BERKELEY, CA (UroToday.com) - This study and its findings reiterate other salient points in the clinical management of and research on prostate cancer in developing countries such as the Philippines, which were not expounded on in our article. The authors have to deal with these issues and find answers to unique problems of the local patient population, while operating in a setting with very limited resources and with established attitudes that are not always beneficial for patients.
- The Asian stock is comprised of a wide variety of ethnicities and its various mixes. East, Southeast, and South Asians, just to name a few, have a wide variety of differences in terms of physical attributes and diet, all of which greatly affect the epigenetics of many diseases, not just prostate cancer. To make “bulk recommendations” or accept certain notions, such as “Asians being low risk for developing prostate cancer” may be a great disservice to many Asian men, who may need more aggressive monitoring than others.
- There may be folly in always looking to developed countries for answers to problems that are unique to developing parts of the world. Clinicians and researchers from resource-poor nations, such as the Philippines, must recognize these unique patterns in their local setting, as these may not be so obvious to experts from other countries. In this case, it may be prudent to change the current assumption that Filipino men have low risk of developing prostate cancer and of dying from it. The time may have come to question what appears to be an accepted fact that it is only socio-economic problems which cause these clinical trends in our patients. Although it is financially challenging to conduct population-based genetic research in third world nations, the expertise is actually locally available. However, it is not as common to see basic scientists and clinicians working together as one team in coming up with new answers for problems unique to their patients. Such collaboration is key in producing a scientific community that is truly relevant to their people’s needs as well as competitive in the global setting. Many focus on keeping abreast with technological advances of surgical care, forgetting that innovative clinical and basic science research are just as important in reaching global competitiveness.
- While the developed world struggles with over-diagnosis and over-treatment, much of the underdeveloped nations must still devote effort and resources to promoting screening and preventive health management. Lack of education and low budget for proper information dissemination are common culprits, as well as the near absence of universal health care systems in many developing nations. Again, clinicians must exercise much prudence in deciding what recommendations coming from many developed countries they should adapt in their local places of practice. While much of the West no longer espouses regular screening for prostate cancer, the same may not be readily applicable to the local needs of the Filipino population.
- Globalization often entails the “spreading” of unhealthy lifestyle choices from one part of the world to another. The culture of the “fast food diet” is slowly but surely negating the protective effects of the East Asian diet, rich in tofu and green tea, against many diseases such as prostate cancer. And in a country where screening is not widely used and universal health care barely exists, health-wise, this can have catastrophic effects that clinicians and public health officials must recognize and act upon efficiently.
Eliza M. Raymundo, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Division of Urology, Department of Surgery, College of Medicine, University of the Philippines Manila, Manila, Philippines
Institute of Molecular Biology & Biotechnology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD USA