Prostate cancer treatment options

By Niyi Akinnaso

Last week on this column, the key symptoms of prostate cancer were outlined and the basic steps to take in getting the prostate examined were described. As previously indicated, the most determinate step in the diagnosis of prostate cancer is a biopsy of the prostate to be examined by a pathologist.

Once cancer is detected, that is, if the biopsy presents a malignant tumour, the urologist will prescribe the course of treatment. There are now up to seven treatment options, depending on the stage and aggressiveness of the cancer.

For example, the treatment needed if the cancer is contained within the prostate gland will be different from the one needed if the cancer has metastasised, that is, if it has spread beyond the prostate gland. In some cases, a combination of treatment options may be necessary.

One, the Wait and See method can be employed, without any other cancer treatment, if the cancer is not aggressive. What this means is that treatment may be deferred while the condition is periodically checked. Wait and See, therefore, translates to a programme of active surveillance. This option may be appropriate for those who have other critical health issues or have attained advanced age, say over 80.

Two, radiation therapy can be used to kill cancer cells, especially if they have migrated beyond the prostate. In some cases, small radioactive pellets can be inserted into the prostate to kill cancer cells.

Three, hormone therapy drugs can be used to reduce the symptoms of prostate cancer and to shrink or slow the growth of the cancer cells. This method, however, only delays the ultimate treatment.

Four, immune therapy is another form of treatment used to slow the the progression of aggressive prostate cancer cells, especially those that have failed to respond to other treatments.

Five, chemotherapy is often used to kill fast-growing cancer cells, especially when prostate cancer cells outgrow the prostate into other sites. This kind of chemotherapy lasts several months.

Six, cryotherapy is a more recent form of treatment that kills cancer cells by freezing the cells, which them break apart when they are warmed up. However, the effectiveness of this treatment over time is still under study.

Seven, by far, perhaps the most effective treatment is radical prostatectomy, especially if the cancer has not spread beyond the prostate. This is the surgical removal of the entire prostate gland. Such surgery used to come with erectile dysfunction and damage to the urinary tract. Fortunately, new surgical techniques, including the use of precision robots, can to avoid nerve damage and lessen the impairment of urinary control.

Each of the various treatment options described above comes with its own side effects. For example, chemotherapy often leads to hair loss, mouth sores, nausea, and vomiting. Cryotherapy too has its own side effects. Erectile dysfunction is more common with this type of treatment than with radical prostatectomy, while a more common side effect with prostatectomy is incontinence. Although this may last for some time, it does not remain forever.

To be sure, some discomfort often follows radical prostate surgery. It is, however, only for a limited time. Besides, the advantages of radical prostatectomy far outweigh such discomfort.

Whatever treatment method applies, follow-up treatment is necessary. Even when the prostate gland is completely removed, it is still necessary to have additional tests, like the PSA test, additional treatments, or advice on appropriate lifestyle modifications, such as appropriate diet and exercise.

What men over 50 should bear in mind at all times is that they are likely candidates for prostate cancer, because the risk increases with age. An Additional determinate factor is heredity. If your father or brother had prostate cancer, your risk for prostate cancer is doubled. If you are about 50 and you have a relative who had prostate cancer, you should start getting your prostate examined immediately and periodically.

Yet another factor to bear in mind is the recent revelation that prostate cancer is not only the most prevalent cancer among Nigerian men, Nigeria has the highest rate of prostate cancer per population in the world! This revelation is particularly significant because most cases go unreported, especially in the rural areas.

This statistic may rise in view of the infusion of toxic agents in food as revealed in my column about three weeks ago (see The underbelly of soft deaths in Nigeria, The Nation, January 15, 2020). Furthermore, the lack of exercise and the ingestion of high fat foods, especially red meat, as well as minimal consumption of fruits and vegetables, are fingered as possible contributors to the prevalence of cancer in Nigeria.

Realising that this column may be read only by a tiny fraction of literate Nigerians, the vast majority will definitely miss this information. Yet, public education is necessary for the generality of the population to know about the danger of prostate cancer.

I, therefore, challenge urologists among us to take up this challenge alongside the Federal and State Ministries of Health and Information across the country. Public education in a variety of local languages is necessary in all 774 Local Government Areas in order to alert men in the rural areas to the danger their prostate may pose to their lives as they age.