INTRODUCTION:

Prostate is a sexual gland only present in males, and is anatomically right in front of the rectum
and in between the penis and Urinary bladder. The Urethra runs through the middle of the
gland. The basic function of this gland is to produce and secrete fluids into the Urethra which
nourish the Sperm and protect it in the semen. The Prostate gland consists of three zone; the
peripheral, central and transition zone. The peripheral zone contains the major bulk of the
gland and is the part felt by doctors when performing a DRE. The central zone surrounds the
Ejaculatory ducts and the transition zone surrounds the Urethra (1). The gland begins to
increase in size, usually in the 40s and can grow up to 40 grams in 70-year-old men. 
Prostrate related diseases are a major issue faced by older men throughout the world. Prostate
gland can lead to a multitude of problems among men who are 40 or older. Prostatitis, BPH,
and Prostate cancer are just a few possible outcomes. Globally Prostatic Cancer is the second
most common cancer among men, affecting 15% of all men, and has the highest mortality rate
among cancers affecting men (2), in Pakistan it is the fourth most common cancer among men
and was the cause of death for 2.9% cases of Cancer deaths in Pakistan for the year 2018 (3).
These figures point towards a grave issue of lack of awareness among general public regarding
prostate which results in such diseases going un-noticed. 
Many doctors recommend that men, Above the age of 50 should get a PSA and DRE done at
least once every year, but a majority quite possibly don’t know about the importance of this
gland and the issues it can present with, let alone getting a medical checkup done (4).  Plethora
of factors contribute to this shortfall in awareness including lack of education and this
conversation being considered a taboo amongst various communities. According to World
Bank’s data of 2015, Pakistan has a national poverty rate of 24.3% which adds to the problem of
education and people not getting screened for prostate diseases. Henceforth, our region has a
deficit of knowledge regarding this topic and the main aim of our study is to identify the
awareness of prostate diseases among older men. The second aim of our study is to identify the
factors which lead to this shortfall in awareness, and at the same educate people about
prostate diseases and persuade them to seek appropriate medical help.

LITERATURE REVIEW:

Prostate Gland and Prostatic disease

Prostate diseases have received heightened cultural and media attention as of late globally. This
trend has not led to a concurrent increase in studies on the public’s knowledge and beliefs vis a
vis the prostate. This is especially true of Pakistan. A cross sectional study in Karachi put this
awareness to the test and found that almost half of the subjects had never heard of the
prostate while 64% did not know about any prostatic disease. (6) A similar trend was observed
in a Lahore study in which at least two thirds of the subjects were literate; 44.3% had never
heard of the oft fatal prostate cancer (9). Knowledge of prostate cancer can be linked to level of
healthcare system of the country and its literacy rates (6). A more despondent picture is seen
in two recent studies in Africa. In 2017, a study in Southwest Nigeria was conducted regarding
the awareness about prostate related diseases among men older than 40. It concluded that
only 46.9% of the sample size had good knowledge(5). Less than half of the 656 participants
had knowledge about the prostate gland whereas only 29% had an idea about prostate cancer
in a 2014 Nigerian study which only included men over 40, which is the population at risk of
PD’s (11)
The data reviewed shows poor knowledge in men of the existence of prostate as an organ an
and even poorer awareness of its common pathologies. This is alarming because knowledge
among the masses about prostatic diseases is crucial for their early detection which can
improve prognosis and clinical outcomes. (6)

RISK FACTORS
In the Karachi study quoted above, it was found out that about half (48%) of the population was
aware of the increasing risk of PDs in the elderly, showing generally low levels of understanding
of link of prostate pathology with age.(6)
It was also found that most the men were not sure whether positive family history was a risk
factor or not (6). This is important because Prostate Cancer tends to develop more in men with
a family history than those with no such history. It has been seen that risks for PC are
substantial for relatives of patients who were diagnosed at a young age as well as for those
already having multiple cases of PCs in their family (7). Added to this genetic predisposition
factor are Germline mutations of BRCA1 and BRCA2, shown to have increased risk for several
cancers including prostate cancer; in particular BRCA2 mutations have shown to be more
important with a greater increase in risk in men under 65 years old (7) 
Subsequently, in a study conducted in New Zealand, it was concluded that people who had
average alcohol consumption had significantly lower risks of BPH and malignant PC; contrary to
this people who smoke and had low levels of selenium in their blood showed an increase risk of
developing these diseases. (8). A major misconception was that prostatic diseases were
sexually transmitted, which two thirds of the people in a large study conducted in Nigeria
believed to be true (11)
 
  

SYMPTOMS
More than two thirds of subjects were not aware of urinary dysfunction being a common
symptom of Prostate diseases(6). When talking about prostate cancer specifically, the
awareness of urinary and other symptoms fell drastically possibly leading to worse prognosis.
(9)The grim outcomes of prostate cancer specifically is reflected by the fact that most of the
Prostatic carcinoma patients in tertiary care hospitals of Islamabad presented late and in 21.3%
of the patients, the cancer had metastasized(4).

SCREENING
PSA and DRE are the most common and well-established screening tools for prostate diseases.
Our reviewed data shows that the majority of respondents did not undergo these with ‘not
being advised by doctor’ as the most common reason, followed by ‘lack of symptoms’. Older
literature on the topic also found the same reasons among men. (6) Moreover, it showed that
information about screening tests was poor(10). Two telephone surveys were carried out in
New York regarding the rate of prostate cancer screening and awareness among men older
than 50. About 60% of men in both surveys had undergone PSA screening (10). A large
proportion of Nigerian men were ignorant of the prostate gland and its diseases, particularly
prostatic carcinoma. In this study; only a total of 38.6% had undergone a DRE or a PSA test prior
to the study (11)

CONCLUSION
There is a high volume of literature available that pertains to risk, incidence and prevalence of
prostate diseases globally and in Pakistan. The major chunk of these are for prostate cancer.
But little work has been done on the awareness among the general public regarding prostate
diseases. The crucial point of importance is that low awareness in public equals low public
screening levels and has a negative contribution to men’s personal health preferences and
decisioning (6). The low awareness can stem from multiple causes which can include lack of
health insurance, literacy, adequate GP counselling and access to health facilities(10).
However a snapshot of current knowledge levels can be helpful in developing strategies to
empower masses with basic essence of prostate and prostate related knowledge and to
recommend useful and timely clinical intervention.(6)
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2012. p. 299. Available from: https://www.elsevier.com/books/lasts-
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2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence
and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J
Cancer. 2015;136(5):E359–86.
3. WHO. Pakistan-Global Cancer Observatory [Internet]. 2018. p. 1–2. Available from:
https://gco.iarc.fr/today/data/factsheets/populations/586-pakistan-fact-sheets.pdf
4. Masood A, Iqbal N, Shohab D, Hasan A, Aimon S, Mahmood U, et al. Clinicopathological
characteristics of prostate cancer in patients presenting to a tertiary care private sector
hospital. J Coll Physicians Surg Pakistan. 2018;28(5):409–11.
5. Ojewola RW, Oridota ES, Balogun OS, Ogundare EO, Alabi TO, Banjo OO, et al.
Knowledge, attitudes and screening practices regarding prostatic diseases among men
older than 40 years: A population-based study in southwest Nigeria. Pan Afr Med J.
2017;27:1–13.
6. Tanveer M, Tahir F, Majid Z, Mustafa Hussain M, Ali Asghar S, Qadar LT, et al. Awareness
and Self Care Practices of Elderly Men Regarding Prostate Diseases in Karachi, Pakistan.
Cureus. 2019;11(5).
7. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer
risk. BJU Int. 2003;91(9):789–94.
8. Karunasinghe N, Han DY, Goudie M, Zhu S, Bishop K, Wang A, et al. Prostate disease risk
factors among a New Zealand cohort. J Nutrigenet Nutrigenomics. 2013;5(6):339–51.
9. Beg BM, Pasha AB, Butt NF, Qureshi SS, Randhawa FA. Prostate Cancer Awareness and
Knowledge; a Study of Adult Men in Lahore, Pakistan. Pakistan J Public Heal.
2018;8(3):128–32.
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practices among older men regarding prostate cancer. Am J Public Health.
2000;90(10):1595–600.
11. Olapade-Olaopa EO, Owoaje ET, Kola L, Ladipo MM, Adebusoye L, Adedeji TG. Knowledge
and Perception of Nigerian Men 40 years and above Regarding Prostate Cancer. J West
African Coll Surg. 2014;4(1):1–16.