Addressing prostate cancer burden in Saudi Arabia

Oncologist attributes low incidence rate to a lack of screening awareness


Saudi Gazette Report

THE incidence rate of prostate cancer among the Saudi population is the lowest in the region but could be a sign of lack of awareness in screening, according to oncologists.

Prostate cancer is a cancer that occurs in the prostate, a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. It is one of the most common types of cancer in men.

The incidence rate of prostate cancer in Saudi Arabia is around 5 to 6 cases per 100,000 men compared to 8 cases in Oman, 13 in Kuwait and 14.5 in Bahrain.

In other Middle Eastern countries where smoking and early detection are more common the incidence rate is higher, according to oncologists.

In Jordan, the rate is 11 per 100,000 and in Lebanon it is 39 per 100,000 men.

Several factors play a role although awareness is among the most prominent, according to Dr. Mohammad Shouqi Bazarbashi, head of medical oncology at King Faisal Specialist Hospital and Research Center.

PSA screening to detect early stages of prostate cancer is less common in the Kingdom, he said.

"While the reported incidence of prostate cancer in the Middle East region is five times lower than that of the United States, the mortality-to-incidence ratio of prostate cancer is five times higher in the Middle East. The percentage of advanced cases in the Kingdom is one-fourth of cases compared to a mere 4 percent in the US. A 5-year survival rate in the US is 100 percent," said Dr. Bazarbashi, who serves as vice president of the Saudi Oncology Society, which recently participated in a workshop in Riyadh titled "Assessing the Clinical and Economic Burden of Prostate Cancer in Saudi Arabia and the Middle East."

Cost remains a major challenge for treating the cancer, Dr. Bazarbashi further said.

"Although all the medication is available, it is costly and its purpose is to prolong life rather than cure. Not a single institution can afford all of them. The challenge is putting the right medication for the right person."

Awareness about prostate cancer is low in general, he added.

"Many of the patients present with symptoms at advanced stages and are referred to other specialists such as orthopedists. Primary care physicians also need to play a role in educating the patients," he said.

A different approach to treating prostate cancer has become evident in recent years. Whereas PSA screening was highly advised in the West, it has become no longer mandatory and involves the physician communicating to the patient the consent to screen.

"Since the cancer is common in patients aged 80 and above, many of them tend to die a normal death and will never be cancer patients if they do the screening," he said.

"The physician needs to communicate to the patient and ask for consent whether they want to do the screening," he added.

At advanced stages, the cure rate for patients is less than 5 percent compared to early stages where it is between 70 and 80 percent.

Moreover, the median life expectancy is also lower here at 73 years, compared to other Western countries where it is above 80.

Nearly 5 percent of the Middle Eastern male population above the age of 60 are placed in the risk group for prostate cancer.

In addition to a younger population, diet and lifestyle have a positive impact. "Apart from large cities that have a sedentary lifestyle, other regions of the Kingdom have a healthier lifestyle," said Dr. Bazarbashi.

"In those areas, people tend to have a better diet and limited in smoking and obesity," he added.

However, prostate cancer is the sixth most common cancer among males in the Kingdom. The most recent statistics are from a study in 2014 by the Saudi Cancer Registry that revealed a total of 1,739 cases between 2001 and 2008 and the number is expected to increase in correlation with the population growth.

While the causes of prostate cancer are universally undetermined, genetic factors are the most identifiable. Men with a family history of prostate cancer have a higher chance of getting it, oncologists have found.

Limited research is available about prostate cancer in the Kingdom apart from epidemiological studies that reveal the eastern region of Asir has the highest age-standardized incidence rate of 10 per 100,000 while Jazan and Najran have the lowest at 2 per 100,000 men.