Israel Sánchez/ Reform Agency
Sunday, January 15, 2023 | 07:59
CDMX.- Although prostate cancer, the leading cause of death from malignant tumors in men, is curable if diagnosed on time, fear and prejudices around the check-up and the treatment itself keep patients at risk.
Men who avoid seeing a specialist and having something as simple as a blood test, known as Prostate Specific Antigen (PSA), for fear that this will find the disease, or even Have a digital rectal exam done to confirm it.
“It is the fear, yes, of the patients first of: ‘It’s not going to be cancer, I better not do it’. And once the antigen came out elevated, well, the fear of going to the doctor and undergoing an examination rectal to touch the prostate, and eventually take a biopsy from there,” says oncologist José Aurelio Athié Rubio in a remote interview.
“We are facing a cultural issue of machismo, of the understanding of masculinity. And these conversations are not easy,” says Leticia Aguiar, representative of the Alliance Joining Forces Against Prostate Cancer.
Furthermore, once diagnosed, some of these patients may refuse to be treated, perhaps due to the so-called “chemophobia”, which, although it strictly refers to the rejection of any type of chemical – “there are people who don’t even want to take aspirin for fear”, exemplifies Athié Rubio-, in this case he alludes to the aversion towards chemotherapy.
“It is a fear that comes from treatments from 20, 15 years ago, or from movies that patients see, where they see the effect of chemotherapy,” considers the specialist in surgical oncology at the Médica Sur hospital.
“But I can tell you that, currently, there are complementary drugs that remove these adverse effects,” he adds, referring to drugs that help bone marrow recovery, for example.
There are other options
Before resorting to chemotherapy, there is a whole series of therapeutic options against this type of cancer, including surgery complemented with radiotherapy, or hormonal therapy. The latter consists of the use of hormone blockers against testosterone, from which the prostate cells are nourished.
“These cells have androgen receptors for testosterone, so I occupy that receptor or block it, and the cell has no way to continue living. And it dies. But there are a group of cells that become resistant, like bacteria that become resistant to antibiotics”, explains Athié Rubio, explaining that this is due to a mutation in the neoplastic cell.
“The only way to be able to treat this group of cells is by no longer blocking the receptor, because it has mutated and no longer responds, but by destroying these cells. And the only option we have to do so is systemic chemotherapy.” he continues. “Chemo destroys these very rapidly dividing cells, but it also has some destruction of normal cells, which is people’s great fear.”
For patients whose conditions do not require chemotherapy, options such as surgery or hormonal therapy still carry effects -such as severe andropause- that, in order to avoid them, end up taking them away from the office and their prognosis may worsen.
“With less testosterone, decreased libido or flat out there is an issue of erectile dysfunction; and in the case of surgery, because the prostate is so close to the urinary system, sometimes there are problems with incontinence. Patients listen to this information and it is : ‘Either I’m going to be powerless or I’m going to have to wear a diaper,'” says Aguiar, also coordinator of the Latin American Movement against Prostate Cancer (Molacap).
“That’s when they prefer not to undergo treatment or delay it, or sometimes there is not this adherence to treatment to complete it completely, and that is when the cancer progresses, unfortunately,” he adds. “Later, when there is no other option but to continue the treatment, it is already too late.”
In contrast, Athié Rubio recalls the case of a patient with bone metastases in the spine and in great, great pain, who was administered radiotherapy and hormone blockers, with which the discomfort began to decrease.
“But after two months it progressed again, destructive images of the bone were seen again in the x-rays, with risk of fracture, and with a prostate antigen that instead of going down was going up,” recalls the oncologist.
“Clearly what we saw was a hormone-resistant tumor, and although we gave it palliation with radiotherapy, we defined that it should receive chemotherapy, a systemic treatment. It was given, and after about three months the prostate antigen began to decrease; the effects side effects weren’t as important as the pain and weakness I was feeling.
With the decrease in pain and even recovery of appetite, the patient was motivated and continued with the chemotherapy cycles indicated in the international guidelines; “Believe me that the doses of antiemetics (drugs against vomiting) and antidiarrheals decreased,” celebrates Athié Rubio.
The key: communication
For the expert, if “chemophobia” and any rejection of treatment are to be overcome, the doctor’s communication with both the patient and their relatives is of great importance, particularly to manage uncertainty.
“The patient is very afraid because they don’t know how much longer they are going to live, they don’t know if they are going to vomit a lot, if they are going to have a lot of diarrhea or if they are going to need transfusions. The key here is to talk to the family, who are the ones who they support the patient a lot; we have forgotten to be very close to the family, which is the factor of success or failure”, he estimates.
“Normally, it is the wives, the daughters, the sons, who push the patient to go and seek care. Obviously, this support, this emotional accompaniment and also not feeling judged or that they are less of a person than they were is vital “, highlights the Molacap coordinator, on whose online site -www.molacap.org- there are several free download guides.
Above all, Aguiar suggests leaving behind the taboos and macho prejudices around tests such as digital rectal examination, which lasts 15 seconds and allows doctors to identify a possible malignant tumor. Likewise, having a greater sense of self-care and responsibility for one’s own health, instead of relegating medical care until it is too late.
“Twenty years ago, women did not get Pap smears or mammograms; now they go to their annual checkups to do it. That is patient education,” emphasizes Athié Rubio.
“Unfortunately, we men have not learned from that. That is why the women in our house, our wife, our mother, our sister, are the ones who take us to the doctor for the prostate, we do not go alone. It is something that we have to overcome with young people”, exhorts.
in numbers
– 1 in 7 men will develop prostate cancer at some point in their lives.
– 70% of cases are detected in advanced stages.
– 7 thousand men lose their lives annually for this cause.
to be alert
Some symptoms of this cancer are:
*When urinating:
– Delay to start
– Efforts when doing it
– Decreased strength
– Increased frequency (bladder does not empty completely)
– Presence of blood
*Pain in:
– Hip
– Spine
– Ribs
*Weakness or numbness in legs and feet
*Weightloss
*Erectile dysfunction
