Dr. Sam Christian

Dr. Sam Christian

That was all he told me. The dapper Dr. Royer was the logical choice to do my student visa application physical. He was our psychiatrist-advisor when I was president of the Dominica Association of Mental Health before leaving in 1977.

“WHOY!!!” I stifled a grunt.

Yes, I did hear the good doctor snapping the rubber gloves as he prepared to do my routine examination. But never having it done before, I had no idea what was in store. By the end of this article YOU will able to give others clear advice as to what to expect.

Dr. Velda Wade’s Health Centre

Fast forward 38 years. I am on the other side of the finger. I was sharing the honours with Dr. Malaker (radiation oncologist) and Bahamian Dr. Maureen Hall, both from Ross University, along with students. Together, we did heaven-knows-how-many prostate checks/rectal examinations last Saturday.

The Dominica Cancer Society membership (mostly female) supported in force. Yet, I was truly impressed by the maturity of the gentlemen-patients taking advantage of the program at Castle Bruce. So highly motivated were they, any advice given to them seemed like preaching to the choir. Ross’ Rosanna Emmanuel in charge of logistics, Dr. Wade, Nurse Vigilant and their team deserve full credit for doing a fantastic job organizing the screening.

Still, the homophobic taboo lingers in the population at large. And macho, macho men risk being taken down by prostate cancer rather than be “penetrated.”

Prostate cancer

The prostate is about the size of a groundnut (gwen peh) located beneath the bladder and in front of the rectum. The gland generally enlarges with age; a condition is called Benign Prostatic Hypertrophy (BPH). This is reflected in the number of times one has to get up at night to urinate (nocturia). Prostate cancer also develops fairly often and is usually slow growing. Upwards of 2/3 of elderly men have evidence of prostate cancer at autopsy that never caused noticeable symptoms. A sharp increase in nocturia suggests a fast-growing cancer and intervention is necessary.

For whatever reason, prostate cancer is more common in blacks. (Don’t worry; it all equals out. There are other cancers less common in blacks such as skin cancer). The good news is that treated prostate cancer generally has only 3-6% death rate depending on race. Cancers of the lung, colon and pancreas for example, are much more lethal.

Prostate cancer screening is traditionally involved annual Digital (finger) Rectal Exam (DRE) and Prostate Specific Antigen blood test starting at age 40. PSA can be ‘falsely’ elevated by prostate infection (prostatitis) and recent sexual activity. In the past, results higher than 4 required an ultrasound-guided prostate biopsy. Once cancer was diagnosed, that meant radiation or surgery overseas and or chemotherapy at the Princess Margaret Hospital oncology clinic. Risks of treatment include erectile dysfunction (impotence), difficulty urinating, incontinence and even hot flashes.

Screening changes

Some stubborn men were hoping the new recommendation meant no more finger exams. Awa!  Changes essentially involve more technical selection of patients. Those with a prostate cancer family history and black males should continue beginning DRE/PSA at age 40. Now, other populations can start at 50. Patients are carefully advised not to ride a bicycle and to avoid ejaculation for two days before the PSA test.

Listen here to details on new screening guidelines

My father was the first patient ever I diagnosed with prostate cancer. He was in his late 60’s at the time and was cured by radiation therapy. By God’s grace, his annual PSA remained normal the rest of his life. He slipped away full of years from other age-related causes. The men in our family know that genetically we are at high risk. We keep on each other about our check-ups. I give thanks and praise mine was good when done just last month.

This time I was prepared! Seriously; it’s really not that bad. Don’t be put off by all that guy-talk and crude humour. So much depends on the women of the family giving them that extra encouragement: Honey, I’ll go with you…Why die from embarrassment?

We all have to go some time. But when I do, it definitely won’t be because I was too carpor to take some stupid, little test.

My brother, t’will be worth it for just one to agree:

‘If it’s good enough for Doc, it’s good enough for me.”

Dr. Sam Christian is surgeon and health activist. He runs the Urgent Care on 137 Bath Road, which offers prompt medical treatment, surgery and acupuncture. He is radio host of the Medical Minute, Medical Adviser to the Dominica Cancer Society and author of the faith and fitness nutrition book, ‘Mannafast Miracle.’ Dr. Christian can be reached at 440-9133 or by writing to urgentcare.da@gmail.com.