Prostate Cancer: What Every Caribbean Man Should Know
There are some conversations men would rather not have. Prostate health may be fairly high on that list.
Mention the prostate and somebody will make a joke. Mention a prostate examination and the jokes become louder. And somewhere between the embarrassment, the teasing and the “Nothing wrong with me”, an important health conversation can get lost.
So let's have it plainly.
Your prostate is part of your body. Looking after it does not make you less of a man. Having questions about it is not embarrassing. And waiting until something hurts before you start paying attention to your prostate is not necessarily a good strategy.
For Caribbean men, particularly men of African ancestry, this conversation matters. Prostate cancer was the most commonly diagnosed cancer among men in Latin America and the Caribbean in 2022, accounting for almost 30 per cent of new cancer cases among men in the region. Caribbean men of African ancestry are also recognised as having a higher risk of developing prostate cancer.
So, bredren, let's talk prostate.
First Things First: What Is The Prostate?
The prostate is a small gland in the male reproductive system.
It sits below the bladder and surrounds part of the urethra, the tube through which urine leaves the body. The prostate produces some of the fluid that forms semen.
A young man's prostate is usually around the size of a walnut, but it commonly becomes larger with age.
And that brings us to an important distinction. An enlarged prostate does not automatically mean prostate cancer.
Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate that becomes increasingly common as men age. Because the prostate surrounds the urethra, enlargement can affect urination.
That means symptoms such as difficulty starting to urinate, a weak stream or needing to urinate frequently can have causes other than cancer. But that doesn't mean you should diagnose yourself either. If something changes, get it checked.
“But I Pee Fine.”
Good. That still doesn't tell us whether you have prostate cancer.
One of the most important things to understand about prostate cancer is that early prostate cancer often causes no symptoms.
You can feel perfectly healthy.
You can have no pain.
Your urine stream can be fine.
Your sex life can be fine.
You can be working, exercising, liming and living normally.
That is precisely why “I'll go to the doctor if something starts bothering me” has limitations when we're talking about prostate cancer.
Symptoms can occur, particularly as cancer progresses, but feeling well does not automatically mean there is nothing happening.
So What Symptoms Should You Pay Attention To?
Changes involving urination deserve attention. These can include difficulty starting to urinate, a slow or weak stream, needing to urinate more frequently, particularly at night, or blood in the urine. Blood in semen can also occur.
More advanced prostate cancer can sometimes cause erectile difficulties, unexplained weight loss, unusual or persistent tiredness, pain in the hips, back, ribs or other bones.
But here's where we need to avoid frightening ourselves unnecessarily: Having one of these symptoms does not mean you have prostate cancer.
Urinary problems, for example, are much more commonly caused by benign enlargement of the prostate than prostate cancer. Other medical conditions can cause similar symptoms too.
The point is not to panic. The point is to investigate.
Who Is At Greater Risk?
Age matters. Prostate cancer is uncommon before 40, and the risk rises significantly after 50.
Family history matters too. Having a father or brother who has had prostate cancer more than doubles a man's risk, with risk increasing further when several relatives have been affected or relatives were diagnosed relatively young. Certain inherited genetic changes, including some BRCA1 and particularly BRCA2 variants, can also increase risk.
And ancestry matters. Prostate cancer occurs more often in men of African ancestry, including Caribbean men of African ancestry, and it can develop at younger ages in these populations. Researchers do not yet completely understand why these differences exist.
That last point is especially important in our region.
It doesn't mean every Black Caribbean man is going to develop prostate cancer. It means knowing your risk matters.
“So When Am I Supposed To Get Checked?”
This is where I am deliberately not going to give every man reading this one magic birthday and say, “Go get screened.”
Prostate cancer screening is more complicated than that.
Different medical organisations have somewhat different recommendations because screening can offer benefits, but it also has potential harms. These include false alarms, unnecessary testing, overdiagnosis and finding slow-growing cancers that might never have caused a man problems during his lifetime.
The American Cancer Society recommends that men make an informed decision about screening after discussing the benefits, risks and uncertainties with a healthcare provider.
It recommends beginning that conversation around:
Age 50 for men at average risk who are expected to live at least another ten years.
Age 45 for men at higher risk, including men of African ancestry and men whose father or brother was diagnosed before age 65.
Age 40 for men at even higher risk, including those with more than one first-degree relative diagnosed at an early age and men who carry BRCA gene mutations.
Notice the word I keep using: Conversation.
These are not instructions for every man to automatically undergo the same test at the same age.
Your age, ancestry, family history, overall health and personal preferences all matter.
Now About That Finger...
Yes. We have arrived at the part some of allyuh have been waiting for.
There is a persistent idea that prostate screening automatically means a doctor performing a digital rectal examination.
Let's clear something up.
One of the primary tools used in prostate cancer screening is the PSA test. And the PSA test is... a blood test.
That's it.
A healthcare professional takes a blood sample and measures the level of prostate-specific antigen, or PSA, in your blood.
A digital rectal examination, or DRE, may also form part of prostate assessment or screening. During a DRE, a healthcare professional inserts a lubricated, gloved finger into the rectum to feel the prostate for abnormalities.
Is that likely to be the highlight of your week? Probably not.
Is it an assault on your masculinity? No.
It's a medical examination.
And depending on your circumstances, you may not even need one as part of screening. The American Cancer Society recommends PSA testing for men who choose screening after an informed discussion, with a DRE potentially included.
Please do not let embarrassment about a brief medical examination keep you away from healthcare altogether.
“My PSA Is High. That Means Cancer, Right?”
No. This one causes unnecessary panic.
PSA stands for prostate-specific antigen, a protein produced by cells in the prostate. Both normal and cancerous prostate cells produce it.
A higher PSA can be associated with prostate cancer. But prostate cancer is not the only thing that can raise PSA.
Benign prostate enlargement and inflammation or infection of the prostate can also affect PSA levels, among other factors. There is also no single PSA number that can definitively tell a doctor that a man does or does not have prostate cancer.
An abnormal PSA result means your healthcare provider may need to investigate further.
It does not mean you should walk out of the doctor's office believing you have cancer.
“Nobody In My Family Had It.”
That is useful information. It is not immunity.
Most prostate cancers occur in men who do not have a family history of the disease. Family history increases risk; its absence does not eliminate risk. And don't only think about your father's health history. Your mother's side of the family counts too when inherited cancer-related gene changes are involved. A family history that includes certain breast, ovarian, pancreatic or prostate cancers can sometimes be relevant to inherited mutations such as BRCA variants.
Knowing your family's medical history, where possible, gives your doctor more information to work with.
“But Prostate Cancer Is An Old Man's Disease.”
Age is one of the strongest risk factors, yes. But older does not mean only old.
Prostate cancer is rare before 40, but risk increases after 50, and men at higher risk may be advised to begin conversations about screening earlier. And for Caribbean men of African ancestry, among whom prostate cancer tends to occur at younger ages, waiting until you consider yourself “old” isn't a particularly useful health strategy.
Know your risk rather than relying on a stereotype.
Screening Is Not A Diagnosis
This distinction matters.
A screening test looks for signs that suggest further investigation may be needed. It does not diagnose prostate cancer.
If a PSA or another assessment raises concern, your doctor may recommend repeating the PSA, using other tests or imaging, referring you to a urologist or, where appropriate, performing a biopsy. A biopsy is what can establish whether cancer cells are present.
That journey will not be identical for every man.
And increasingly, prostate-cancer care is trying to distinguish between cancers that are likely to become dangerous and those that may grow so slowly that aggressive treatment could cause more harm than benefit. The International Agency for Research on Cancer notes that overdiagnosis remains an important concern in prostate-cancer screening and that newer risk-stratified approaches incorporating PSA, risk assessment and MRI may help reduce unnecessary diagnoses and treatment.
In other words: Finding something does not automatically mean surgery. It does not automatically mean chemotherapy. And it does not automatically tell you what happens next.
Don't Wait Until Your Body Forces The Conversation
Maybe you are 35 and have no particular risk factors.
Maybe you're 45 and of African ancestry.
Maybe you're 52 and haven't seen a doctor in years.
Maybe your father had prostate cancer and you've been quietly hoping that doesn't mean anything for you.
Maybe you've noticed changes in your urination and keep telling yourself you'll deal with it eventually.
The appropriate next step will not be identical for every one of you. But there is one thing every man can do: Know your risk.
Know whether prostate cancer runs in your family. Pay attention when your body changes. Ask your healthcare provider when you should begin discussing screening. And if something doesn't feel right, don't wait for it to become unbearable before seeking medical attention.
There is nothing particularly masculine about avoiding information about your own body.
Your prostate does not care how tough you are. Cancer does not care whether you are embarrassed. And getting checked does not make you weak. It makes you informed.
For Caribbean men, especially those at higher risk, that information may matter more than you realise.
Whisper To Your Heart
You spend so much of your life being expected to take care of things. Your work. Your family. Your responsibilities. The people who depend on you. Your body deserves some of that attention too. You do not have to wait until you are in pain to take your health seriously. You do not have to be fearless before making an appointment. And there is no shame in asking questions about a part of your body you may not usually talk about. Taking care of yourself is not stepping away from your responsibilities. You are one of them. — Nadia Renata | Audacious Evolution
Affirmation
I choose to pay attention to my health before my body has to demand it. I can ask questions, seek information and make informed decisions about my care without embarrassment or shame. — Nadia Renata | Audacious Evolution
If you’d like to sit with this a little longer, you can find more affirmations like this in my YouTube playlist; a quiet space to return to whenever you need grounding.
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