Below the belt

Dan Roberts

• Last Updated: November 22. 2009 7:32PM UAE / November 22. 2009 3:32PM GMT

Doctors suspect that being overweight can play a part in the development of prostate cancer, while the causal relationship between obesity and diabetes is well-established. Science Photo Library

This month, more than 200,000 men from New Zealand to the UAE to Hawaii are sporting increasingly bushy upper lips in aid of Movember – a fund/awareness-raising campaign that involves “mo bros” growing a “mo” (Australian slang for moustache) in aid of charity. The Movember movement was dreamt up by 30 mo-loving Australians, initially just to bring back the much-maligned moustache.

But, after huge media interest, the founders decided to use their campaign to benefit a specific area of men’s health, as the co-founder Justin Coghlan explains: “When we set it up we really just wanted to bring back the moustache, which had vanished off the face of the earth. Our dads had them, sporting heroes had them – basically everyone we knew who was a bit of an icon. But we had so much interest in it that first year we decided to turn it into a men’s health thing.”

Coghlan and his fellow mo bros quickly realised that prostate cancer was the biggest threat to the health of Australian men. “Prostate cancer was the clear leader in the men’s health epidemic at that time and still is – it’s one of our biggest killers. And the crazy thing about this disease is that in the UK alone it kills one man every hour and 35,000 men get it every year, but in 90 per cent of cases it’s curable if detected early enough.”

Determined to reduce these needless deaths, Coghlan has turned his initially playful movement into a powerful force for change. Since its inception in 2003, Movember has raised £30 million (Dh185 million) for prostate cancer charities, has an official presence in 12 countries and an unofficial one in 20 more, and this year 225,000 mo bros are lending their hirsute support to the campaign. Each of these mo bros is a key link in a viral marketing campaign.

Coghlan says: “We’ve got mo bros from all walks of life: firemen, teachers, doctors, lawyers, guys on Wall Street, in bars, fashion and the media. They suddenly go from clean-shaven to moustache-wearers for a month and that’s where the awareness comes in – if each bloke tells three or four people a day they’re doing it for prostate cancer, that message is getting out to millions of people a year.”

And it is vitally important that this message reach as many men as possible because, despite the best effort of all those mo bros, and the “mo sistas” who support them, alongside governments, public health departments, doctors and researchers across the globe, prostate cancer remains a lethal threat. The actor Dennis Hopper is the latest high-profile personality to be diagnosed with the disease, following the former US secretary of state Colin Powell and Gen David Petraeus, the head of US central command in Iraq and Afghanistan, who have both undergone treatment for prostate cancer.

The latest available figures from the World Health Organisation show that in 2004 there were 605,000 cases of prostate cancer worldwide, with 236,000 in the Americas and 180,000 in Europe.

In the UK, the fight against prostate cancer remains a vigorous one. But, as Suresh Rambaran, a specialist support and information nurse with The Prostate Cancer Charity, explains, there is still no standardised system of checks for men. “There is no national screening programme in the UK, or anywhere else for that matter,” he says. “The main tool we use is the PSA [prostate-specific antigen] test, which checks for a protein released by the prostate gland. Levels of this protein can increase in the bloodstream due to problems with the prostate.”

Unfortunately, as Rambaran explains, the PSA test is far from perfect. “If you get a positive result it’s a good indication that something is wrong with your prostate, but it’s not a reliable diagnostic tool for cancer,” he says. “Someone could have a negative PSA result but still have prostate cancer, so that would give them false reassurance. And they could have a negative result and not have prostate cancer.”

This sounds confusing, but it is not uncommon for screening techniques to be imperfect. The debate over whether mammograms are the best way of screening for breast cancer is a good example. Just last year a highly controversial report in The Lancet questioned the value of mammographies. The Danish researchers argued that studies showing that mammography screening programmes reduced mortality were poorly designed.

This view was rejected by the US Preventive Services Task Force, which reviewed the same studies and argued that screening definitely did reduce breast-cancer deaths.

Such debate is a normal, healthy part of medicine, but what is not at issue is the importance of men over 50 getting an annual prostate check.

The PSA test is just one of a battery of diagnostic techniques at physicians’ disposal, as Rambaran explains: “We know that with prostate cancer, the older you get the higher chance there is of you developing the disease. For men in their sixties, prostate cancer is common, but it’s very rare in men under 40 – only a handful of cases out of the 35,000 sufferers in the UK. So all men over 50 should get a regular checkup, involving a PSA and a DRE [digital rectal exam].”

The latter is necessary because of the prostate’s awkward location – just under the bladder and surrounding the urethra. This means men can’t check their own prostates.

“In a DRE your doctor will feel the prostate to see whether it’s lumpy or nice and smooth,” says Rambaran. “That tells your GP whether something is wrong.”

It’s important to note that even if the prostate is lumpy, that’s not necessarily an indication of cancer. A non-cancerous condition called BPH (benign prostatic hyperplasia) is far more common, affecting up to four in 10 men over 65.

This hits men in their fifties as testosterone levels drop, which causes the prostate to increase in size. The symptoms of BPH are similar to those of prostate cancer: difficulty in starting to pass urine; a weak flow of urine that starts and stops; dribbling of urine before and after urinating; and a frequent or urgent need to pass urine, especially at night.

The other point worth making is that, unlike skin cancer, for example, prostate cancer is relatively non-aggressive and slow-growing. That’s why, as Coghlan says, it’s so important to catch it early, because the vast majority of cases can then be treated. It’s also why most elderly men will die with, rather than from, prostate cancer, partly because detection and treatment in old age have slowed the disease’s progress.

“Knowing about prostate cancer and its possible symptoms is important because it gives men the best chance of catching the disease in its early stages – when there are more treatment options available,” confirms Martin Ledwick, Cancer Research UK’s head information nurse. “Men diagnosed with prostate cancer who have treatment may be offered surgery, radiotherapy or hormone therapy, depending on the stage of the disease,” he adds.

So what causes prostate cancer, and what can you do to avoid it? Along with the ageing process, the strongest risk factor is genetic – men with one or more first-degree relatives (father, brother or son) diagnosed with prostate cancer have an increased risk, especially if the relative was diagnosed before the age of 60.

Other risk factors are less clear, but it’s thought that there is a link with obesity and that diet has some effect. “One of the messages I give is that we can’t change our ethnicity, age or sex, but one thing we can change is our diet,” says Rambaran. “If you look at the western world, the incidence is high in the UK, US and Europe, because we eat too much processed food, red meat, fat and dairy products.”

The lowest global incidence of prostate cancer is among the Japanese, because their diet is low in these potentially cancer-causing foods. When Japanese men emigrated to the US after the Second World War, their incidence of prostate cancer soared to match that among white Americans, lending strong credence to the diet theory.

In the UAE, as with the UK and US, there is no screening programme for men. But Dr Ron McCulloch, a British general practitioner who has treated patients in the Emirates for over 30 years, applies the North American model in his practice. “I follow the US guidelines on prostate cancer screening because I find them to be superior,” he explains. “They are quite clear that males over 50 should be screened on an annual basis, and I advise that to all my patients, whether they’re Sri Lankan, Iraqi, British or Canadian.”

In addition to the annual PSA and rectal exam, McCulloch also recommends an ultrasound scan every two to three years. He is excited about a brand-new test that looks likely to replace the unreliable PSA. “A new test has just been approved in the US and Europe, called the PCA3. It looks set to make the PSA obsolete, because it’s a gene test and is much more accurate. If you have elevated amounts of the PCA3 gene you are likely to have prostate cancer,” he says.

McCulloch explains that the incidence of this particular gene only increases if there is “turbulent” growth in the prostate, which usually indicates cancer. The downside is that the test is rather uncomfortable, but if you are in a high-risk group it might be worth a little discomfort.

“I’m likely to be the first in my clinic to have a PCA3 test,” says McCulloch, “because I’m 68 so am at risk of prostate problems.”

And his recommendation to men in the UAE echoes that of cancer specialists around the world. “If you have no family history of prostate cancer, get an annual check from 50 onwards, including a PSA – or PCA3 if it’s available – and a digital rectal exam, which remains the gold standard, plus an ultrasound every few years. And if you have a family history, get checked from 40 onwards,” he says.

Sound advice. Far too many men are dying from a cancer that is treatable if caught early. Let’s hope that, a decade from now, men will only die with prostate cancer, not from it.