Prostate cancer and retirees in Costa Rica

The other day I was sitting in a local gringo watering hole and a friend, who I hadn’t seen for a long time, entered and sat next to me. The first thing I noticed was that he appeared to be a lot thinner. I asked him how he had been and what he had done since the last time I had seen him. He replied, “I am going to die.” I said, “Come on! You must be kidding.” He then responded, “No, the doctors have only given me ten months to live because I have incurable prostate cancer.” I told him how bad I felt about the news and ended up trying to console him for about a half hour. On the way home I couldn’t help stop thinking about poor Bob and his plight. The sad part of this story is that in most cases, if detected in time this type of cancer is curable.

During the 32 years I have lived in Costa Rica I have lost at least 8 male friends to prostate cancer. Most died an uncomfortable and painful death which probably could probably have been avoided if they had taken responsibility for their health and had started the proper medical screening between 45 and 50 years of age. Dying of prostate cancer is terrible way to go and I saw my own father go through it. Advanced prostate cancer can spread to other parts of the body. The most common symptom is bone pain, often in the vertebrae, pelvis, or ribs. Prostate cancer in the spine can compress the spinal cord, causing leg weakness and urinary and fecal incontinence. Not very pleasant.

If detected in time and the cancer has not spread beyond the prostate itself, it is usually curable with a variety of treatment options available.

Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men. What are the measures that should be taken to detect the disease? Options include the digital rectal exam (DRE) and the prostate-specific antigen (PSA). The latter is included as part of many physical exams for men after 50 years of age. The danger with prostate cancer is that often there are no symptoms in the early stages and those who have it don’t find out until it is too late. Symptoms can potentially develop during later stages of the disease. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Because of PSA screening, ninety-percent of patients who are diagnosed with prostate cancer that is confined to the glad itself and then have it removed by surgery, end up being cured.

Most prostate cancers are slow growing, however, there are cases of aggressive prostate cancers. The latter usually occur in younger men with the former taking place in older men. In fact, in some cases in elderly men the disease goes untreated because it develops so slowly that doctors figure the person will be deceased before the disease becomes full blown. The general rule is that the younger you are when you get this disease the more aggressive it is.

Finally, the risk factors for prostate cancer are more prevalent in the developed world, including longer life expectancy and diets high in red meat. People who consume larger amounts of meat and dairy also tend to consume fewer portions of fruits and vegetables. It is not currently clear whether both of these factors, or just one of them, contribute to the occurrence of prostate cancer. Also, where there is more access to screening programs, there is a higher detection rate. Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease compared to men without prostate cancer in the family. This risk appears to be greater for men with an affected brother than for men with an affected father. Prostate cancer is the ninth-most-common cancer in the world, but is the number-one non-skin cancer in men from the United States. Prostate cancer affects 18 percent of American men and caused death in three percent.

In Costa Rican retired men have access to good health care and it is relatively easy to get screened for prostate cancer because of the availability of the PSA exam here. Every time I have a physical I make sure this exam is part of it. Furthermore, there are many excellent urologists in Costa Rica. I use Dr. Grunhaus at Cima Hospital and he is a top-notch physician. I would advise those men who use the caja (the public health care system) to have the contact information of a good private urologist in case of an emergency or health crisis. Prostate health is nothing to fool around with. Many elderly men suffer from an enlarged prostate which is a very painful issue. A good urologist can help you if that is the case. I know many retirees in Costa Rica who suffer from this problem.

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