Not when you’re 50, not even at 45. According to Dr. Buenaventura Jose B. Reyes, men should have their prostates checked once they turn 40. The urologist and professor at St. Luke’s Medical Center said, however, that there are a number of challenges to getting men to take that first step and schedule an appointment.

“First is awareness of what an aging male is. Second is the time period between the first consult and the next. As early as 40 years old, men should have themselves checked. Forty is the cut-off for international guidelines on prostate health. It has been proven in studies that the noticeable enlargement of the prostate in aging men begins at that age,” Reyes told Lifestyle in a phone interview.

Prostate cancer or PCa is described as the uncontrolled growth of cells in the prostate, a small, walnut-shaped gland located in the male reproductive system below the bladder that’s responsible for producing seminal fluid.

Blood tests as well as a digital rectal examination can detect abnormal growth of prostate tissue, although the idea of a finger being inserted in their anus makes most men feel squeamish, which can in turn prevent them from setting up that appointment.

“This leads me to my third point, which is the macho culture still prevalent among Filipino men. They tell themselves, ‘I feel good, I’m okay—hindi pa naman ako matanda, saka na ‘yan (I’m not that old, I can put it off for the meantime).’ Those are the usual reasons most men don’t have themselves checked for PCa, unlike women who schedule their Pap smears to check for cervical cancer regularly.”

Pain-free

As a professor at the College of Medicine at St. Luke’s, Dr. Reyes has taught countless students techniques to ensure a relatively pain-free rectal examination. “All the students I’ve taught and who do it right get similar feedback from patients. ‘Hindi naman pala masakit, bakit tinakot ako ng iba? (It didn’t hurt so why was I warned by others about the pain involved?)’ The short answer is because those were the ones who had a bad experience. If done properly by an expert, the digital rectal exam shouldn’t hurt.”

Dr. Alexandre Omar Arabia can attest to this. The urologist, who is affiliated with Ospital ng Maynila and World Citi Medical Center, was one of the residents Reyes mentored. “Older patients who get themselves checked for PCa are not that squeamish anymore. They even joke about it. What they are afraid of is the chance that they might have PCa if they have themselves checked,” Dr. Arabia told Lifestyle in a phone interview.

“Cancer is still seen as a death sentence for many Filipinos, but even more so for those in the lower-income brackets, for financial reasons,” he added.

According to the World Health Organization (WHO), PCa is the third most common type of cancer among Filipino men, with close to 9,764 men diagnosed with the disease in 2022, higher than the estimated 8,242 diagnosed in 2020. Although there are some types of PCa that grow slowly and might require minimal or no treatment, there are other types that are aggressive and can spread quickly. But when detected early, PCa patients have the best chance for successful treatment.

Dr. Arabia said that men who are diagnosed with PCa are “lucky” given how there are different treatment modalities that can be used, because PCa is one of the most studied diseases.

“The Philippine Urological Association (PUA) is one of the major societies promoting PCa awareness. Every year for over a decade now, we have been campaigning for annual digital rectal exams. It’s usually timed to coincide with Father’s Day in June, and we do this in line with the Department of Health (DOH),” Dr. Reyes said.

The DOH designated June as Prostate Cancer Disease Awareness Month. On that month, the PUA, in partnership with the DOH, implements programs that aim to train primary care physicians on PCa early detection and screening, increase lay awareness, and provide free consultations/teleconsults at institutions specializing in urologic care.

However, even with annual PCa awareness campaigns, there is still a lack of understanding on the importance of regular screenings. “People are afraid of the Big C, not only PCa. The fear is always there, but with the developments in science and technology, a cure can be offered if cancer is caught in its early stages,” Dr. Reyes said.

Misinformation

In the article “Overcoming barriers to prostate cancer in the Philippines” published in the Frontiers science journal (frontiersin.org) in February, a team of Filipino doctors described the unique factors that influence access to screening, diagnosis, treatment and supportive services in the country. The team included doctors Thomas Vincent Vergara, Juan Martin Magsanoc, Marvin Jonne Mendoza, Gerardo Tomas Cornelio, Rudolfo de Guzman, Dennis Serrano, and Nikko Magsanoc.

A survey conducted by the team among Filipino men living in Hawaii suggested that “misinformation, lack of awareness and knowledge about PCa contribute to attitudes of fatalism, dread, and hopelessness—all of which lead to poorer health-seeking behavior. Traditional notions of masculinity in the Philippines … can lead to reluctance to address health issues promptly, particularly when these concerns are related to sexual function.”

To combat this, Dr. Reyes suggests that people refrain from getting their medical “advice” from the internet. “Block Dr. Google from your research because Dr. Google sometimes scares the patient. As a result or rebound effect, the patient won’t want to go to the doctor.”

He then called out another subset of patient, one who is so intelligent that they feel they can “play doctor” by sifting through the information available at their fingertips.

“I’ve seen a lot of patients who, after managing on their own, will come to me but by then they’re already gravely ill. That’s when their family members will say, ‘Kasi naman si Daddy akala niya lahat alam niya (Dad thinks he knows everything).’ When I ask if the patient relied on Dr. Google, sisihan na sila (they start blaming one another).

“That is the culture. If only I can contribute and tell these people, searching the internet for medical advice only creates more troubles than solutions,” Dr. Reyes said. INQ