Despite prostate cancer being the most frequent cancer overall and the most common cause of cancer-related deaths in Jamaica, it is a ‘Cinderella disease’ in that it has consistently suffered from undeserved neglect by health authorities and civil society who must seemingly believe that men destined to suffer from or currently afflicted with prostate cancer are ‘children of a lesser god’. This is the conclusion drawn because of the stark contrast in the allocation and mobilisation of resources and investments made in breast cancer (a predominantly female disease of lower incidence and mortality), for example,when compared to prostate cancer.
Prostate cancer disproportionately affects men of African ancestry and the risk of affliction increases inexorably with age reaching its peak incidence in men in their 70s. The Jamaican population is documented to be ageing: by 2030 the over-65s will form 16 per cent of our population from its current level of eight per cent. We can therefore expect an exacerbation of the high death rate from prostate cancer if we don’t change the way we do things. There are only three established risk factors for prostate cancer, and they are all non-modifiable: one cannot do anything about one’s age, race or family history.
If the high mortality from prostate cancer in Jamaica is to be seriously and intelligently tackled several things must be instituted quickly and concurrently. Firstly, a credible ‘champion’ of the disease needs to be identified who men respect and can therefore serve as a role model that they will pattern their health-seeking behaviour after. This ‘champion’ would serve as the ‘face’ of a sustained public education campaign about prostate cancer and the importance of early detection through screening.
Secondly, the Ministry of Health & Wellness must lead in establishing and facilitating screening of Jamaican men through the primary health care system so that early detection of prostate cancer is accessible to Jamaican men, regardless of their financial resources and geographic location. This is particularly important given the known barriers to accessing healthcare due to a lack of money/insurance as well as geographic barriers especially relevant to Jamaica given the mountainous and relatively inaccessible terrain of many rural areas.
Thirdly, the health ministry must immediately address the maldistribution of urologists and cancer specialists who are mainly located in Kingston and Montego Bay. Urban centres such as Mandeville, May Pen, Spanish Town, St Ann’s Bay, Port Antonio and Morant Bay do not have any urologists while at the Kingston Public Hospital (KPH) alone you have seven. In the south-western part of the island, for example, one single part-time urologist serves a population of 793,000 people.This is unacceptable and inexcusable given that that The University of the West Indies has been training consultant-level urologists since 1995. With a more even distribution of urologists, patients will be able to access general urological care of a high standard at these hospitals, something they cannot access currently, and be referred to centres of excellence at the University Hospital of the West Indies (UHWI), KPH and Cornwall Regional Hospital (CRH) if necessary.
Fourthly, the Government must ensure that patients have access to the necessary equipment for timely diagnosis and treatment by equipping hospitals that serve as treatment centres (KPH, UHWI, CRH) and embracing public-private partnerships, thereby making available state-of-the-art technologies such as 3 Tesla multiparametric MRI that have proven value in the diagnosis, staging, and follow-up of men with prostate cancer.
Drugs scientifically proven to be of benefit in significantly improving survival in advanced prostate cancer should be accessible to all Jamaican men through subsidies by the National Health Fund (NHF). Currently, this is not the case as locally available drugs such as Abiraterone Acetate and Apalutamide, both scientifically proven to significantly prolong survival in advanced prostate cancer, are not on the approved list of drugs by the NHF. This causes untold suffering and unnecessary shortened lifespans in men with advanced prostate cancer. Advanced disease which ultimately results in death is commonly seen in Jamaican men partly due to the lack of access to affordable early detection programmes.
Finally, as is the case with women with breast cancer who have formed their breast cancer support groups, so too must men and the women who love them, assisted by civil society, non-government organisations and churches come together and form prostate cancer support groups that offer men succour and support as they face a diagnosis of prostate cancer, navigate the complex health care system, and journey with them through the various forms of treatment. A lot of myths, half-truths, and misinformation about prostate cancer and its treatments abound; men who have been previously diagnosed and treated for prostate cancer are a potentially potent resource as they can offer correct information, guidance,and encouragement to men newly diagnosed with prostate cancer.
While the emphasis on prostate cancer during the month of September is welcome, the token efforts and events during the month are simply not enough to make any dent in the high mortality from prostate cancer in Jamaica. A sustained, coordinated and wholistic programme rooted in a primary health care approach and integrating with tertiary care where necessary, intelligently lead by the Health Ministry, and involving all the elements and stakeholders integral in the prevention and treatment of prostate cancer is required, to finally realise a reduction in prostate cancer mortality in Jamaica.
William D. Aiken, DM (Urol), FRCSEd, FACS, FCCS, is senior lecturer (Urology) and consultant urologist, The UWI/UHWI, president, Association of Surgeons in Jamaica, and a past president, Jamaica Urological Society.