Nearly 100 per cent of men diagnosed with prostate cancer at early stages, experts say, will be disease-free after five years. But, ignorance has made many suffer from this disease whose cure rate is very high, writes OYEYEMI GBENGA-MUSTAPHA
Tomorrow morning, cyclists wearing helmets and kitted with other riding gears will ride from the United Bank for Africa (UBA) head office in Marina, Lagos Island to the National Stadium, Surulere on the Lagos mainland. They will be riding because of men, such as 47-year-old Simeon Unachukwu, who are down with prostate cancer, a disease which one in every 38 men between the ages of 40-59 get diagnosed with.
The first sign that all might not be well with Unachukwu started when he was always having an urgent need to pass urine; yet had less urine flow and was feeling burning sensation when he passed urine. He was always getting up many times during the night to pass urine.
He visited the Lagos University Teaching Hospital (LUTH), Idi Araba and had audience with an urologist, Dr Habeeb Tijani, who told him to go for Prostate Specific Antigen (PSA) test and a prostate exam (digital rectal exam) to ascertain the risk of prostate cancer.
The PSA is a screening tool to detect prostate cancer. The result indicated an elevated PSA with value greater than 4.0ng/dl. He was confirmed with having prostate cancer.
The late Prof Omo Omoruyi, who was the boss of the Centre for Democratic Studies (CDS), also battled prostate cancer. In his book ‘Journey Back to Life’, he recounted his experience and preached the gospel of early detection.
As a cancer patient, he passed through the National Hospital, Abuja, the Boston Medical Center, the Dana Farber Cancer Institute and Harvard University Medical School.
In the book he gave hope to those living with cancer that contrary to the general claim that cancer is an instant death sentence, appropriate treatment regime, continuing advancement in science, and the will to survive could see them through.
Foremost lawyer and Senior Advocate of Nigeria (SAN) Prof Ben Nwabueze recently announced that he was battling prostate cancer. Last October, in a statement, he explained why he turned down his appointment as a member of the National Conference Advisory Committee.
He said: “It is not generally known to people that I have been fighting prostrate cancer for some years now, and have been kept going by consultations from time to time with, and treatment by, a Consultant Oncologist at Charing Cross Hospital, London. My appointment with the Consultant Oncologist had been shifted many times because of several postponements in the dates of The Patriots meeting with President Goodluck Jonathan and the National Summit at Uyo, both of which eventually took place on 29 August and 3/4 September respectively, leaving me free at last to travel to London on 8 September for my medical appointments.
“After The Patriots fruitful meeting with the President, a member of our team who has access to him on a personal basis was mandated to go back to get him to set up the Committee on the National Conference of which he had earlier given a hint. My understanding from the contacts with him was that The Patriots would be asked to nominate a member to the Committee. I never expected to be appointed chairman or member of the Committee, and would, quite frankly, have considered such an appointment inappropriate in the circumstances. It is an appointment for a younger person, not for an old man of 83 years afflicted by ill-health.”
Tijani, who is a Senior Lecturer/Consultant Urological Surgeon at the Department of Surgery, College of Medicine University of Lagos (CMUL) / LUTH, says growing older raises risk of prostate problems.
He said: “The three most common prostate problems are: Inflammation (prostatitis); Enlarged prostate (BPH, or benign prostatic hyperplasia) and Prostate cancer. One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time. However, not all prostatic enlargements are cancerous and many enlargements do not require treatment. Having that patient go for the PSA test is in order people. PSA test is a simple, reproducible, and relatively accurate blood test. It is used to detect a protein (the prostate specific antigen) that is released from the prostate gland into the blood.
“The PSA level is usually higher than 4ng/mL in people with prostate cancer than in people without the cancer. Situations of large prostate size, infection and inflammation are other reasons why the PSA may be elevated. The PSA, therefore, is valuable as a screening test for prostate cancer. Accordingly, doctors usually recommend doing a PSA in men age 40 and over. Subsequent screening is recommended based on individual preference and assessment of risk for developing prostate cancer. For example, patients with a high risk of developing prostate cancer due to a family history or a high initial PSA should have more frequent evaluation (usually annually).
“And the number of cases we see at LUTH is also increasing. Poor records keeping in Nigeria means that we do not have adequate data. It is however the number one causes of cancer death in men above 45 in Nigeria. World-wide, it is more common in blacks. It is more aggressive in blacks and it tends to occur at an earlier age in blacks. In short, the black man of West African origin is more likely to be killed by the cancer compared with other races. Screening for Prostate cancer among Nigerian men is low because awareness on screening for Prostate cancer is still poor. Every black man after 40 should have an annual evaluation of his prostate. With less than a N2, 000. 00 the screening can be obtained.”
Routine screening is about N10 000. Patients, who have suspicious results, will then need confirmatory test, which costs a little over N50, 000.
Tijani described Prostate cancer as an abnormal and uncontrollable growth of the prostate subsequently spreading to vital organs and thereby destroying them.
“Unchecked, this ultimately leads to the demise of the individual. The level of awareness of this disease is so low among men. The reason is largely due to the fact that there are no early symptoms for prostate cancer. In fact, at diagnosis, the disease is already advanced. As such, an aggressive campaign like that done for breast and cervical cancer in women should be embarked upon.”
Tijani also had some experience with a man in his early fifties who came to the hospital with an obvious prostate cancer on examination. Based on the clinical examination, he was told to go for further diagnostics screening but declined saying he was ‘shot’ (Yoruba- ‘won ta mi lofa’) at by his enemies.
According to Tijani, such assumptions do not hold water and it is amazing that at this age people with medical challenge, such as this, could be frivolous as to believe in African bellicose and superstitions such as the claim of the patient above. He did not show up again at the hospital.
Another patient was also attended to. He was in his early 60s and a retiree. He had his children brought him to the hospital but could not afford the cost of the screening nor the treatment. More so, he could not come alone to the hospital because he lives outside the state. He was not able to be followed up and was lost as a patient.
Consultant General and Urological Surgeon, Delta State University Teaching Hospital (DELSUTH), Oghara, Dr Leslie Akporiaye, had attended to many patients with success stories/happy ending. He was working with an oil company in Delta, as a Medical Director of the oil company’s clinic before he moved to DELSUTH. While at the oil company, he was attending to the retirees and the company footed their bill. He was also holding constant health talk with them because most of them are advanced in age. They knew what to look out for and report promptly to the clinic on sensing any suspicion. A lot of the retirees were saved from progressing into advanced stages of prostate cancer or death. And they enjoyed their lives in retirement.
Some also who were private citizens had been coming to DELSUTH either from recommendations from survivors or preventive cases from the oil company or referrals from other hospitals. According to Dr Akporiaye, DELSUTH has all it takes to attend to any man with prostate cancer of any stage.
Causes/ way out
Explaining the causes of prostate cancer, Dr Akporiaye said the cause of prostate cancer is unknown, but the cancer is not related to benign prostatic hyperplasia (BPH). The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. “The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. As a matter of fact, some studies have suggested that among men over 80 years of age, 50 per cent to 80 per cent of them may have prostate cancer cells present in the prostate gland. More than 80 per cent of prostate cancers are diagnosed in men older than 65 years of age.”
Another urologist, Dr Emmanuel Audu-Obe, Director, Fertigene Diagnostics/Salem Hospitals, Benue, said if the prostate cancer is advanced the following symptoms are also possible: Bone pain, often in the spine (vertebrae), pelvis, or ribs; the proximal part of the femur can be painful; leg weakness (if cancer has spread to the spine and compressed the spinal cord); urinary incontinence (if cancer has spread to the spine and compressed the spinal cord) and fecal incontinence (if cancer has spread to the spine and compressed the spinal cord).
Dr Obe explained that the prostate is a walnut-sized gland located between the bladder and the penis. “The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra; and it’s expelled with sperm as semen. The vasa deferentia bring sperm from the testes to the seminal vesicles. The seminal vesicles contribute fluid to semen during ejaculation.
“Cancer affecting this organ is called prostate cancer and it is the most common form of cancer in men (besides skin cancer), but only one in 35 men die from prostate cancer. This ailment is more prevalent in the elderly. Younger men usually have Prostatitis (Inflammation of the prostate, sometimes caused by infection). In some cases, it is treated with antibiotics, and Enlarged prostate: Called benign prostatic hypertrophy or BPH, prostate growth affects virtually all men over 50. Symptoms of difficult urination tend to increase with age. During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test.”
He said: “Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few. Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 40, but much more common after the age of 45.
“Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups – in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men.”
A medical practitioner, Dr Gafar Akinsanya, advised men who are above 40 years of age to abstain from diets which are rich in animal fat.
The doctor, a staff of the Federal Medical Centre at Idi-Aba in Abeokuta, told the News Agency of Nigeria (NAN) abstinence would help to reduce the risk of Prostate cancer.
He said prostate cancer was a common cause of death among elderly men.
“The prostate is a small, walnut-sized structure that makes up part of a man’s reproductive system,” Akinsanya said.
He said the men mostly at risk of being affected by the disease included men who are above 60 years, and men with excessive alcohol habit.
The doctor said farmers, as well as men who have a family history of the disease, could also be affected.
“Others are painters, men who indulge in diets high in fat, especially animal fat and men who have been exposed to cadmium,” he said.
Akinsanya noted that some of the symptoms associated with this type of cancer may not result in prostate cancer.
He listed some of the symptoms to include delayed urine, blood in urine or semen, leakage of urine after urinating, low back or pelvic bone pain and a slow urinary stream.
“A common problem in most men as they grow older is an enlarged prostate but the problem does not raise the risk of prostate cancer,” the doctor said.
Akinsanya said blood test was required to screen men for prostate cancer, adding that most prostate cancer could be detected and treated before they caused any harm.
He added that the disease could be treated with radiation therapy, chemotherapy or surgery.
“Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy,” Akinsanya said.
He listed some side effects of the surgery to include difficulty in controlling urine or bowel movements and erection problems.
The doctor advised patients to follow a vegetarian, low-fat diet which includes foods high in Omega-3 fatty acids.
The UBA Foundation, which is organising tomorrow’s cycling for prostate cancer, will be conducting free prostrate screening at the National Satdium, Surulere, Lagos, the Millennium Park, Abuja, UBA Business Office, Nike Lake, Trans-Ekulu, Enugu and Trans Amadi, Port Harcourt.
