Urologist Jerry Emtage returned to Barbados in 1990 after a four-year medical practice in Windsor, Ontario, to find the incidence of prostate cancer “quite high, but nobody was doing anything about it”.
It was the early nineties and he recalls “We did not have any access to PSA here and this disease was basically being found by serendipity. Men would have symptoms of bone pain, so oftentimes it would spread and there were no tools for early detection. A lot of men who had symptoms associated with prostate cancer would be treated as though they had prostate cancer without biopsies, so it was really and truly the dark ages.”
Over the next two decades Emtage has worked to bring treatment for prostate cancer into the modern age.
In his well-appointed office at Bush Hill, Garrison, last week, Emtage walked me through the various processes and methodologies of testing for prostate cancer and the indications of PSA testing. Clearly passionate about what he does, he drew diagrams, animatedly explaining procedures and his intense involvement in the fight against the dreaded men’s disease.
About the decision to specialise in urology, he said: “When I did my internship I had a situation where there was a patient in trouble and I did what I thought was right and that did not sit right with my consultant at the time, and that is what motivated me.”
Emtage first obtained an honours degree in medicine from the University of the West Indies before going off to Queens University in Kingston, Ontario, to do his residency. He also did a clinical fellowship in paediatric urology as well as uro oncology there, following up with a fellowship in stone surgery at George Washington University.
Barbados continues to reap the benefits of that knowledge and experience.
He immediately goes into full drive when he starts to talk about the matter of PSA (prostate specific antigen) testing. The test he said, can give an indication of early prostate disease, and would drive the decision for biopsies to be done.
He explained further: “If a man’s PSA goes from four to six in six months, that’s a problem. You need to biopsy. One of the important things, however, about PSA is that it should not be done in men who have irritative voiding symptoms.
“A man comes to your office and he says, ‘Doc, you know I have burning when I pass water, low back pain in my testicles, pain on ejaculation’. You cannot do a PSA on that man because those are symptoms reflective of prostatitis. Prostatitis will cause a false-positive increase in PSA and then what you are doing is making that man very fearful because he associates an elevation in PSA with malignancy.”
Emtage is concerned that men in Barbados are presenting with prostate cancer “very late” and he notes the island has one of the highest incidences of this disease in the world.
“From my practice we know our rates are about 115 to 116 per 100 000 which tell us that if we are not the highest in terms of incidence within the Western Hemisphere, we sure are very close to the top.”
In addition, he said since the downturn in the economy he had noticed there were more men with PSAs over 100 in whom the cancer had metastasized or spread beyond the prostate “than at any time I have seen over the last 15 years”.
“We are going backwards,” declared the prominent urologist, as he again implored men to get tested early.
He advised: “A man with small volume, low grade disease can be dealt with, with seed implantation (a form of radiation) or freezing. A man with high grade, high volume disease, no matter what age, should come to radical surgery.”
Emtage worked with the Queen Elizabeth Hospital until recently and wishes that more up-to-date equipment could be available there to treat that sector of the Barbadian public who have no alternative than the public health care service.
In recent times, however, his main focus has been his private practice.
Since 2002 several of his private patients have benefited from Brachytherapy, a type of radiation treatment in which tiny radioactive particles known as seeds are implanted directly into or very close to the site of the tumour, without affecting the normal healthy tissue around it, and is satisfied with the effectiveness of this form of therapy, with the number of patients benefiting now approaching about 1 000.
For him, building to the stage where he is able to offer the level of treatment that he does has been “a lot of hard work and a lot of investment”.
“I have invested heavily in myself to the tune of about four or five million US dollars,” he said, and the state-of-the-art equipment in his surgery bears testimony to this claim.
Emtage pulls no punches when he talks about the expense associated with cancer treatment, pointing out that medication more often than not tops that list.
As an example, he cited one drug, Zytiga, which he estimated cost between $15 000 and $20 000 per month. The cost of palliative care (treatment) for the discomfort, symptoms and stress of the disease), he added “can be much more expensive than the cost for primary curative therapy”.
Another drug, Provenge, an end-stage sort of drug prescribed in the late, advanced stage of the disease costs a whopping $90 000 a month.
Emtage argues these astronomical prices “tell the story as to why it is so important to have men offered the option of having the PSA so the disease can be found early.
“I think it is incumbent in the national interest both at an individual as well as at Government level to make sure that this disease is found early to reduce the cost of treating late stage disease.”
He tells men: “With regards to treatment, understand that the earlier you are found your quality of life can be maintained; you have different options in terms of treatment. But if you are found late, you have very few options and oftentimes there are options you cannot afford and there is nothing worse than knowing there is something there that can help you, but you just don’t have the money for that.”
When the question was posed about his approach when confronted with the challenge of breaking the devastating news of a positive result of a prostate cancer test to a young man, Emtage, who throughout the interview drifted between intense seriousness to playful banter, at once became serious.
“I remember my professor telling me when I am dealing with my patients, I am either like a joint, a good stiff drink or some boosting agent, because if you go to people with long faces, you transfer that to them, they don’t feel that help is available and if you take away that notion of hope, then you are left with a shell.”
His first thought therefore is to give that young man hope. “Tell him you can be helped. I never tell anybody they are going to die in three months or six months. That’s not my role. My role is not to keep you thinking about dying. It is to keep you living.”
He asserts this is the Jerry Emtage who those who do not have that kind of personal interaction with him do not know.
Told about a perception out there of an austere, impersonal and sometimes brusque urologist that some perceive as Jerry Emtage, he reined back in his chair and with his characteristic toothy grin remarked: “Those people do not know me.”
Instead he was satisfied his patients saw a completely different person, a doctor who showed them lots of empathy and held their hand throughout the journey together.
“People out there don’t know me,” he protested, and chided: “You are not getting into my life.”
As far as he is concerned he is adored by his six grandchildren. “They call me a wonderful grandfather. That is why I bought a truck because we are always at the beach, surfing, sailing, kayaking every weekend.”
He is a fit 62-year-old whose life revolves around his work, his family and a rigorous fitness regimen. “I like to travel. I ride all over the world, I ride road bikes and I race. I rode from Saigon in Vietnam to Cambodia, Lisbon to Granada in Spain, the Loire Valley in France, Prague to Budapest, I hiked Peru.”
His commitment may have influenced his son Justin, now in his fourth year of urology in Tampa, Florida, to follow in his father’s footsteps.
Emtage has a message for men in Barbados: “Look after yourselves. Be like women. Women have to subject themselves to specula and pap smears; to having their breasts squeezed. So if you have to get a finger up your (rectum), get with it.”