Island urologist Charles Dyer believes homophobia is in part to blame for male deaths from prostate cancer.

For some reason, many will refuse a Digital Rectal Examination (DRE) due to fears the simple procedure may turn them 'gay'.

According to the 2008 'Well Bermuda A National Health Promotion Strategy' report, 79 percent of men over 40 said they had a DRE in 2006, up ten percent on the previous year.

The Department of Health said the 2006 self-reports were also "positive" in that 77 percent claimed to have undergone a PSA (Prostate Specific Antigen) test, compared to 60 percent in 2005.

However, many doctors on the Island will tell you there is still reluctance and anxiety by men towards the DRE.

Dr. Dyer, Bermuda's only urologist, says: "It's amazing how it does put a lot of men off, but done properly it is totally painless and only takes less than 30 seconds.

"The man just has to relax, just like women have to for a mammogram or Pap smear. But a lot of them find it impossible to relax."

Dr. Dyer says: "I do think it's a homophobic thing. The fear for many of us is quite genuine.

"Some men tend to think it may change their relationship to the female sex, whereas other men just have this fear of the rectal exam. But there is no evidence to support any of the fears they might have.

"I think men need to be proactive but also honest with themselves, and ask whether they really think having a rectal examination once a year is going to change their sexual orientation in some way.

"Just how could it produce any change at all?"

He says: "The rectal exam can tell you the size, shape and consistency of the prostate, but a PSA test should also be carried out. You should really not do one at the expense of the other, you should really do both of them together."

While the PSA test consists of a blood sample, the DRE involves a doctor inserting a lubricated, gloved finger into the rectum to feel the prostate gland through the wall of the back passage, checking for any hard or lumpy areas.

If the examination gives any cause for concern, the patient is referred to a urologist. Hospital tests may then include: a TRUS (Trans-Rectal Ultra Sound) guided biopsy, CT scan, MRI scan, or bone scan.

Before the introduction of the PSA test in the 1980s, men were even less inclined to visit their doctor.

Dr. Dyer says: "Up until the 80s when the PSA blood test was introduced, we had a significant number of men diagnosed with prostate cancer where it had spread.

"Men weren't that proactive 20 years ago. They are certainly a lot more proactive now but there's still a significant percentage that need an impetus from their wives or better-half to go and see a doctor."

Research has shown that wives, mothers and daughters are more likely to make a screening appointment for men over 40, or be the one to encourage a man to make an appointment.

"I think women need to continue to be as supportive of their partners as they've always been, and that support should involve ensuring their partner has regular checkups with a doctor," says Dr. Dyer.

Medical experts say early screening is the key to detecting prostate problems. They recommend annual DRE and PSA tests from the age of 50, but 45 for black men and those with a family history of the disease.

The Bermuda Cancer and Health Centre however, wants to see men getting tested from the age of 40, so as to set a 'benchmark' reading for future health checks.

Cancer is the second leading cause of death in Bermuda, responsible for 24 percent of all deaths in 2006 14 percent of men (62) and 10 percent of women (44).

The 'Well Bermuda' report states: "While the cancer incidence rate is similar in Bermuda to the US, overall cancer mortality is higher in Bermuda, in particular for prostate, ovary, pancreas and breast cancers."

On prostate cancer, the Department of Health report says: "The benefits of early detection are evident, and it is clear that more education would improve the local picture in this area."

Dr. Dyer says: "Having a Prostate Cancer Awareness Month in Bermuda is a good idea and patients should also have access to reading material and leaflets."

For more information on Prostate Cancer Awareness Month, contact the Bermuda Cancer and Health Centre on 236-001 or visit www.chc.bm.