Avia Ustanny, Sunday Gleaner Writer

Michael Manley, former Prime Minister of Jamaica, died of prostate cancer (left) and Nelson Mandela was stricken with prostate cancer, but survived it (right).

The fear of losing their virility and fear of going to doctors are behind the reluctance and disinterest among men in penile and prostate cancer.

Michael Manley died from it. Nelson Mandela, Ben Carson, Sydney Poitier, Quincy Jones, Louis Farrakhan, Colin Powell and Harry Belafonte were stricken with, but survived, prostate cancer.

Locally, despite the cancer's prevalence and deadly effects, it appears that much more money is spent on programmes to increase awareness about cancers affecting women than males.

Head of urology at the University Hospital of the West Indies and president of the Jamaica Urological Society, Dr. William Aiken, states that funding for breast and cervical cancer has been much more than that for prostate.

"It has been so for a long time. This has recently changed in the United States, but compared to breast cancer, it is still woefully inadequate. I don't know if it is because the persons who drive these programmes are women."

Second leading cause of death among black men

Research shows that prostate cancer is the cause of death among thousands of black men each year. The World Health Organisation reports that next to heart disease, prostate cancer is the leading cause of death among black men in the United States, Canada, United Kingdom and the Caribbean.

In Jamaica, the incidence is even higher proportionally than in the U.S. where prostate cancer victimises over 220,000 men per year, eventually killing well over 25,000 every year. While one in six men in America is projected to get prostate cancer, it occurs almost 70 per cent more in African American men.

The latest mortality data for Jamaica are for 1999, during which there were 1,466 male cancer deaths - 445 were from prostate cancer. In that year a total of 2,697 persons died of cancer.

In a 1997 study, 'The Epidemio-logy of Prostate Cancer in Jamaica', authored by F.E. Glover, et al, demonstrated that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period.

It also stated that the cancers are "more significant clinically with greater morbidity in Jamaica than in the United States".

One source at the Ministry of Health (MOH) told The Sunday Gleaner said that all awareness promotions on cancer were left to the Jamaica Cancer Society.

Speaking on condition of anonymity, he said, "Even during Cancer Month we can't get a doctor here to speak on it. There are no promotions. It is left up to the Cancer Society. The only thing they talk about here is cervical cancer."

However, Kim Mair of the Jamaica Cancer Society (JCS) states that, while she is aware of a stipend granted in the Govern-ment's annual budget for use by the Cancer Society for its programmes, "I am not aware of us getting it."

According to Marva Lee, administrative director of the JCS, "The MOH does not usually send us any money, and certainly not for awareness about prostate cancer, nor do they do any promotion in this area."

Outreach screening and education

She adds: "In 2006 they gave us a donation of $500,000 to contribute to our work in outreach screening and education. We do cancer screening for breast, cervical and prostate cancer and cancer awareness for breast, cervical, prostate, colon and tobacco control."

Ms. Lee says, despite budgetary constraints, the JCS will attempt a publicity campaign on prostate cancer.

Doctors in the medical fraternity state that the fear of losing their virility and fear of going to doctors are behind the reluctance and disinterest among men in penile and prostate cancer.

According to Dr. Aiken, different methods are needed to reach men from those used for women. "You need to go to the places where they hang out to find them. Take the message to them. Let them see that men who have been tested for prostate cancer are normal men," says Dr. Aiken.

The doctor noted that the number of men who come for screenings for prostate cancer at the JCS are minuscule compared to the women who come in for their Pap smears and other tests. In one year, he recalled, 8,000 women came in, while only 200 men came for screenings. Many men who experience symptoms keep it to themselves until it is way too late.

Promoting prostate examinations

According to Dr. Aiken, Jamaican doctors have not been negligent in cautioning their male clients about prostate cancer. In fact, he notes, they have been accused of the very opposite, as one well-known member of the medical fraternity has accused urologists of promoting prostate examinations as a means of making money.

However, the main problem with prostate cancer was that men are afraid. "They figure, what you don't know can't kill you,' Dr. Aiken argues.

There is also the stigma of the rectal examination. "They don't go to doctors unless they are feeling pain or something is wrong with their erections. Real men bear pain. Many men have boasted to me that they have never been to see a doctor," the urologist reveals.

For further information, go to www.jamaicacancersociety.org/pages/penilecancer.htm

Cancer study of 90 men

30% presented with acute urinary retention.

16% presented with bone metastases.

15% had gross haematuria.

42% had abnormal rectal examination which could lead to cancer.

Source:Department of Pathology at the University Hospital of the West Indies.