- Email: [email protected]
Prostatic Disease in Indonesia
THE JOURNAL OF UROLOGY
Vol. 86, No. 4 October 1961 Copyright © 1961 by The Williams & Wilkins Co. Printed in U.S.A.
PROSTATIC DISEASE IN INDONESIA R.E. TAN From the Surgical Department, Stella Maris Hospital, Macassar, Indonesia
Prostatic hypertrophy and carcinoma are commonly supposed to be rare diseases among the Asiatic peoples. Many reports have been published on prostatic hypertrophy and carcinoma among the Chinese (Chang and Char: J.A.M.A., 162: 1928, 1956), but as for Indonesia an exact knowledge of the occurrence of these two diseases is not at hand. De Langen relates that he found only 6 cases of prostatic hypertrophy among a total of 400,000 Indonesian patients. De Waard and Doorenbos in 1930 strengthened the supposition that prostatic hypertrophy was rarely found among Indonesians. Until the present day this opinion seems to have been accepted as the true one, but for Reddingius, who denied it in 1936, and wrote that he was convinced that both diseases were not at all rare among Indonesians. According to his idea, a great number of cases might never be brought to light because the sufferers would not call for medical help. Tan stated the same, as he had found out that 49 per cent of the male Indonesians above 40 years of age are probably suffering from prostatic adenoma; whereas 62.8 per cent of this ratio are suspected of having real complaints. As to prostatic carcinoma, it is said that 6.99 per cent of the Indonesian men over forty are suffering from it. So, by this paper I will prove that apparently the supposition, just mentioned, does not hold good. THE PATIENTS
The statistics of prostatic hypertrophy and carcinoma in Indonesia have been acquired by questionnaires, sent to various hospitals in this country. Since 1956, the facts have been collected. Many hospitals have not answered these inquiries, probably because of lack of statistics and insufficient administration. Except for Sourabaya, Macassar and Tarakan, where I worked myself and was personally present, I can't tell whether the prostates were histopathologically examined in order to detect prostatic carcinoma. That is Accepted for publication March 24, 1961.
why the other places may show smaller final results than would be expected. Reports have come from Sourabaya, Semarang, Jocjakarta, Bandoong, Bandjarmasin, Tarakan, Macassar and Manado. The Chinese were excluded from this examination; in the figures included in table 1, only Indonesians were reported. NUMBER OF PATIENTS
The number of patients suffering from prostatic hypertrophy and carcinoma is stated in table 1. One notes a remarkable diversity in the quantities as well as in the years that they were taken. On these figures the following comments can be made: 1) Except for the better part of the major hospitals (central general hospitals), the minor hospitals, and especially those on the islands outside Java, have only insufficient records and statistics or they have none at all, so that the necessary information cannot be had. 2) Even Java has regions in which the population never sees a doctor, or see him only once or more a year. 3) Difficulties in transportation to and from the islands and to the major medical centers cause cases of prostatic hypertrophy and carcinoma to remain untreated and consequently they are never reported. 4) There is a deficit of capable personnel, and little interest on the side of the doctors for these diseases. 5) Many persons die without the causes being known, as autopsies are very rarely performed. These five arguments may explain the reason why prostatic hypertrophy and carcinoma seemingly occur rather seldom, as a great number of sufferers are never seen by a doctor. However, the figures in table 1 show that the quantity of prostatic hypertrophy and carcinoma is not so small as it is always suspected to be. In the future, the given quantities may increase in consequence of the continually improving sociohygienic condition in Indonesia, a result of which will be that
428
PROSTA~'IC nISEASFJ IN INDONESIA
the number of old men will he increased in the srune ,vay. AGJc
(lF'
PAT!ENTb
The Asiatic peoples commonly don't reach the same higb old ages as those in the more cleYelopcd countries. Hence, prostatic hypertrophy and careinonm among the former will more frequently occur before tlrn sixth decade of age has been reached, as is to be seen in table 1. One will also note that prostatic diseases appear evrn under the age of fifty. It seldom occurs that pati(:nts admitted into our hospital have slight urinary complaints. The complaint for \Yhich the: sufferer is admitted is always complctr. retention. The patients are sometimes fully ignornnt of thPir difficult urination. Due to long Rtanding disease, most of them have gross rpnal damage:. Their condition is also aggmvatc:d by otlwr diseases of which anemia and h1bcrculosis of the lungs :ue the commonest. patients with slight urinary difficulties are not easily detected, unless careful examination is done. For example: 208 Tndonesiarrn under the age of 40 having no complaints underwent a rectal digital examination . Those with a hard or enTABLE
Iarged prostate had a perimcal punch tained by Veenema's needle:. The tissue was aminecl histopathologically. fifty-five cases appeared to have prostatic adenoma while thr,ii prostates were enlarged. On further these patients seemed indeed to have: but they had grown accustomed to tlwir .c,ymp toms and had accepted them as a natural m their lives. These figures nmy convinrn u.s that great number of sufferers n'.main far away from medical treatmrnt ..\ncl, as nach prost:ht:c mn.1 hide a prostatic carcinoma it means that the lni ter disease may also remain unobserved. Add this that in this country for mcH abm P 40 of age the routine reGtal digital examination ic not clone, and also the fact that ])(Xlplc will fin,t gu to a quack. Only if they do not find help then', do they go to a physician. In ord(:r to know tlw of prosL:ittc cancer in men above 40 years of age, ;337 were submitted to rectal digital examination ami. a perinea] punch biopsy. From this amount patients clicl not show any signs of cer; yet in 28 cases the prostat,'.s were hard. Hi.,topathological examination diNdosccl ,,hat 2? patients had cancern, while five noh,iOi--
1. Incidence of pro.static adenoma and carcinoma in the di.fferent places of Indonesia Adenoma
Carcinoma Yea.rs of Collection
1956
Ages
19,8-1956
1960 for 8 months
19541960
1958
Places Bandjar
l\Jacas-
1 4lh50
l.5
,51-55
12
51:HlO Gl-65 (16-70 71-7.5
20
7G-80 81-85
1()
,,
2 g
10
2 4
4
9
2
14
15 6
9
4
10
10
2
6
H
(l
3 2
2
,)
l
4
5
3 7
7 5 9
"
3
/.
1
2
4 G
;J
;3
]
1
3
2
2
2
')
,j
2 2
l
2
Onr 85 The great number of occurrences of prostatic carcinoma in Sournbaya and .\:facassar is due to chc· fact that a preoperative biopsy was obtained in each patient who had a hard prostate. In other plaec:,, a differentiation between benig1rnncy and malignancy of the prostate is hardly ever m:ule.
430
R. E. TAN
standing smooth prostates on rectal digital examination, after histopathological examination also appeared to have cancer.
R. S. Stella Nlaris (Surgical Department), Macassar, Indonesia REFERENCES
SUMMARY This is a brief report about the incidence of prostatic hypertrophy and cancer among Indonesians. The general opinion that this disease is rare is erroneous. The reasons for this wrong opinion may be lack of knowledge and proper physical examination in various regions of the country. I express my thanks to the sisters of the Roman Catholic Hospital Stella Maris for their kind help in finding the reports of patients and in preparing this brief report.
CHANG, H. L. AND CHAR, G. Y.: Benign hypertrophy of prostate. Chinese Med. J., 50: 1707-1722, 1936. LANGEN, DE: Verslag van het wetenschappelijke gedeelte der vergaderingen van de afdeeling Batavia. Geneesk. T. Ned. Indiii, 58: 1, 1918. REDDINGIUS, T.: Prostaat hijpertrophie in het C. B. Z. te Batavia Centrum. Geneesk. T. Ned. Indiii, 76: 2748-2754, 1936. TAN, R. E.: Doctoral dissertation: Some aspects of prostatic hypertrophy. Malang: The Paragon Press, 1959. WAARD, DE AND DooRENBos: Verslagen der afdeelingsvergaderingen. Afdeeling Oostkust van Sumatra. Vergadering van 25 Maart 1930. Geneesk. T. Ned. Indie, 70: 725, 1930.
Vol. 86, No. 4 October 1961 Copyright © 1961 by The Williams & Wilkins Co. Printed in U.S.A.
PROSTATIC DISEASE IN INDONESIA R.E. TAN From the Surgical Department, Stella Maris Hospital, Macassar, Indonesia
Prostatic hypertrophy and carcinoma are commonly supposed to be rare diseases among the Asiatic peoples. Many reports have been published on prostatic hypertrophy and carcinoma among the Chinese (Chang and Char: J.A.M.A., 162: 1928, 1956), but as for Indonesia an exact knowledge of the occurrence of these two diseases is not at hand. De Langen relates that he found only 6 cases of prostatic hypertrophy among a total of 400,000 Indonesian patients. De Waard and Doorenbos in 1930 strengthened the supposition that prostatic hypertrophy was rarely found among Indonesians. Until the present day this opinion seems to have been accepted as the true one, but for Reddingius, who denied it in 1936, and wrote that he was convinced that both diseases were not at all rare among Indonesians. According to his idea, a great number of cases might never be brought to light because the sufferers would not call for medical help. Tan stated the same, as he had found out that 49 per cent of the male Indonesians above 40 years of age are probably suffering from prostatic adenoma; whereas 62.8 per cent of this ratio are suspected of having real complaints. As to prostatic carcinoma, it is said that 6.99 per cent of the Indonesian men over forty are suffering from it. So, by this paper I will prove that apparently the supposition, just mentioned, does not hold good. THE PATIENTS
The statistics of prostatic hypertrophy and carcinoma in Indonesia have been acquired by questionnaires, sent to various hospitals in this country. Since 1956, the facts have been collected. Many hospitals have not answered these inquiries, probably because of lack of statistics and insufficient administration. Except for Sourabaya, Macassar and Tarakan, where I worked myself and was personally present, I can't tell whether the prostates were histopathologically examined in order to detect prostatic carcinoma. That is Accepted for publication March 24, 1961.
why the other places may show smaller final results than would be expected. Reports have come from Sourabaya, Semarang, Jocjakarta, Bandoong, Bandjarmasin, Tarakan, Macassar and Manado. The Chinese were excluded from this examination; in the figures included in table 1, only Indonesians were reported. NUMBER OF PATIENTS
The number of patients suffering from prostatic hypertrophy and carcinoma is stated in table 1. One notes a remarkable diversity in the quantities as well as in the years that they were taken. On these figures the following comments can be made: 1) Except for the better part of the major hospitals (central general hospitals), the minor hospitals, and especially those on the islands outside Java, have only insufficient records and statistics or they have none at all, so that the necessary information cannot be had. 2) Even Java has regions in which the population never sees a doctor, or see him only once or more a year. 3) Difficulties in transportation to and from the islands and to the major medical centers cause cases of prostatic hypertrophy and carcinoma to remain untreated and consequently they are never reported. 4) There is a deficit of capable personnel, and little interest on the side of the doctors for these diseases. 5) Many persons die without the causes being known, as autopsies are very rarely performed. These five arguments may explain the reason why prostatic hypertrophy and carcinoma seemingly occur rather seldom, as a great number of sufferers are never seen by a doctor. However, the figures in table 1 show that the quantity of prostatic hypertrophy and carcinoma is not so small as it is always suspected to be. In the future, the given quantities may increase in consequence of the continually improving sociohygienic condition in Indonesia, a result of which will be that
428
PROSTA~'IC nISEASFJ IN INDONESIA
the number of old men will he increased in the srune ,vay. AGJc
(lF'
PAT!ENTb
The Asiatic peoples commonly don't reach the same higb old ages as those in the more cleYelopcd countries. Hence, prostatic hypertrophy and careinonm among the former will more frequently occur before tlrn sixth decade of age has been reached, as is to be seen in table 1. One will also note that prostatic diseases appear evrn under the age of fifty. It seldom occurs that pati(:nts admitted into our hospital have slight urinary complaints. The complaint for \Yhich the: sufferer is admitted is always complctr. retention. The patients are sometimes fully ignornnt of thPir difficult urination. Due to long Rtanding disease, most of them have gross rpnal damage:. Their condition is also aggmvatc:d by otlwr diseases of which anemia and h1bcrculosis of the lungs :ue the commonest. patients with slight urinary difficulties are not easily detected, unless careful examination is done. For example: 208 Tndonesiarrn under the age of 40 having no complaints underwent a rectal digital examination . Those with a hard or enTABLE
Iarged prostate had a perimcal punch tained by Veenema's needle:. The tissue was aminecl histopathologically. fifty-five cases appeared to have prostatic adenoma while thr,ii prostates were enlarged. On further these patients seemed indeed to have: but they had grown accustomed to tlwir .c,ymp toms and had accepted them as a natural m their lives. These figures nmy convinrn u.s that great number of sufferers n'.main far away from medical treatmrnt ..\ncl, as nach prost:ht:c mn.1 hide a prostatic carcinoma it means that the lni ter disease may also remain unobserved. Add this that in this country for mcH abm P 40 of age the routine reGtal digital examination ic not clone, and also the fact that ])(Xlplc will fin,t gu to a quack. Only if they do not find help then', do they go to a physician. In ord(:r to know tlw of prosL:ittc cancer in men above 40 years of age, ;337 were submitted to rectal digital examination ami. a perinea] punch biopsy. From this amount patients clicl not show any signs of cer; yet in 28 cases the prostat,'.s were hard. Hi.,topathological examination diNdosccl ,,hat 2? patients had cancern, while five noh,iOi--
1. Incidence of pro.static adenoma and carcinoma in the di.fferent places of Indonesia Adenoma
Carcinoma Yea.rs of Collection
1956
Ages
19,8-1956
1960 for 8 months
19541960
1958
Places Bandjar
l\Jacas-
1 4lh50
l.5
,51-55
12
51:HlO Gl-65 (16-70 71-7.5
20
7G-80 81-85
1()
,,
2 g
10
2 4
4
9
2
14
15 6
9
4
10
10
2
6
H
(l
3 2
2
,)
l
4
5
3 7
7 5 9
"
3
/.
1
2
4 G
;J
;3
]
1
3
2
2
2
')
,j
2 2
l
2
Onr 85 The great number of occurrences of prostatic carcinoma in Sournbaya and .\:facassar is due to chc· fact that a preoperative biopsy was obtained in each patient who had a hard prostate. In other plaec:,, a differentiation between benig1rnncy and malignancy of the prostate is hardly ever m:ule.
430
R. E. TAN
standing smooth prostates on rectal digital examination, after histopathological examination also appeared to have cancer.
R. S. Stella Nlaris (Surgical Department), Macassar, Indonesia REFERENCES
SUMMARY This is a brief report about the incidence of prostatic hypertrophy and cancer among Indonesians. The general opinion that this disease is rare is erroneous. The reasons for this wrong opinion may be lack of knowledge and proper physical examination in various regions of the country. I express my thanks to the sisters of the Roman Catholic Hospital Stella Maris for their kind help in finding the reports of patients and in preparing this brief report.
CHANG, H. L. AND CHAR, G. Y.: Benign hypertrophy of prostate. Chinese Med. J., 50: 1707-1722, 1936. LANGEN, DE: Verslag van het wetenschappelijke gedeelte der vergaderingen van de afdeeling Batavia. Geneesk. T. Ned. Indiii, 58: 1, 1918. REDDINGIUS, T.: Prostaat hijpertrophie in het C. B. Z. te Batavia Centrum. Geneesk. T. Ned. Indiii, 76: 2748-2754, 1936. TAN, R. E.: Doctoral dissertation: Some aspects of prostatic hypertrophy. Malang: The Paragon Press, 1959. WAARD, DE AND DooRENBos: Verslagen der afdeelingsvergaderingen. Afdeeling Oostkust van Sumatra. Vergadering van 25 Maart 1930. Geneesk. T. Ned. Indie, 70: 725, 1930.