Avia Ustanny, Outlook Writer

Two months after radical surgery to deal with prostate cancer, Kingston-based attorney-at-law, Alfred McPherson, is insisting some local doctors are downplaying the prostate cancer in a way that might be detrimental to the lives of men who rely on their expert opinion. He is also encouraging men to be more assertive about getting annual prostate examinations done.

Pointing to the vigorous breast cancer campaign

pursued annually by the medical fraternity, he said that there is nothing of equal weight for men and prostate cancer, even though Jamaican men have the highest incidence of occurrence and death from this disease.

"I don't think enough is being done. In my opinion, there is a very cavalier approach to prostate cancer. Internationally, we have the highest rates and deaths too," he told Outlook. His conviction is the result of his own harrowing experience.

In February 2006 Alfred McPherson's wife thought that he was a bit overweight and made arrangements for him to see a nutritionist. He went in March and by July I had lost 50 pounds. McPherson took the nutritionist 's advice to cut out sweets and was becoming an exercise fanatic, including cycling.

"Up to July 2006, I thought I had perfect health."

Underneath, McPherson knew that he was in the high-risk category for men for cancer, as his father had had the disease. "I had begun screening from in my 30s because of this," he said.

At this age, he had also began experiencing repeated episodes of prostatitis. Tests showed that his PSA (Prostate Specific Antigen which indicates the possible presence of cancer) level was a little higher than usual so he continued to do annual examinations.

In October 2004, the lawyer went through the usual examinations with his urologist, including blood tests. It was a stressful period, he recalls and after calling the urologist's office for the results, he simply forgot about it after he was told that he was not available. He had requested that the doctor call him back. That call was never made.

In July 2006 Alfred McPherson did his annual examination and went off happily to vacation in Canada. On his return he called the urologists office to get his results but met upon the usual unavailability. Two weeks into his return another urologist who shared offices with his own called to say he needed to meet with him. This doctor apparently heard the office receptions commenting on McPherson's frequent calls and comments of dissatisfaction. When they met, the urologist told him that his PSA levels were high and had in fact been worryingly above normal since 2004.

It was the moment, McPherson said, when he started a downward spiral in medical treatment locally. "The urologist divulged to me that, in 2004 my PSA level was 7.3. The range considered normal is 0 to 4. No one ever contacted me for further screening. I remained for two years in darkness." The urologist also told him that his PSA for July 2006 was 10.2 - again showing a significant rise.

The doctors said that an ultrasound and biopsy would be necessary. He did both and, two weeks later, was called to be told the good news that he was cancer free. He called his wife and his entire family aboard to share his joy. But just one day later McPherson was told the opposite of what he had heard the day before. Cancer had been seen on the slides after they were re-examined.

His family was disconcerted and immediately started to insist that he seek a second opinion overseas. While he considered that, however, his doctor was telling him that he was a good candidate for brache therapy which involves the use of radioactive therapy to treat cancer. This, the doctor told him would encourage remission of up to five years and more. He added that the cancer in his prostate was so minuscule that it was no bigger than a the head of a ball point pen.

McPherson was not comforted. "I did not want to start counting my life in five year tracts," he recalls.

While he wondered what to do, he was also doing extensive research about prostate cancer and its treatment. He also had a good friend from school days who had test done overseas. It was he who called Dr. Paul Kham at Euro-Surg Associates in Florida and made the appointment for testing.

Arriving at the centre in early October, McPherson recalls, "It was the first time I felt I was being treated with the respect any patient deserves form a medical practitioner. I felt that I was the important person and not that I was coming to see someone akin to God. I felt I was there to be served and would get what I paid for."

Unlike the Jamaican experience of a four-core biopsy, the doctors in Florida did 12 cores, telling him that 16 was in fact the norm. The new test showed that he had cancer and much more pervasively than had been said. It also suggested that the brache therapy suggested by his Jamaican doctor would not have helped.

Reviewing his medical records, the doctor also noted that McPherson's PSA level had really risen since 2002. He also said that if a radical intervention was not done the lawyer would possibly die from prostate cancer. The doctor suggested removing the prostate entirely by surgery.

McPherson was scheduled for laparoscopic surgery, which utilised a robot to remove the prostate non-invasively with six minuscule incisions. The operation lasted for seven hours. Laporoscopic surgery also known as the Da'Vinchy prostatectomy spared the nerves which affect sexual function - lessening the likelihood of erectile dysfunction. It also lessens the persistence of incontinence (the inability to hold urine) which usually accompanies conventional surgery.

After removal, it was discovered that 35 per cent of McPherson prostate had cancer. Had the organ not been removed, it might have been only a matter of a few months before the cancer spread to his bladder, lungs, liver and kidney in its usual fashion.

"It is not true to say that one can outlive prostate cancer. More and more Jamaican men are contracting the cancer in their 40s 50s and 60s. When you get it at a later stage in life, it is true that you might die from some other health complication related to old age. But for those who are younger, prostate cancer remains the highest cause of cancer related deaths among men in Jamaica. In the United States, it is number two."

The medical profession and even the Jamaica Cancer Society, the lawyer now states, need to do a much better job of helping men to prevent the worst effects of the disease. While women are well informed about breast cancer especially, many men remain the dark, Alfred McPherson states.

The lawyer notes that the medical profession might be cautious because of the the male fear of sexual dysfunction which is often associated with prostate cancer, and so be forced to downplay the disease.

But, unless the general attitude towards the disease among the medical profession is changed, even younger men will continue to die from prostate cancer, he believes.

For those who are concerned about being able to have sex, he states that "being alive and present with your family, is much more important that retaining sexual prowess."

Additionally, with new techniques such as the laporoscopic prostatectomy, the chances of recovering sexual function are much higher.

In his case, two months after the radical prostatectomy his sexual function has not yet returned, but incontinence has improved significantly. While he is as yet unable to restart his exercise regime, he is very happy to be alive and is vigorously encouraging other men to do their annual examinations - including the blood test for PSA levels and ask tough questions of their doctors.

"It is more important to have a life with your family than to think that you are a stud. My two sons are grown and I want to see my grandchildren. Do your tests and check your PSA levels."

He hopes that post-operative tests in February will show that he is cancer free.