One man every week is diagnosed with prostate cancer in Bermuda.

Between January and May, the Island's urologist Dr. Charles Dyer reported 20 new cases five a month, or 60 a year.

"It is one of the commonest cancers in men on Bermuda, after skin cancer," says Dr. Dyer.

If caught early enough however, the survival rate is almost 100 percent.

"As soon as you mention the word cancer it produces sudden emotional issues such as fear of death, but prostate is a totally different cancer to colon, stomach or lung cancer, because of its tendency of being a slow grower.

"It can be confined to the prostate for years before it spreads, and it is very amenable to treatment," says Dr. Dyer.

"Most men who are diagnosed, the cancer is still confined to the prostate. Many prostate cancers don't even need to be treated."

>The disease affects men in their 40s onwards, but most cases are diagnosed between 65 and 75. As with any medical problem, the risk increases with age.

"Whereas men in their 40s may have a 10 percent chance of having prostate cancer, this can rise to 50-60 percent among men in their 80s and 90s," says Dr. Dyer.

As Bermuda's only urologist, he is a specialist on the prevalence of the disease on the Island.

Trained at the University of London, at St. Mary's Hospital Medical School in Paddington, he is also a Fellow of the Royal College of Surgeons (FRCS) and a member of the American Urological Association and the British Association of Urological Surgeons.

Dr. Dyer says: "Prostate cancer is like breast cancer in women, in that it is a sex hormone-dependent cancer. Women need oestrogen for breast cancer to grow, and men who have prostate cancer need testosterone for it to grow."

Compared to other cancers such as colon or stomach cancer, there are very few symptoms.

"You don't tend to get urinary symptoms directly related to prostate cancer, as when men aren't passing urine as easily as they used to, that can be because the prostate has grown bigger, which happens in all men as they get older."

Dr. Dyer says: "When they visit the doctor they may have a PSA test taken which if elevated, sometimes will result in a biopsy being taken of the prostate."

However, the PSA is not a definitive test for the presence of cancer.

"PSA testing has helped to stabilise deaths from prostate cancer to a great extent, in that it has increased the level of diagnosis," says Dr. Dyer.

"But it is not a clear test on its own. It is a pointer to what could be a problem."

He says that is why it is important for men over 40 to start having annual tests, in order to establish a 'baseline'.

Scientists are currently developing a urine test the PCA3 which Dr. Dyer describes as "a far more specific cancer test and easier to do".

"This test will most likely supercede the PSA," he says. "However it's important to get a PSA test done if you haven't already, to have a baseline.

"And if you are black this is even more important as prostate cancer tends to be more common in black males and more aggressive."

>In the event of cancer, there are various treatments which specialists will tailor to the individual patient.

>They include: surgery (a prostatectomy <\!m> removal of all or part of the prostate gland); radiation treatment; cyrotherapy (freezing the prostate to kill the cells); and high-intensity focused ultrasound (heating up the prostate to kill the cells).

Dr. Dyer says: "If you look at an advanced cancer, the average survival rate with treatment is usually two years.

"Whereas if you have a man referred to a urologist because his PSA is above normal and whose prostate is removed, depending on the grading of the cancer you would expect him to have a 20 percent risk of reoccurrence."

A man's survival rate will also depend on maintaining a healthy diet and exercise.

There are risks to having a prostatectomy, such as erectile dysfunction and urinary control issues, and the man will no longer be able to ejaculate.

However Dr. Dyer says: "In the past 20 years surgery has evolved into 'nerve sparing', where the nerves associated with getting an erection are teased away from the prostate during surgery to preserve them.

"If you can preserve the nerves it may take up to a year-and-a-half, but 60-70 percent of men will be able to maintain their erections."

For men suffering incontinence problems, there are also treatments and Kegel exercises.

"The men who do these pelvic exercises, most will regain control but if that doesn't work for them, there are also surgical procedures to help them," says Dr. Dyer.

>For more information on prostate cancer, contact the Bermuda Cancer and Health Centre on: www.chc.bm or 236 1001.

The Centre is holding a free PSA screening for men over 40 who have no medical insurance or who have not had a test for 12 months, in partnership with the Bermuda Hospitals Board. It takes place at 46 Point Finger Road on Saturday, June 27, between 10 a.m. and 3 p.m.