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Late diagnosis, patients’ silence cause high rate of prostate cancer
By Tumininu Ojelabi Hassan
The prevalence of prostrate cancer, especially amongst older Nigerian men is an issue, which has been swept under the carpet for ages bordering on lack of awareness and silence by victims, who prefer to bottle up their problems than speak out, perhaps, because the society encourages women to speak out than men. Nonetheless, this health issue requires urgent attention and awareness to ensure the survival of prostate cancer victims.
Prostrate cancer is the commonest cancer amongst men, especially in West Africa. In Nigeria, prostate cancer is the most common cancer affecting men with 32.8 cases and 16.3 deaths per 100,000 men. Prostate cancer develops, when abnormal cells form and grow in the prostate gland. Prostrate is an organ in men, which adds constituent to the semen.
Recently, Prof. Pat Utomi shared his battle with prostrate cancer via his X (Twitter) page, stating that the health condition is bringing death and misery to many men, especially those, who are over 60 years.
“I am moved this dawn of light to confront an epidemic under the carpet with great harm to men. Prostate cancer is bringing death and misery to many men. Had they been forewarned the misery containment and even chances of cure could be much enhanced, like women have with breast cancer.
“When a biopsy showed I was positive last year I began treatment with a cancer Centre with a branch in Ikeja and VI. I sometimes came from election campaigns to the Ikeja Centre near the Airport. The doctors would try to smuggle me out from the back. The well known shielded? Did not see why it was taboo to say you were in a battle with cancer.
“The more I talked about it, the more I found many of my age in similar circumstances. It almost seems like an epidemic for Nigerian men over 60. Not talking makes them lose the benefit of early detection,” he posted.
In an interview with our correspondent, Dr. Adebowale Oyebade, Urology unit, Department of surgery, LASUTH shared some insights on the causes of prostate cancer, which include the race factor, family history, obesity and age.
“Basically you can’t say this is the actual cause of prostate cancer. There is something called the race factor. Being black increases the chances of having prostate cancer because it is common among the blacks. Also, Family history is a risk factor. For example, if someone’s father had prostate cancer, there is a likelihood that such a person will have prostate cancer. Obesity is another risk factor but it is not a strong cause of the disease because it has minimal effects,” he explained.
To address doctors’ advice against the consumption of processed foods, canned foods and microwaved foods, Dr. Oyebade said some of the machines used in producing these foods release carcinogenic, a particular chemical linked to the cause of cancer. These foods do not cause cancer, however because of the lack of control on imported foods, there should be a safe limit.
“In developed climes, there is a high level of control over what is imported into the country, but you can’t trust the type of canned foods and processed foods that are imported into Nigeria and that’s where the role of the Standard Organisation of Nigeria (SON) comes to play. It’s not like these foods cause cancer but we need to be sure these products are CFC (chlorofluoro carbon) free. In this part of the world we tend to go overboard, and there should be a safe limit to how much of these processed foods we consume,” he advised.
According to him, the symptoms of prostate cancer vary based on the stage of the cancer. Some symptoms experienced include urinating frequently, especially at night, straining when urinating, issues with urinating, blood in the semen, when the cancer spreads other symptoms like back pain, difficulty with walking, swollen leg, poor erection and erectile dysfunction can be experienced.
“There are different stages of prostate cancer. The first stage is when there is no elevated PSA. At the early stage, it doesn’t show symptoms. Thus, it is advisable for men above 40 years old to go for screening/ routine check up yearly. Subsequently, some symptoms like urinating frequently, waiting before the urine comes, blood in the urine, trying to urinate and urine not coming at all, blood in the semen can be noticed. When it spreads, symptoms like back pain, difficulty with walking, swollen leg, poor erection and erectile dysfunction are experienced,” he added.
Oyebade shared the treatment process of prostate cancer, which is in different stages depending on the symptoms and the stage of the cancer. The treatment process begins with the digital rectal examination, after this is the prostate biopsy, then a microscopic examination will be carried out to determine if the growth is normal or cancerous.
“Treatment depends on the symptoms. The first thing is to carry out a digital rectal examination by an urologist. Just like women have gynecologists, an urologist is the gynecologist for men. Digital rectal examination involves putting a finger in the person’s anus to feel and access the prostate.
“After this, a prostrate biopsy will be carried out, that is, taking pieces of the prostate using a special needle, the pieces of the prostate will be taken to the lab, then it will be examined under the microscope. Then it can be determined if the growth is normal or cancerous. If it is cancerous, the treatment will depend on the stage of the cancer and how far it has spread.
“Treatment can be in two ways. It can be curative, which means to cure the disease either by surgery called Radical prostatectomy or Radiation therapy. Another way is Palliative care, this is in a case, whereby it has spread beyond the prostrate, it can be treated either by undergoing a surgery or using medications.
“This surgery (orchidectomy) involves removing the balls (testicles) and the other way involves giving a particular injection or medication depending on the patient’s history or the characteristics of the disease. The duration of treatment takes about 3-6 months if money for the treatment is available. Also, family support plays a significant and psychological role in helping the patients,” he explained.
He noted that it can’t be prevented as long as there is prostate. However, someone with a family history of prostate cancer needs to monitor their health by going for screening and routine check up regularly.
“Men that are 80% years old have a 80% chance of developing prostate cancer, 90 years old men have a 90% chance while 100 years old men have a 100% chance of developing prostate cancer. This is because it is an indolent cancer and a disease of the elderly. If it’s not aggressive, most times it is not prostate cancer that kills the patients but death can be caused by other diseases like hypertension, diabetes and arthritis. You know at that age it is unlikely to find someone without any of these ailments,” he further explained.
He stressed the need to keep family history so as to reduce the rate of prostate cancer. He ascribed the mortality rate of prostate cancer to late presentation, financial burden, cultural and religious beliefs.
“We don’t keep record of family history and there is a need to keep family history. For someone with a family history of prostate cancer, there is something called the BRCA gene, therefore his sisters should go for screening because they have a high chance of having breast cancer, even the daughters as well,” he said.
“Talking about the factors that contribute to the death rate of prostate cancer, in this part of the world, as a man you are expected to show signs that you are a man, due to this belief most times we don’t speak up when we are going through something. The first factor is late presentation, that is, presenting the case when it is overboard, advanced or metastatic, meaning when it has spread.
“At this stage, there is really nothing we can do. Another factor is financial burden, this is because majority of the prostate cancer patients have retired and just living on allowance from their children, so they can’t afford the cost of treatment.
“The test cost about hundreds of thousands, radiotherapy costs millions of naira, one injection is about N140,000, the medications for a month is about N300,000 coupled with the fact that these people buy medications for other health conditions they are battling with.
“Late presentation can also be tied to ignorance, particularly on men’s health and prostate cancer. Cultural and religious beliefs also contributes to the rate of prostate cancer, because one of the treatments includes removal of the balls, which some people are against. They usually say they must die with a complete body,” he stated.
He shared some tips to ensure the survival of prostate cancer patients, particularly access to affordable treatment, awareness, enlightenment programs, regular checkup, healthcare insurance and access to more healthcare facilities.
“Awareness, enlightenment programs and regular checkup are needed to ensure the survival of prostate cancer patients. Everyone has a special day, which is their birthday, this day should be dedicated for checkup. In addition, big diagnosis centres should have a health plan to screen people, when the test result is out, counseling should commence. Including cancer care into state and national health insurance is paramount because treatment of prostate cancer is out of pocket.
“Government should provide more cancer centres. For instance, the nuclear bone scan, a specialized test for individuals with prostate cancer should be readily affordable. In Lagos, only private facilities do this scan, the public hospitals doing this scan are UCH Ibadan and National hospital, Abuja. When people go to these hospitals, there will be a long waiting list, even in the private setting there is a long waiting list. It’s not all centres that have the machines for radical radiotherapy and not all centers do prostatectomy,” he suggested.
According to Oyebade, a recurrence of prostate cancer after undergoing Radical prostatectomy is possible. He emphasized the need to monitor survivors at intervals, sometimes every three months or six months.
“During the surgery, everything might not be removed in totality, a tiny trait might have been left out so there is a chance of recurrence and that is why we have to monitor patiently closely, at every three months and six months,” he said.
He addressed the lack of manpower in the health sector, especially in the urology and oncology units. He attributed the low figure of urologists and oncologists in the country to “japa syndrome” as a result of the negligence of the government towards the welfare of doctors.
“People are specializing in oncology and urology but due to the the japa syndrome the number of urologists and oncologists in the country has dropped drastically because they go to places, where they are appreciated. I have been in the hospital since Monday, everyday I enter the theatre at 9am and I don’t come out until 8:30pm. I slept at 2am in the midnight and as early as 7am this morning, I was already in the theatre.
“After doing all these, at the end of the day, what you have isn’t enough to take care of yourself, as well as to afford an apartment close to your place of work, or afford a brand new car, or to enroll your children to a good school of your choice and to go on vacation. We use our personal money to buy things needed to treat patients and equip the reading room.
“If doctors are comfortable, if they have an accommodation close to their place of work, if paid a competitive salary and they don’t have to beg for salary reviews, or bother about paying their children’s school fees from primary to secondary school level, they go on sponsored vacations, like in sane climes, where all these things are statutory, doctors will stay in the country,” he decried.
