Dr Teh Guan Chou, head of Urology Department.

“BPH sufferers are reluctant to consult a doctor perhaps because of fear of surgery or cancer. It’s ironic, but men in Malaysia seem too adaptive. They rather skip going to the cinema or golf course just because of the need to urinate more frequently. They don’t mind waking up often at night to urinate either.

“Of course, those in the farther reaches do have limited access to medical facilities. But most just appear to have high tolerance.”

By his own estimate, about 20 per cent of the department’s workload is concentrated on BPH. There is also a 10 percent rise in cases every year although the figure is in line with the aging population.

“Nevertheless,” he added, “too many seek medical help too late.”

Which is not surprising, one might add. Even the hardest of men will cringe when talking about urology … what with words like dribbling, bloody discharge, erectile dysfunction, finger up the anus, needle up the penis and many many more sore points.

Medical help can offer three kinds of treatment. “There’s watchful waiting, which is the most passive treatment,” Dr Teh said.

“Patients once diagnosed obtain regular examinations to monitor the problem. If symptoms do not improve, doctors may advise on drug treatment, the second option.”

One of the more common and well-received BPH therapies is Alpha-blocker drugs. Taken orally, it relaxes prostate muscles, relieving compression.

Symptoms can improve within one or two weeks. Another kind of drug — 5-Alpha Reductace Inhibitor — decreases the male hormone responsible for prostate growth.

Oddly though, proven treatments for erectile dysfunction also seem to help BPH, studies suggest.

“The third option is surgery where a portion of the prostate can be removed,” Dr Teh said, adding quickly that surgery could be avoided if patients took earlier medical advice.

It’s a key point that the specialist stresses over and over again. The greatest worry he has are with patients who endure their urination problems for too long.

“That’s when prostate cancer can arise. Symptoms can take five to 10 years before they are realised,” Dr Teh pointed out.

Age is the strongest risk factor for prostate cancer. Statistics show that prevalence of the cancer doubles every five years among men 50 years old upwards.

For those above 75, nearly 400 incidences of prostate cancer are reported out of every 1,000 men in the western world, where more studies have been done.

Globally, it ranks as the commonest cancer affecting men and the second commonest cause of cancer death. At SGH, at least one new prostate cancer patient is diagnosed every week.

“In the early stages of prostate cancer, almost no symptoms would show. The only way to detect it is via medical examination like a PSA test, followed by a biopsy if there is suspicion,” Dr Teh said.

“Most cancer patients diagnosed at SGH are in the late stage — their cancers have already spread to other parts of the body. They come to us when they are completely unable to pass urine or have detected blood in urine. There are even some who experience paralysis of legs and bone pain. Others are referred to us after complaining loss of weight and appetite.”

When it comes to cancer treatment, there are, again, three options — chemotherapy, radiotherapy or surgery.
SGH offers all three at rather respectable levels of medical advancement. In the last option, patients’ worries ought to be soothed by the public hospital’s latest acquisition.

“We have what is called the da Vinci Prostatectomy system,” Dr Teh said, pointing to what looked like a photo of a robotic spider.

“The da Vinci system is a breakthrough surgical technology allowing surgeons to offer a minimally invasive option for prostatectomy.”

The RM5 million machine comes in two parts — tiny robotic limbs that cut and sew and are controlled by the surgeon from a console.

“It is important for patients to know that da Vinci does not replace a robot at the controls. Surgeons still control every aspect of the surgery.

“What it does is allow humans to do better surgeries by dramatically enhancing visualisation, precision, control and dexterity.”

The end result is patients experience less scaring and recover in shorter periods of time.
Purchased at the massive cost (not to mention the RM10,000 the hospital absorbs for each surgery), SGH is the only the second hospital in Malaysia to have the system. But all the best technology in the world cannot help save lives if people are not willing to submit to a doctor’s consultation.

And on alternative medicine like herbal ones, Dr Teh said: “It’s not wrong to try them but if there is no improvement within after six months why continue with these expensive alternatives?”

A check up at any public facility is only RM5 and proven drugs are highly subsidised. Some are even free.

Perhaps another reason for the lack of prostate health awareness comes down to the number of specialists available in Sarawak.

“Yes, there are only three urologists in the state. I’m one while another is at a private hospital and another at Unimas,” Dr Teh said.

Only three! Yes, that must be the main reason. And Sarawakian men will need all the help they can get.

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