Ojewola: Prevent prostate cancer with healthy lifestyles, early screening
Dr. Rufus Wale Ojewola, a Consultant Urologist, Department of Surgery, Lagos University Teaching Hospital, is also a lecturer in Surgery, College of Medicine, University of Lagos, Idi-Araba. In this interview, he spoke to PAUL ADUNWOKE on treatments, preventions and management of prostrate cancer.
What should men know generally about prostate cancer?
Prostate is an accessory organ of reproduction, found below the bladder in men. Prostate cancer is when cancer develops from the prostate organ. Prostate cancer is the commonest cancer in adult males. About one in 36 men will develop the cancer in their life time, while one in six afflicted men will die of the disease. Prostate cancer can be aggressive and lead to death, but can also be slow growing, in which case, patients can live long and die of other diseases or causes, such as, complications from diabetes, hypertension, lung diseases or even road traffic accidents and old age.
The risk of developing prostate cancer increases with age. The peak incidence is in the sixth and seventh decades of life. It was rarely diagnosed in men below the age of 50 years in the past, but this has changed, as younger men are increasingly being afflicted now. We now diagnose prostate cancer in men around 40 years of age. This is what we call age migration in cancer and this is not peculiar to prostate cancer. For example, breast cancers are being increasingly diagnosed in teenagers now. There is a racial predisposition to prostate cancer, as it is an established fact that the disease is commoner and more aggressive in blacks than whites. Men should also know that prostate cancer is curable, if detected at the early stage.
What are the symptoms?
The manifestations of prostate cancer depend on the stage at diagnosis. In the very early stage, it might not manifest with any symptom. It is only discovered during screening for prostate cancer. This is the commonest method of detection in the Western world, where there are organised screening programmes for men.
If not discovered at this stage, it can then progress to manifest as lower urinary tract symptoms. These are symptoms of difficulty in passing urine, like urinary frequency, nocturia (frequent urination at night), intermittent stop and start pattern of urination, urgent inability to postpone urination, straining, applying force during urination, incomplete voiding, feeling of urine remaining in the bladder after urination or poor urinary stream. There may also be passage of blood in the urine or bloodstain in the seminal fluid. By the time prostate cancer is advanced, there may be weight loss, loss of appetite or general weakness. There may be back pains, if it has spread to the back or weakness or paralysis of the legs, if the spinal cord is involved. There may be yellowness of eye and abdominal swelling, if the liver has been involved. There may be cough, chest pains and passage of bloody sputum, if the lungs are affected. The truth is that it can spread to any organ in the body, if not discovered and treated early.
What should men do to avoid or prevent prostate cancer?
The bitter truth is that prostate cancer is not totally preventable, as one cannot modify the established risk factors. The major risk factors are age, more than 50 years, black race, and genetic factors, which include family history. Modifying or eliminating these factors could have helped to prevent prostate cancer. Unfortunately, none of these major factors is modifiable. For example, no man can change his age, race or family genetic factor.
However, there are other less important risk factors, such as, the type of food one eats. Eating food containing less fatty components and food rich in vegetables, tomatoes and fruits have been found to reduce the risk slightly. Avoidance of smoking, including healthy lifestyles among men are generally helpful.
What is the next step after the signs have been noticed?
Once there is presence of any of the symptoms above, there is need to consult a doctor, preferably urologists, who are the specialists that treat prostate diseases. There is no need to panic or live in fear of being diagnosed with prostate cancer. This is because there are other noncancerous conditions of the prostate, which include benign prostatic hyperplasia, chronic prostatitis of the bladder that can also manifest as difficulty in passing urine.
The doctor will take the history around the symptoms listed above and conduct a thorough examination, especially on the prostate to determine if it is enlarged or not, smooth or rough and if rubbery or hard in consistency. Findings of irregular and hard prostate on examination may suggest malignancy.
Conducting a prostate specific antigen (PSA) test is mandatory, and elevated values may also suggest cancer. However, there are other diseases that can cause elevated PSA. This is why there is need for specialist consultation to differentiate some of these conditions from cancer of the prostate. A transrectal ultrasound test is also necessary to give more details about the prostate organ, which is an organ hidden deep in the pelvic region of the body. With abnormality in any of examination of the prostate, PSA test or prostate scan, there is need to perform a prostate biopsy to confirm the diagnosis. Biopsy is the process by which samples are collected from the prostate for histological examination to determine whether it is cancerous or not.
Do high number of ejaculations lower the risk of having prostate cancer?
Ejaculation or sexual activities, whether infrequent, frequent or excessive, has no relationship with the development of prostate cancer. Studies have not demonstrated a causal and effective relationship between the two. So, it is one of the several misconceptions about the aetiology or cause of prostate cancer. Other misconceptions include, multiple sexual partners, sexually transmitted diseases and celibacy. None of these have been proven to predispose a man to developing cancer of the prostate.So, men of God are not at increased risk of prostate cancer than other men, and at the same time, they are not protected by their celibacy.
What are treatments for prostate cancer?
Treatments and their success depend on the stage of detection. If detected early, prostrate cancer is curable by surgery radical prostatectomy or radical radiotherapy. Radical prostatectomy involves the removal of the entire prostate gland and the nearest organ to it, the seminal vesicles. For late or advanced cases, there is no cure. We can only palliate, increase survival time and improve the patient’s quality of life. This is achievable with the use of hormonal methods, which deprive the prostate of male hormones. Male hormones are responsible for the growth of the prostate and the cancer therein. Surgical removal of the two testicles Bilateral Total Orchiectomy, which are the major source of male hormones and monthly, or three monthly hormonal injection, which achieve the same low level of male hormones in the system are the commonly used methods of palliating advanced cases.
What is your advice for all?
All men above 50 years of age should make themselves available for screening without delay, even if they are without symptoms. Screening entails a rectal examination of the prostate by a doctor, preferably a urologist, a PSA test and a prostate scan. Actually, this should be undertaken on yearly basis. The beauty of cancers detected by this method is that they are early and are potentially curable. High acceptability and practice of screening for prostate cancer is the reason for improved survival and low death rates from prostate cancer in the Western World.
Unfortunately, Nigerians are yet to embrace screening for cancers generally, including prostate cancer. They wait until there is presence of symptoms for months or even years, by which time the cancer has spread to other organs in the body and is potentially incurable. Late presentation and therefore, late diagnosis is the main reason why mortality or deaths from prostate cancer is still very high in Nigeria. This is what is killing Nigerian men suffering from cancer, when other people survive cancer. The difference is time of detection. Since prostate cancer is not totally preventable, the message we preach is early detection, which is only possible with screening. If at risk, by the virtue of presence of any of the risk factors highlighted in this piece, see your doctor and demand for screening.
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