Monday, November 4, 2013 C9
HEALTH
FURRY
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am Gilbert is 26 years old, but already knows just how protracted and painful a battle with prostate cancer can be. For nine years, Gilbert witnessed his grandfather’s health deteriorate until June, when he succumbed to the disease at the age of 76. “I saw the decline in my grandfather’s standard of living. And it was tough because he was the big chief, the patriarch of the family,” says Gilbert, a Briton who has lived in Hong Kong for four years. “The cancer spread to the rest of his body and his bones. It affected his joints and so he had problems getting around. It was debilitating. People see cancer as a fast track to death when, in fact, it can be a really long and horrible battle.” Motivated by his first-hand encounter with prostate cancer and concerned by a lack of awareness about the disease here, Gilbert and his teammates from the DeA Tigers Rugby Football Club are taking part in Movember for the first time. The rules of the annual fundraiser for men’s health are simple: start November cleanshaven, before growing and grooming a moustache for the next four weeks. Curious questions about furry upper lips are meant to help break the ice in discussing men’s health, and each of the participants is supposed to seek sponsorship. “Prostate cancer is not talked about in Hong Kong; I think there’s a slight taboo associated with it,” says Gilbert. The usual test for signs of the cancer involves a doctor feeling the surface of a walnut-sized gland in the anal canal. The process is known as a digital rectal examination. A second test, the prostate-specific antigen (PSA) test, involves taking a blood sample. “[The rectal examination] is a rather intimate check-up. Guys are often too proud to have another person’s finger up their behind. But at the end of the day, if it could give you another 20 years of life, why not?” The incidence of prostate cancer has risen rapidly throughout Asia, including Hong Kong, according to researchers at the Chinese University of Hong Kong. Statistics from the Hong Kong Cancer Registry show prostate cancer was the third most common cancer in local men in 2010, accounting for 10.7 per cent of new cancer cases in males. About one-third of men older than 50 have cancer cells within the gland, and nearly all men over 80 have some degree of prostate cancer, says the Hong Kong Cancer Fund. In many cases, the cancer
LOGIC
Raising funds for Movember starts with a clean shave for Sam Gilbert (left).
Movember’s month of facial hair and fundraising highlights the importance of prostate cancer screening, writes Jeanette Wang
cells grow so slowly that they do not pose a problem. A man suffering from prostate cancer will often die of another cause. About one in five men with prostate cancer here die from the disease, based on the registry’s data. The problem is there’s no screening test that can accurately tell if the cancer is slow-growing and benign, or
Prostate cancer is not talked about … there’s a slight taboo associated with it SAM GILBERT (BELOW)
fast-growing and malignant. The PSA test has been used, controversially, to indicate the cancer’s presence in the blood. High or rising levels of PSA – a protein made in the prostate – may indicate the presence of a tumour. However, the test is not disease-specific: non-cancerous conditions such as an enlarged or inflamed gland can cause elevated test results. When PSA levels rise above 4 nanograms per ml in the blood – a threshold that is itself contentious – a biopsy is recommended, but there is often no sign of cancer in up to 70 per cent of cases, says Dr Tam Po-chor, a urologist at the University of Hong Kong’s Department of Surgery. Up to 44 per cent of PSAtriggered biopsies find prostate cancer cells that are indolent and non-lethal, says the Prostate Cancer Foundation in the US. “The harms of PSA screening include false-positive test results in up to 13 per cent of screened men and can be associated with significant psychological distress, in addition to the potential adverse effects of biopsy (bleeding, urosepsis, and acute urinary retention),” Tam wrote in an editorial for the Hong Kong Medical Journal last December. “Many men diagnosed with prostate cancer by screening have low-risk disease, which is associated with a low risk of prostate cancer-specific death after 15 years.” The search is on for new biological indicators that could help physicians identify higherrisk tumours and put an end to unnecessary operations. A gene-based marker called
LAB REPORT ............................................... Jeanette Wang jeanette.wang@scmp.com Pregnancy test may predict severe high blood pressure Scientists in Britain have created a new test to identify pregnant women at risk of developing severe high blood pressure known as pre-eclampsia, which can damage the kidneys, liver and brain and lead to serious fetal complications. The test can check whether placental protein levels are too low and may prevent unnecessary hospitalisation of women not likely to develop preeclampsia, says Lucy Chappell, clinical senior lecturer in obstetrics at King’s College in London. The study was published in the journal Circulation. Scientists expose secrets of lethal cancer Researchers from institutions in Singapore, Romania and Thailand have found the molecular basis of highly lethal and incurable bile duct cancer, which has a five-year survival rate of 5 per cent. They identified genes that were disrupted in order for the cancer to develop. Cellular pathways controlled by these genes could be avenues to treatment. The study, published yesterday in the journal Nature Genetics, also sheds more light on how cancer develops: the disease was found to be caused by various carcinogenic exposures globally.
Way out of left field Left-handed people are more likely to have psychotic disorders such as schizophrenia, according to a Yale University study published in the journal SAGE Open. According to researcher Jadon Webb, who has an interest in biomarkers of psychosis, “a striking 40 per cent of those with schizophrenia or a schizo-affective disorder are lefthanded”. He adds: “In general, people with psychosis are those who have lost touch with reality through delusions, hallucinations, or false beliefs, and this symptom constellation seems to correlate with being left-handed. Finding biomarkers such as this can hopefully enable us to identify and differentiate mental disorders earlier, and perhaps one day tailor treatments in more effective ways.”
10.7%
Urology has prostate cancer antigen 3, or researched PCA-3, has shown PCA-3 and The annual percentage promising results. concluded it of new cancers in men This protein is could help linked to the prostate diagnose prostate found only in the cancer among prostate and its Chinese. However, elevated presence in urine could the study’s lead potentially be a better indicator researcher, Chinese University of the cancer’s presence. Professor Anthony Ng Chi-fai says mainland research has The test requires a rectal found that T2:ERG occurs in just examination beforehand, which 20 per cent of Chinese patients is supposed to loosen and shed cells within the gland. and may not be useful in making A urine test assessing the a correct diagnosis. In Ng’s latest study, levels of PCA-3 and T2:ERG, published in International a genetic anomaly present in Urology and Nephrology last about half of prostate cancer patients, became available in the month, another new test, the US last month. The Prince of Prostate Health Index (Phi), was evaluated in Chinese patients. Wales Hospital’s Division of
The test, a version of the PSA test, is said to be 2.5 times better than typical PSA screening at detecting prostate cancer. The hope is the test will better identify biopsy candidates and reduce over-detection rates. The Phi was approved by the US Food and Drug Administration in June last year and has been available in the US since December. Ng’s retrospective study of 230 Chinese patients over 50 years old, with a PSA level of 4-10 ng/ml and without any indication of the cancer after a rectal examination, found the test helped decrease the number of unnecessary biopsies. “So, it may be helpful for patients with a mild increase in
PSA and who are a bit reluctant for a biopsy,” he says. Ng says his team is working on other indicators to diagnose prostate cancer. “But we believe that prostate cancer in Chinese and Caucasians may be different, and so the management of the disease in Caucasians needs to be verified by local studies.” The funds raised by Movember’s participants will go to the Cancer Fund and research. Some 65 per cent of the net funds raised here will be allocated by the Cancer Fund to research that supports the Movember Global Action Plan, an international research programme into prostate and testicular cancers. The rest will help the fund pay for programmes to support men with prostate cancer and their families. For example, the fund provides Prostate Recovery Packs to newly diagnosed patients in hospital. They contain information and supplies, including an adult diaper, urinary sleeve and cranberry juice. As of last week, nearly 700 participants – known as “Mo Bros” and “Mo Sistas” – had signed up locally to take part in Movember. Last year, the first time an official campaign was held here, more than 1,800 participants raised nearly HK$4.5 million. “I feel really confident that we’ll increase the number of participants this year,” says Greg Rafferty, manager for Movember Asia. The charity began 11 years ago with 30 Mo Bros in Melbourne. Last year, 1.13 million participants in 21 countries raised A$141.5 million (HK$1.04 billion), a 14 per cent increase over 2011’s efforts. jeanette.wang@scmp.com