Movember fundraising brings issue of prostate cancer screening to the fore
Movember's month of facial hair and fundraising highlights the importance of prostate cancer screening
Sam Gilbert is 26 years old, but already knows just how protracted and painful a battle with prostate cancer can be. For nine years, Gilbert witnessed his grandfather's health deteriorate until June, when he succumbed to the disease at the age of 76.
"I saw the decline in my grandfather's standard of living. And it was tough because he was the big chief, the patriarch of the family," says Gilbert, a Briton who has lived in Hong Kong for four years.
"The cancer spread to the rest of his body and his bones. It affected his joints and so he had problems getting around. It was debilitating. People see cancer as a fast track to death when, in fact, it can be a really long and horrible battle."
Motivated by his first-hand encounter with prostate cancer and concerned by a lack of awareness about the disease here, Gilbert and his teammates from the DeA Tigers Rugby Football Club are taking part in Movember for the first time. The rules of the annual fundraiser for men's health are simple: start November clean-shaven, before growing and grooming a moustache for the next four weeks.
Curious questions about furry upper lips are meant to help break the ice in discussing men's health, and each of the participants is supposed to seek sponsorship. "Prostate cancer is not talked about in Hong Kong; I think there's a slight taboo associated with it," says Gilbert.
The usual test for signs of the cancer involves a doctor feeling the surface of a walnut-sized gland in the anal canal. The process is known as a digital rectal examination. A second test, the prostate-specific antigen (PSA) test, involves taking a blood sample.
"[The rectal examination] is a rather intimate check-up. Guys are often too proud to have another person's finger up their behind. But at the end of the day, if it could give you another 20 years of life, why not?"
The incidence of prostate cancer has risen rapidly throughout Asia, including Hong Kong, according to researchers at the Chinese University of Hong Kong.
Statistics from the Hong Kong Cancer Registry show prostate cancer was the third most common cancer in local men in 2010, accounting for 10.7 per cent of new cancer cases in males. About one-third of men older than 50 have cancer cells within the gland, and nearly all men over 80 have some degree of prostate cancer, says the Hong Kong Cancer Fund.
In many cases, the cancer cells grow so slowly that theydo not pose a problem. A man suffering from prostate cancer will often die of another cause.
About one in five men with prostate cancer here die from the disease, based on the registry's data. The problem is there's no screening test that can accurately tell if the cancer is slow-growing and benign, or fast-growing and malignant. The PSA test has been used, controversially, to indicate the cancer's presence in the blood. High or rising levels of PSA - a protein made in the prostate - may indicate the presence of a tumour. However, the test is not disease-specific: non-cancerous conditions such as an enlarged or inflamed gland can cause elevated test results.
When PSA levels rise above 4 nanograms per ml in the blood - a threshold that is itself contentious - a biopsy is recommended, but there is often no sign of cancer in up to 70 per cent of cases, says Dr Tam Po-chor, a urologist at the University of Hong Kong's Department of Surgery.
Up to 44 per cent of PSA-triggered biopsies find prostate cancer cells that are indolent and non-lethal, says the Prostate Cancer Foundation in the US.
"The harms of PSA screening include false-positive test results in up to 13 per cent of screened men and can be associated with significant psychological distress, in addition to the potential adverse effects of biopsy (bleeding, urosepsis, and acute urinary retention)," Tam wrote in an editorial for the Hong Kong Medical Journal last December.
"Many men diagnosed with prostate cancer by screening have low-risk disease, which is associated with a low risk of prostate cancer-specific death after 15 years."
The search is on for new biological indicators that could help physicians identify higher-risk tumours and put an end to unnecessary operations.
A gene-based marker called prostate cancer antigen 3, or PCA-3, has shown promising results.
This protein is found only in the prostate and its elevated presence in urine could potentially be a better indicator of the cancer's presence.
The test requires a rectal examination beforehand, which is supposed to loosen and shed cells within the gland.
A urine test assessing the levels of PCA-3 and T2:ERG, a genetic anomaly present in about half of prostate cancer patients, became available in the US last month. The Prince of Wales Hospital's Division of Urology has researched PCA-3 and concluded it could help diagnose prostate cancer among Chinese. However, the study's lead researcher, Chinese University Professor Anthony Ng Chi-fai says mainland research has found that T2:ERG occurs in just 20 per cent of Chinese patients and may not be useful in making a correct diagnosis.
In Ng's latest study, published in International Urology and Nephrology last month, another new test, the Prostate Health Index (Phi), was evaluated in Chinese patients. The test, a version of the PSA test, is said to be 2.5 times better than typical PSA screening at detecting prostate cancer. The hope is the test will better identify biopsy candidates and reduce over-detection rates.
The Phi was approved by the US Food and Drug Administration in June last year and has been available in the US since December.
Ng's retrospective study of 230 Chinese patients over 50 years old, with a PSA level of 4-10 ng/ml and without any indication of the cancer after a rectal examination, found the test helped decrease the number of unnecessary biopsies.
"So, it may be helpful for patients with a mild increase in PSA and who are a bit reluctant for a biopsy," he says. Ng says his team is working on other indicators to diagnose prostate cancer. "But we believe that prostate cancer in Chinese and Caucasians may be different, and so the management of the disease in Caucasians needs to be verified by local studies."
The funds raised by Movember's participants will go to the Cancer Fund and research. Some 65 per cent of the net funds raised here will be allocated by the Cancer Fund to research that supports the Movember Global Action Plan, an international research programme into prostate and testicular cancers.
The rest will help the fund pay for programmes to support men with prostate cancer and their families. For example, the fund provides Prostate Recovery Packs to newly diagnosed patients in hospital. They contain information and supplies, including an adult diaper, urinary sleeve and cranberry juice.
As of last week, nearly 700 participants - known as "Mo Bros" and "Mo Sistas" - had signed up locally to take part in Movember. Last year, the first time an official campaign was held here, more than 1,800 participants raised nearly HK$4.5 million.
"I feel really confident that we'll increase the number of participants this year," says Greg Rafferty, manager for Movember Asia. The charity began 11 years ago with 30 Mo Bros in Melbourne.
Last year, 1.13 million participants in 21 countries raised A$141.5 million (HK$1.04 billion), a 14 per cent increase over 2011's efforts.