PROSTATE CANCER. Should I be concerned?

Modern men are becoming increasingly aware of male health issues. The recent formation of a prostate cancer support group in Gibraltar reflects the growing concern about this treatable disease in the local male population and whilst much information is available, many people are concerned and confused by the data that is published on the Internet and within the media. This article is aimed to try to explain about the incidence and presentation of prostate cancer and how it differs and mimics other diseases of the prostate gland. The article also explores the myths and truths of Prostate Specific Antigen (“PSA”) testing, and explores what can be done for those who are concerned.

Before proceeding it is important to remember that whilst prostate cancer affects 1 in 12 men during their lifetime, 6 times more men (1 in 2) will develop simple benign (non cancerous) enlargement of their prostate during their life. Consequently most men who experience urinary symptoms will have benign prostate enlargement rather than cancer.

What can go wrong with the Prostate Gland?

The most common problems of the prostate are benign (non-cancerous) enlargement, inflammation and infection. Cancer is relatively infrequent when compared to these other conditions. 

Unfortunately however the symptoms of benign prostate enlargement and cancer can be very similar. This is why doctors are keen to check all patients with symptoms such as a poor urinary stream, dribbling at the end of urination, the need to pass urine more frequently, an inability to wait or hold on to urine (urgency)), poor bladder emptying, and a need to get up at night to pass urine (nocturia). Many men suffer these symptoms without realizing that they can be alleviated or cured. To complicate things, not all men with an enlarged or diseased prostate will have symptoms.

Conversely, patients with an inflamed prostate or prostatic infection tend to experience some of the above symptoms, plus burning or pain at the base of the bladder during urination, and patients with these symptoms should see their GP or a urologist.

What are the symptoms and risk factors of prostate cancer?

There are no specific diagnostic symptoms associated with prostate cancer however symptoms such as frequent visits to the toilet, getting up at night to pass urine, rushing to get to the toilet (and a period of pause before starting to urinate), having a slow flow of urine and dribbling at the end are all associated with prostate enlargement. Whilst most patients with these symptoms will have benign prostate enlargement, sometimes the cause is underlying prostate cancer and therefore it is advisable to get checked if you have any of these symptoms.

Furthermore, a family history of prostate cancer increases an individual’s risk of developing prostate cancer so patients with a positive family history should seek medical advice. The disease is also more common in smokers.

When you see your doctor with any of the above symptoms, the doctor might order a PSA blood test (see below) and / or perform a digital rectal examination to assess the size and texture of the prostate gland.

The good news is that with modern treatment, it is now possible to cure prostate cancer if it is detected early.

Who is at risk?

In the UK, prostate cancer is the most common cancer in men. Currently it accounts for nearly a quarter (24%) of all new male cancers diagnosed each year in the UK. Recent epidemiological studies of local cancer incidences indicate that the local disease incidence in Gibraltar reflects that elsewhere in Europe.

Although the medical literature reports a huge rise in prostate cancer incidence over the last 20 years, most of this increase is simply because of the incidental discovery of small areas of prostate cancer in the tissue removed during surgery for presumed benign prostate enlargement. In other words, modern diagnostics enable doctors to diagnose very small cancers which have in the past probably been missed – but which have also been cured simply by removing the prostate gland when the cancers were very small. More recently, the use of the PSA testing has led to disease diagnosis in patients with very few symptoms.

Interestingly though, during the last 20 years, although the incidence of the disease has increased, mortality rates from the disease have not increased significantly. Indeed modern treatments have led to prolonged survival rates.

In 2008, there were 37,051 new cases of prostate cancer diagnosed in the UK. This equates to around 101 men every day or one man every 15 minutes!  From these data it has been estimated that the lifetime risk of being diagnosed with prostate cancer in 2008 is 1 in 9 for men in the UK. Prostate cancer is however rare in men under the age of 40 but the incidence increases with age and peaks in men aged between 70 and 79. For men aged 55-59 the incidence rate is 155 per 100,000 men; ten years later, at age 65-69, the rate more than triples to 510 per 100,000, and by 75-79 the rate is almost five times higher at 751 per 100,000. 

Men who have had a close family member (father/brother) diagnosed with prostate cancer at a younger age (under 55) are three times more likely to be affected. Inherited faulty genes can also be a cause.

Men, who have an increased family risk of prostate cancer, may wish to have regular screening once they are over the age of 40 or 50, to monitor against the potential onset of the disease.

What is a Prostate Specific Antigen (PSA) test?

PSA is a protein produced by the prostate gland the level of which is measured by a blood test. It is a non specific test and its use is therefore controversial, however it is useful in directing doctors to look more closely at the prostate and telling doctors which treatment may benefit patients with benign prostate disease or prostate cancer. It can also be used to monitor treatment for prostate cancer.

A raised PSA should prompt doctors to investigate the prostate gland and if present, will help them detect prostate cancer at an early stage, often before any other symptoms develop.

It must be remembered however that not all men with a raised PSA level will have prostate cancer. A raised PSA level can be due to many non cancerous causes, such as increasing age, benign prostate enlargement, urinary tract infection, perineal trauma (for example distance cycling on a regular basis), sexual intercourse and bladder investigation (cystoscopy), therefore as a test on its own, PSA is not diagnostic and a raised PSA level does not necessarily mean that you have prostate cancer. 

What happens if my PSA test is abnormal?

If the PSA test comes back elevated it will alert the doctor to a potential problem with the prostate. Some further tests will probably be requested which usually include a urine sample (to test for infection) and a digital rectal examination.  

If you have an infection you should receive a course of antibiotics, and if the digital examination of the prostate is unremarkable, your doctor may chose to monitor your PSA level without further investigation. 

If however there is no infection or rectal examination of the prostate shows an abnormal texture of your prostate gland, you will be advised to undergo a prostate biopsy.

What is a Prostate Biopsy?

These days, prostate biopsy is a routine day-case procedure performed under local anaesthesia.  It can be performed in the clinic or hospital setting.

Following suitable preparation and consent, a thin finger shaped ultrasound probe is placed into the back passage to scan the prostate gland. This allows the doctor to take various size measurements and allow injection of the local anaesthetic into the tissues prior to taking a number of biopsies (small samples of prostate tissue), which are sent for analysis. 

You will need to take some antibiotics for a couple of days around the time of the biopsy to prevent infection. After the procedure, it is common to see some blood when passing urine and also from the back passage which usually clears after a day or so.

You will have a follow up appointment to discuss the biopsy results and any ongoing treatment that may be necessary.

What should I do?

Most men will probably not have symptoms and therefore will not need to do anything. If however you have any of the symptoms described above, you should seek the advice of your GP or a specialist urologist.

PSA testing and analysis along with prostate assessment and biopsying is now routinely performed by the visiting Specialist Consultants from the “Edinburgh Urological Specialists” who hold regular clinics in the Specialist  Medical Clinic, in the ICC building, Gibraltar.

For further information contact the Specialist Medical Clinic, 1st Floor, ICC, Casemates Square,

Tel no. +350 2004999

Fax no. +350 200 68999

Email: reception@smg.gi

 

Edinburgh UrologicalSpecialists (EUS)-European Division at the Specialist Medical Group. Gibraltar.

www.specialistmedicalclinic.com

www.edinburghurologyspecialists.com

Dr Monique Risso, Specialist in Family Medicine, joins the Specialist Medical Clinic

Dr Monique Risso has been a General Practitioner for 9 years. She qualified from Leeds University Medical School and joined the Vocational Training Scheme for General Practitioners at Airedale General Hospital in Yorkshire, where she gained experience in Obstetrics and Gynaecology, Paediatrics, Accident and Emergency and Psychiatry, all essential to General Practice. She worked in Settle and Ilkley as a General Practitioner Registrar, before returning to Gibraltar. In Gibraltar she worked at the Primary Care Centre for seven years, providing General Practice services to the local community.
In 2010 she travelled to Sydney, Australia and Omaha, Nebraska to train in NaProTechnology and the Creighton Model FertilityCare System. NaProTechnology (Natural Procreative Technology) is a new women’s health science that monitors and maintains a woman’s reproductive and gynaecological health. It provides medical and surgical treatments that cooperate completely with the reproductive system, and has been extremely successful in the treatment of many infertility problems.

More information can be found at: Dr Risso’s website www.ladyofeuropefertilitycare.com
or www.fertilitycare.net/WhatisFCare2.htm

Dr Risso is pleased to be working alongside Dr Nerney in this exciting new venture to offer General Practice Services for all ages, at the Medical Specialist Clinic. This will include acute and chronic disease management, travel advice and vaccinations, well man and well woman checks. She will also be providing general woman health and reproductive services with NaPro Technology including fertility awareness, natural family planning, treatment of Pre Menstrual Syndrome, Ovarian Cysts, recurrent miscarriage, pre-menopausal management and infertility treatment, to name a few.

To make an appointment with Dr Risso at the specialist medical clinic or for more enquires please contact T +200 49999 or at reception@smg.gi

Specialist Medical Clinic joins MEDILINK

We are delighted to announce that we have joined the Medilink medical network and are now their PREFERRED PARTNER for the Gibraltar area. 

For more information on Medilink, please take a look at their website: www.medilinkspain.com

From the Archives! 2005 article about Gallbladder surgery in Gibraltar.

Keyhole gallbladder surgery in Gibraltar

The Gibraltar Health Authority says that as another further step in the expansion and improvement of the Healthcare Services. Four Laparoscopic Cholecystectomy Procedures (Keyhole surgery to remove the gallbladder) were performed in Gibraltar this past week. The GHA?s Surgical Team, was led by Mr David Deardon who was recently recruited second Consultant General Surgeon, and who completed the first four Laparoscopic Cholecystectomies successfully on 15th September at St Bernards Hospital. The following day all patients were well and mobilised with a view to discharge from hospital within a further 24 hours. The patients ranged in age from 12 to 36 years of age. ?It had been impossible to perform keyhole surgery locally in the old St Bernard?s due to the absence of the necessary equipment and expertise but all that has now changed," says the GHA. They add: "The second Consultant General Surgeon recently employed by the GHA has the training, medical skills and experience to carry out keyhole surgery and this, together with the recent acquisition by the GHA of the necessary equipment has made this major breakthrough possible. In the past when such operations were carried out in Gibraltar by traditional methods patients were usually required to spend an extended period of time of many days as an inpatient before being discharged. Full recovery would take several weeks." "As from now, when such operations are carried out using keyhole surgery, it will mean that the patient can normally expect to be up and about the day after surgery and to leave Hospital some 24 hours later. It will also mean that patients will no longer need to travel away from Gibraltar to have such operations done elsewhere and thus avoid all the inconvenience and expense to patients and their families that this entails," says the GHA.

Benjamin Hassan joins the SMC team.

We are delighted to welcome Benjamin Hassan to the clinic team!

Benjamin Hassan, Gibraltarian born, is a psychotherapist with a particular interest and specialization in medical trauma psychotherapy.  Benjamin has extensive experience of working for the National Health Service in United Kingdom having held the post of Senior Psychotherapist. In this post he was responsible for the service delivery and development of the Psychotherapy Department with the lead Consultant at Kings College Hospital London. He worked very closely with many of the staff and patients in the departments of psychological medicine, neurology, palliative care, transplantation, accident and emergency, stroke, rehabilitation, dementia, amputees, sexual clinics and many others. Benjamin went on to lecture nationally and internationally on aspects of medical conditions and their psychological impact on the life cycle.

More recently, Benjamin worked for the UNITED NATIONS under the office of the high Commissioner for Refugees. His role was to assess and implement Psychological services for African Refugees in Israel. During this time, Benjamin developed specific clinics, seeing patients and managing the clinicians working in areas that ranged from immediate crisis intervention, psychological first aid, sexual and gender base violence, psychosomatic and post traumatic stress disorder. In the two years that Benjamin served as Project Manager for psychological and mental health services for the UNHCR in Israel, he obtained further support from the European Union and acknowledgement for his creative and professional work in the field of trauma and medical psychological care in humanitarian settings. Outside of public service, Benjamin has been working in private practice and continues to be involved with other colleagues in clinical research in the field of trauma and the impact of terminal medical diagnosis on the lifecycle.

 In the spring of this year, Benjamin returned to Gibraltar to join our practice and return home. Having the opportunity to work in such dynamic settings and gain a broad wealth of experience he feels it is the right time to return and start using what he has gained abroad and bring it to his own people here on the Rock.  He strongly believes, having kept informed of the development of psychological and mental health services in Gibraltar that it is progressing in the right direction, with many allied professionals such as counsellors and psychologists offering good services. It is however in his opinion important that in such a community specialist confidential psychotherapeutic services particularly in the area of medical psychotherapy exist.  He explains that Gibraltar is a wonderful community where people look out for one another. There is an assumption that people do not suffer in silence and that there is always a friend, lover or another with whom they can confide and find support. This is very important, however not always enough, particularly for those situations in life when an individual finds that they are asking themselves the same questions and feeling that things have a grip on them.  In the case of individuals with mental health issues or specifically anyone experiencing unmanageable levels of anxiety, there really is no need to struggle with these alone. Professional psychotherapists and other clinicians have developed understanding to work with these areas and facilitate the development of stronger resilience with these struggles. Most closely to Benjamin heart and in his words  he “has had the privilege to work with many ordinary individuals and family members who have had the misfortunate of being diagnosed with life changing diseases” and offer them professional attention in finding ways to manage the impact this has on their living. His clinics are carefully informed by a strong background in a broad range of fields and designed to meet his patient’s needs.

Benjamin believes that everyone in Gibraltar and anywhere else needs to know that there exists an open space where they can bring questions that are replaying in their minds and be with another with whom you can think the unthinkable and speak the unspeakable.  

To make an appointment to meet with Benjamin at the specialist medical clinic or for more enquires please contact T +200 49999 or at reception@smg.gi

Dr Patrick Nerney, MRCGP, Specialist in Family Medicine, joins the Specialist Medical Clinic

The Specialist Medical Group Ltd is delighted to announce that one of Gibraltar’s most senior General Practitioners, Dr Patrick Nerney MBBCh, (formerly a General Practitioner at the GHA Primary Care Centre in the ICC) has dusted off his stethoscope, after a couple of months of well deserved rest and relaxation, and joined the specialist team at the Specialist Medical Clinic. 

Dr Nerney, who is well known to many in Gibraltar, has been a GP for 32 years. He qualified as a doctor from Welsh Medical School at Cardiff University and gained hospital experience in Paediatrics,  Geriatrics, Psychiatry, Obstetrics and Gynaecology and Traumatology before chosing a career in General Practice initially in South Wales. He moved to Gibraltar in 1980 to become a general Practitioner in the Gibraltar health Authority. Between 2002 and 2007 he was the Primary Care Co-ordinator for the GHA and from 2009 until his retirement earlier this year was one of the lead GPs in the Primary Care Centre. 

Over the years Dr Nerney has become well known to many patients in Gibraltar. Within the Specialist Medical Clinic, he will be providing Specialist Family Medicine services for adults and children, including acute illness diagnosis and management, vaccinations, chronic disease management, sexually transmitted disease, travel vaccinations and well man and well woman checks. He will also continue to offer musculo-skeletal medical expertise for sports injuries and inflammatory musculo-skeletal conditions.  

Initially Dr Nerney will be available for consultation Monday to Friday between 10.00am – 01.00pm each morning. There will be a choice of short (15 minute) or long (30 minute) consultations.

Mr David Deardon, Specialist Surgeon and Managing Director of the Specialist Medical Group said “over the last 12 months we have experienced an increasing demand for family medicine services within our clinic, and it was therefore a delight when Dr Nerney asked to join our practice. His arrival brings to our clinic a wealth of clinical experience and leads the way for the clinic to expand the services we offer to include emergency and routine family medicine, providing patients with the option to receive a same day emergency illness service”.  

To book an appointment or for any further information, please contact the Specialist Medical Clinic team on 00 350 2004 9999, or e-mail to info@specialistmedicalclinic.com.

An interesting article in the Daily Mail on Gastric Balloons.