20 November 2019

Don’t take simple symptoms for granted. Just get checked. 

  Specialist Urologist, Dr Ho Lap Yin, explains what men can do to be prostate cancer aware.
Real Stories | In the Barber Chair

We put specialist urologist, Dr Ho Lap Yin, in the Barber’s Chair, to find out more about how prostate cancer affects men in Hong Kong, why the increase and what we can do about it.
First of all, what is a specialist urologist?
A urologist diagnoses and treats men with prostate cancer.  Men come to me with symptoms such as increased frequency of night-time peeing, a stronger urge to pee when they have a full bladder, a weak flow or slowness.  I also see men with sexual health issues, such as erectile dysfunction or reproductive issues.  Men can talk to their urologist about all issues relating to this part of their body!
I’ve been practicing as a doctor for over 20 years, and have been specialising in urology for over 14 years.  When it came to choosing between general surgery, which requires life-threatening decisions made in a matter of minutes or even seconds, and studying a broader spectrum area, such as urology, I became more and more fascinated with understanding all the issues around prostate cancer, including the complex surgery which is involved, the ongoing medical research and evolving drug treatments.
How does prostate cancer effect men in Hong Kong?
Prostate cancer in men in Hong Kong is on the increase.  And that’s worrying.  In fact, incidences of prostate cancer diagnosis in Hong Kong, in the last 10 years, have almost doubled, rising to more than 2,200 new diagnoses each year.  Prostate cancer is the third most common cancer in men in Hong Kong after colorectal and lung cancer.
There are three key risk factors relating to prostate cancer and these sadly can’t be changed.  Older men (70-75) are at higher risk, although men as young as 50 should be checked if they are worried, or seeing any of the symptoms.  Genetics also plays a part and men who have fathers or uncles with prostate cancer will be at higher risk.  And thirdly, ethnicity does play a role.  Asian men are at a lower risk of being diagnosed with prostate cancer than other men around the world; there are more incidences among Caucasian men, and those of African descent.
We don’t know why there is a difference in risk relating to ethnicity.  There are studies being conducted around lifestyle, including dietary habits, but there are no concrete results on this as yet.
We do tend to see that prostate cancer in older men is more latent, which means it is slow growing and can develop over 15-20 years.  However, when prostate cancer occurs in younger men, from 50-70, this can be a more aggressive type which needs treating early.
What can men in do, in Hong Kong, and around the world, do to prevent prostate cancer?
Unfortunately, while many studies are ongoing, there is nothing we can do to actually prevent prostate cancer.  But what we can do is be aware of the risk factors, and symptoms, and early checking and detection is the most vital thing we can do.
Checking is so easy these days!  There is a simple PSA (prostate specific antigen) blood check that can easily be conducted at your annual body check, or by any GP or physician.
We are finding that people are more comfortable going to the doctor these days.   We hope this is down to the great work of campaigns such as Movember, and the ongoing communications of the Hong Kong Cancer Fund.  This is great news.   If something is worrying you, talk to the doctor about it.  Much better to rule out the possibility of prostate cancer now!
How do men know when they should be checked?
Every man above the age of 50 should be paying attention to their health.
Every man above the age of 50 who has any symptoms of increased need to pass urine, particularly at night, an uncomfortably strong urge to pass urine when the bladder is full, or a weak flow so slower to pass urine, are all worth getting checked out. 
Every man above the age of 50 with genetic incidence of prostate cancer, should be checked every couple of years.
Every man above the age of 50 with an ethnicity which has great risk of prostate cancer, eg African descent, Caucasian, should also be checked every couple of years.
Remember, it is possible that there are no symptoms which is why those in the higher risk factor groups should be checked.
For those in low risk groups, checking can take place every 4-5 years, unless you experience any symptoms.
What are some of the myths around prostate cancer?
There’s a lot of banter around men’s health and prostate cancer.  Let’s rule out a few things!
Symptoms of prostate cancer are not always just the normal process of ageing.  Just because your friends may have them too and it becomes something to laugh about, like increased frequency of peeing at night, it’s still worth getting checked out.
However, it is normal to pass a few urine drops after pee-ing, it’s because the urethra in men is so long!
There are studies suggesting that ejaculating 21+ times a month can help to prevent prostate cancer, well, we can’t really say for sure yet. Indeed, it is much more likely that other lifestyle factors in these studies such as happiness, good relationships, lots of exercise, socialising, friends and a generally positive approach to life are likely to contribute more!
Eat more cooked tomatoes!  It won’t hurt, but much better to adopt an all-round healthy diet and lifestyle.  There are many tomato extract products on the market as a result of evidence that suggests tomatoes might be beneficial.  Please note that these products are not regulated in any way.  Stick to a healthy balanced diet with lots of fresh fruit and veg.
You’ve dealt with prostate cancer for many years now, what stories have left a lasting impression on you?
I have the privilege of building up great relationships with many of my patients as they embark on their journey with cancer. 
In particular, there was one patient who throughout his life had been very consumed with his job as a sailor, spending many years working unsociable hours on the sea, and not really appreciating the role of his wife or family.  Sadly, he was diagnosed with prostate cancer at the age of 60, which is quite young.  Unfortunately, the cancer was quite aggressive and had spread quickly; we spent 7 years together, going through all of the different therapies and fighting the growth of the disease.  At the end, this patient was much like a friend, and he explained to me, “I may have lost the battle, but I have won many blessings”.  What he meant was that the experience, although very difficult, had showed him that he was surrounded by a wonderful wife, family and friends and he had never appreciated that before.  Now he felt blessed.
Another lasting impression is that of a close family member and the irony of being related to a urologist.  Although he started to show symptoms, he still didn’t get checked by the doctor and was sadly not diagnosed until it is too late.
So, if you need to leave us with one key message, what would that be?
Don’t take simple symptoms for granted.  Younger men are more likely to suffer from more aggressive forms of prostate cancer.  Just get checked.  It’s easy.