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Prostate cancer requires year-round awareness and regular screening in all South African communities to help reduce the toll of this disease on our nation’s fathers, brothers, husbands and sons. Three urologists share their specialist insights on the advances that are enabling earlier detection and more treatment options that are considered only when needed.

Cause for concern among SA men
“Prostate cancer is the most common non-cutaneous, that is not skin-related, cancer in South Africa in males,” says Dr Sumesh Padayachee, a urologist practising at Netcare Rosebank Hospital.

“The local historical data on prostate cancer has not always necessarily been an accurate reflection of the true extent of this major health burden, but in the last 15 years, we have seen the prevalence increase by 60%.

In part, this is due to better screening policies and more men coming forward for screening with the improved technology we have available to detect prostate cancer. Even with these factors considered, unfortunately,  prostate cancer is definitely on the rise – the good news is that we are better equipped than ever to manage this common urological condition,” Dr Padayachee says.

Pic: Dr Amit Kalpee

 

Pic: Dr Megan Fisher

 

Pic: Dr Sumesh Padayachee

 

Dr Amit Kalpee, a urologist who practises at Netcare Christiaan Barnard Memorial Hospital, explains that there are generally two very different variants of prostate cancer.

“The more aggressive variant, which tends to appear earlier, shows a strong genetic link. Patients with this type could be in their 40s or early 50s and usually have a strong family history of cancer, whether prostate or another kind. Fortunately, this variant is generally rare,” he says.

“A more common presentation is later in life, at age 70 and beyond. This group generally present with a slower growing cancer and often treatment may not be required at all, as the cancer is less likely to become advanced to a stage where it would affect their remaining life expectancy.”

Studies locally and internationally have shown that a family history, with a father or brother with prostate cancer, and being of African heritage are factors associated with a higher risk of prostate cancer. A sedentary lifestyle, consuming a high fat diet, smoking and being overweight can also contribute to an individual’s risk,” Dr Kalpee notes.

Emerging technologically driven trends
Dr MeganFisher, a urologist practising at Netcare Linksfield Hospital, adds that the emerging trends in prostate cancer screening and treatment are refining the experience for men while also improving outcomes.

“Multiparametric MRI scans are helping to better target biopsies, when needed, which helps to rule out the need for further investigation or treatment in many cases,” she says.

“Where men do require treatment, the methods today are far less invasive, with tools such as brachytherapy seed implants, or minimally invasive surgical options including robotic‑assisted or laparoscopic surgery which reduce recovery time and complications.”

For men with higher risk localised prostate cancer, that is when the cancer is still confined to the prostate gland, therapies are sometimes combined for greater effectiveness, such as radiotherapy and androgen deprivation both being incorporated as part of the person specific treatment plan.

“Newer types of imaging and biomarkers, which are blood tests that look for signs of potential progression, are helping to predict more aggressive forms of prostate cancer better, and this gives the person and their multidisciplinary team an informed basis for managing or monitoring the disease,” Dr Fischer says.

Active surveillance
Dr Padayachee explains that active surveillance is sometimes all that is required for men with prostate cancer. This involves regular Prostate Specific Antigen (PSA) blood tests and MRI scans that closely monitor the tumour, enabling the person to potentially live without treatment for years, while allowing for an early opportunity to intervene and explore treatment options for a cure if the need should arise.

“Sometimes, there can be a window of 10 to 15 years from diagnosis before prostate cancer progresses. So, in many cases, a man may outlive the cancer with no symptoms, as prostate cancer tends to be very slow growing unless it is an aggressive subtype, such as those that are more common in African males, unfortunately.”

Person centred treatment options
Dr Padayachee emphasises that if treatment is required, the risk and benefit of each option should be weighed up carefully with the support of the multidisciplinary team, which includes urologists, oncologists, radiologists, nuclear physicians and psychologists for holistic consideration according to the person’s personal choices and circumstances.

“The treatment of prostate cancer has certainly evolved over the years, with treatments that not only prolong life but also improve the quality of life. The options are also individualised based on the person’s overall health, the stage or aggressiveness of the cancer and the best possible shared outcome,” Dr Kalpee adds.

Treatment options for more aggressive prostate cancers include external beam radiation therapy, chemotherapy and hormonal therapy with treatment plans that are centred around the needs of the individual in a shared decision-making environment.

“For individuals for whom surgery is an option, we are fortunate in South Africa to have several skilled robotic surgeons who can remove the prostate entirely through keyhole procedures. In healthy patients with early cancer, this is often the treatment of choice,” Dr Kalpee says.

Screening remains key
All three urologists emphasise that regular screening and understanding your individual risk are essential for men with an anticipated lifespan of over a decade. “Discuss screening with your doctor; it's not a one-size-fits-all approach,” they say.

To book a screening or doctors and specialists’ appointments conveniently according to your location and preferences at any Netcare or Netcare Medicross facility nationwide, simply call Appointmed on 0860 5555 65 during office hours or visit https://www.netcare.co.za/netcare-appointmed.

Screening guidelines
Early PSA testing is encouraged for well-informed men who do not have noticeable symptoms and have with a life expectancy of over 10 years who are at high risk of prostate cancer.

PSA screening should be initiated as follows for groups at higher risk for prostate cancer:

• All men, from the age of 50 years.
• From the age of 45 years in black African men, and in men with a positive family history of prostate and/or breast cancer in a first-degree relative (e.g. father, mother, brother or sister).
• In men who have undergone genetic testing and who are carriers of the BRCA2, BRCA1, HOXB13, ATM or CHEK2 genes, screening should be performed at 40 years of age or at 10 years younger than the age of onset of the youngest affected family member where this was before 40 years of age.

Ends

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