According to the World Health Organization (WHO), prostate cancer is the second most common malignant tumor. It is a non­dermatological tumor diagnosed in patients beyond the age of 50, which is also the second leading cause of cancer-related mortality across the globe after skin cancer. The lifetime risk of developing a microscopic, clinical disease and prostate cancer-related death is 30% in developing countries.

The prostate is a small walnut-shaped gland that sits below the bladder near the rectum, surrounding the urethra, the passage in the penis through which urine and semen pass. Most people are not sure what the prostate is, what it does or when to call a doctor if they think they might have a problem.

I reached out to medical experts and doctors in Pakistan to find out more about the disease. The overall elderly population of Pakistan currently stands at 10 million, half of which live in rural settings where health facilities are not as upgraded as they are in cities, according to the Pakistan Bureau of Statistics (PBS), 2017.

Dr. Shahzad Ali, an oncology consultant, said that prostatic cancer does not show early signs of physical harm unlike other forms of cancer.

“As cancer progresses, it spreads to the bones causing intense pain in the back, hips, and the pelvis,” he said, adding that there is still no robust medical arrangement that could detect the malignancy at its earliest.

“The cancer detection rate using prostate-specific antigen (PSA) measurements is between 2 to 4%.”

He further added that about 20% of men with prostate cancer will have PSA levels within the normal range. Therefore, PSA alone as a screening test is controversial.

“If digital rectal examination reveals a prostate that is hard and nodular accompanied with high PSA levels, then trans-rectal ultrasound scan (TRUS) and biopsy are indicated. Magnetic resonance imaging (MRI) and TRUS are for staging the local disease. While x-ray of chest and liver function tests are carried out for metastatic spread of the disease,” explained Dr. Ali.

Sohail Rauf, 61, was diagnosed with prostate cancer last year. To further understand the impact and toll it takes to battle this disease, I reached out to him.

“I am a diabetic patient and last year I was facing excessive urinary problems. I thought it was due to high diabetes so I went to a doctor only to find out that I was suffering from prostate cancer,” he said.

Rauf went through a physical examination, followed by a biopsy. A biopsy is the only way a firm diagnosis of prostate cancer can be made. “The doctor removed small samples of tissue from the prostate, using very thin, hollow needles guided by an ultrasound,” he said.

Rauf faces no hurdles in his day-to-day life after going through prostate surgery.

“I was asked to limit my consumption of red meat, including beef, lamb, and goat, and was advised to stop smoking and drinking alcohol.”

The doctor suggested he consume healthier sources of protein such as fish, skinless poultry, beans, and eggs.

Apart from these precautionary measures, Rauf is supposed to visit his consultant for the rest of his life for regular check-ups every six months.

In response to a question about delay in seeking medical care, Dr. Masood A. Sheikh, a urologist said, “Men with urinary symptoms are hesitant to discuss the problem, perhaps, because of embarrassment, believing that all of it is part of ageing or due to the fear of treatments such as surgery.”

The findings of the study on clinicopathological characteristics of prostate cancer suggest that there is also a need to improve public attitude regarding urinary symptoms in older age men and knowledge about prostate cancer in Pakistan.

The Distinguished Gentlemen’s Ride (DGR) is a unique event that helps raise awareness and funds for prostate cancer in Pakistan since 2015.

“It is a themed ride for café racers, scooter riders, bobbers, choppers, and scramblers,” said Faisal Malik, the official spokesman for DGR in Karachi.

“DGR takes place on the last Sunday of September. The event’s main aim is to spread awareness and raise funds for prostate cancer research and other health issues that men face in Pakistan,” said Nabil Hasan, media executive of DGR.

Talking about the event, Hasan said it takes place in over 400 cities, across all five continents, with more than 15,000 participants that ride their classic motorcycles, dressed up in their finest attire, taking the cause to the streets of Karachi.

One thing that sets DGR apart from other cancer-related campaigns is its future-oriented approach.

Prostate cancer is a risk for people as they age, but if it is caught and treated early, the outlook is generally good. So, as you or someone you know gets older, be sure to have open conversations with your doctor about your risk.

If you have any symptoms you think might be prostate cancer, talk to your doctor right away. And even if you do not have symptoms, consider adopting a healthy lifestyle to decrease your risk.

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