Prostate, testes, intestines: you better have them checked every now and then to prevent cancer. “Many men know their car’s oil level better than their own bodies.”
Being male, it’s not always an advantage. Slightly more men than women in Belgium get cancer before the age of 75. Is it the men’s lifestyle, or are there biological differences that give women an immune advantage? The science isn’t quite there yet. It has been established that most people can avoid about 40 percent of cancer risks by watching their lifestyle and getting screened.
prostate cancer
Prostate cancer is known as an old man’s disease, but every year in our country there are also about 400 prostate cancers in people under 55. ‘It is the most common cancer and the second most common cause of cancer death in Western men,’ says Filip Poelaert (urologist, GZA hospitals). ‘The disease does have a broad spectrum. For example, the mortality of low-grade prostate cancer is so low that there is not really a clear survival advantage with early detection. We need to focus on the screening of aggressive forms of prostate cancer.’
How to screen? Prostate cancer is detected by measuring the prostate-specific antigen (PSA) in the blood, a protein produced by the prostate. The European guidelines recommend screening from the age of 50 and even from the age of 45 if there is a family history or African descent. Depending on the PSA level and the rate at which PSA evolves between two measurements, the urologist may consider a biopsy based on an MRI scan.
‘All too often it is said that the PSA test actually does more harm than good, also as advice to GPs. That is based on an overly simplistic interpretation of the scientific literature.’
But prostate screening is not a black and white story. Poelaert: ‘All too often people say that the PSA test actually does more harm than good, also as advice to GPs. This is based on an overly simplistic interpretation of the scientific literature. Sometimes high-risk patients are told that screening is no longer necessary, while in others PSA is determined inappropriately and inappropriately at the patient’s expense. Many variables play a role in a PSA screening. It is certainly useful as a test to detect prostate cancer, but the question is at what threshold value you speak of an “elevated” PSA. The PSA can also be increased due to an enlarged prostate or prostatitis. We should not just biopsy everyone with a slightly elevated PSA value at the population level. Then you run the risk of overdiagnosis and overtreatment. I usually recommend a PSA determination to someone aged 50 who comes to me for a consultation, even without an increased risk. The biggest risk factor is age. A one-time determination at 50 can certainly provide direction, in the context of a diagnostic process to prevent overdiagnosis.’
No Nut November?
The annual internet challenge ‘No Nut November’ calls for people not to masturbate for a month. That would be good for male health. Piet Hoebeke (urologist, UZ Gent) is not convinced: ‘Masturbating is a very meaningful activity and has no negative health effects whatsoever, as long as it does not interfere with daily activities. Discharging things once in a while is actually very healthy. There is even one major proven benefit of masturbation: men are less likely to develop prostate cancer later in life if they ejaculate about twenty times a month between the ages of 20 and 40. Mental health also benefits.’
Testicular cancer
Testicular cancer is a rather rare form of cancer – with an average of 400 diagnoses per year – but unfortunately the disease is on the rise. It is the most common type of cancer in men between the ages of 15 and 40. “The main risk factor is cryptorchidism, in which one or both testes are not descended at birth,” says urologist Thierry Roumeguere of the Academic Hospital Brussels. ‘The diagnosis of testicular cancer has doubled in Europe in recent years. Chemical pollution probably plays a role, but that is not certain because the studies are still ongoing. Endocrine disruptors would affect the development of the genitals already in the womb and increase the number of cases of undescended testes.’
How to screen?
Easy. By checking the testicles yourself every month. Check for enlargement (bloating and heaviness), induration (usually painless), and crazy nodules (pea-sized). Men who act early have a 98 percent survival rate after five years.
Colon cancer
More and more patients under the age of 50 are affected by colorectal cancer. It is therefore important to take into account personal risk factors as a guideline for screening, such as a low-fiber diet, high meat and alcohol consumption, little physical activity and being overweight. ‘Worldwide, the number of colon cancers is slightly higher in men than in women, but the difference is small,’ says gastro-intestinal specialist Luc Colemont. ‘This may have something to do with a protective role of estrogens in women in the mechanism of development of colorectal cancer.’
‘The active, vital, young over-50s should have themselves tested much more often.’
How to screen?
You can from the age of 50 having the stool tested for blood every two years, or having a colonoscopy performed every 10 years. The risk of colorectal cancer is higher if there is a history of colorectal cancer or inflammatory bowel disease in the immediate family. Then a colonoscopy is recommended every 2 to 5 years, sometimes from the age of 40. Colemont: ‘Flemish men generally participate less often in the population screening. Maybe they think cancer won’t happen to them, or they procrastinate more than women. More worrying is that the participation rate in the 50 to 54 age group is barely 36 percent. The active, vital, young over-50s should get tested much more often. The earlier the detection, the greater the chance of survival. Many men know the oil level or the condition of their car’s exhaust better than the condition of their own bodies.’
Lung cancer
Lifestyle is a determining factor in lung cancer. More than 80 percent of lung cancer cases can be traced to risky behavior. And because men smoke more often than women, lung cancer in Belgium is most common in men.
How to screen?
The best prevention of lung cancer is, of course, to quit smoking. Lung cancer screening is recommended for people over 55 who have smoked a pack of cigarettes a day for 30 years and who stopped smoking less than 15 years ago (or not yet). Those at risk are advised to have a CT scan with a low radiation dose every year. In this group, a quarter of deaths from lung cancer can be prevented.