Acting chairman of the Trinidad and Tobago Cancer Society (TTCS) Dr George Laquis says T&T has the highest deaths from prostate cancer in the world.He was speaking at a lecture on prostate cancer titled Lack of Evidence-based Medicine: Understanding and Implementing PSA Guidelines into Practice, hosted by the TTCS and TT Medical Association's CME at the Courtyard Marriott Hotel, Invaders Bay, Port-of-Spain, last week.
"The highest mortality rate from prostate cancer in the world is T&T, probably because we're not screening our population who're at risk, so we're losing our men at an alarming rate," Laquis said."That data from the cancer registry of T&T is very disturbing and it's a wake-up call, we have to get more active with this and educate our healthcare providers on the uses of these tests."A lot of us have a lot of doubts about the PSA test, what is an aggressive cancer as opposed to a non-aggressive cancer.
"It's very important that we don't want to do any harm by taking a non-aggressive cancer and treating it like an aggressive cancer and subject the patient to surgery, radiation therapy, when that cancer would not have harmed the patient, yet we don't want to miss the aggressive ones."The PSA test measures the blood level of PSA (prostate-specific antigen), a protein that is produced by the prostate gland.
Prof Vijay Naraynsingh said T&T had a steady increase in the mortality rate for prostate cancer since 1970 and an unrelenting rise in deaths not only in new cases but in deaths."Our death-to-incidence ratio is very high, one of the highest in the world and certainly the highest in Latin America and the Caribbean," Naraynsingh said.
"While it is the second most common cause of death in the US, it is the most common cause of death in T&T, so we have significant differences from the data that Dr Slawin presented and I think, therefore, we have to use different guidelines, because we're dealing with a more aggressive disease that is affecting more Afro-Trinidadians and many of them at younger ages as well."
Tobago-based Dr Alan Patrick said the prevalence and incidence in the mortality rate from the disease in Tobago was similar to Barbados and was accepted as "very high," but not yet published."Regarding the US policy, whether it would not make sense to pursue the issue of screening, we intend to submit an article this year to the British Journal of Urology International," Patrick said.
Patrick said prostate cancer affected all races, the most severe and most common in mortality appeared to be much higher in Afro-Trinbagonians, less so in Indo-Trinbagonians and least in Caucasians.Dr Philip Ayoung-Chee said while PSA was important in the diagnosis of prostate cancer, it did not equate to cancer so it had to be used very carefully in the diagnosis."We also need to look into the report of the high mortality rate of prostate cancer in T&T," Ayoung-Chee said.
"The information is that from the Tobago study, there is a high prevalence of cancer and this needs to be backed up by evidence that there is a high mortality and incidence rate."Slawin's lecture will be available on the T&T Cancer Society's Web site shortly.Also present at the event were TTCS chairman Dr Jacqueline Pereira-Sabga and first vice chair Dr Marlene Sukhdeo.