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What to know about prostate cancer, enlargement

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By Dayo Ojerinde

Prostate cancer is the third leading cause of cancer deaths in Nigeria after breast and cervical cancer.

It is also the leading cause of cancer deaths in Nigerian men.

GLOBOCAN 2021 Report reveals that Nigeria has the highest number of deaths from prostate cancer with 8, 382 (58.5%) deaths out of the 14,334 deaths recorded globally in 2020.

The Medicaid Cancer Foundation said, 13,0781 new prostate cancer cases are recorded annually.

The Chief Executive Officer of the foundation, Dr Zainab Shinkafi-Bagudu, recently said, “For Nigerian men, prostate cancer is both the most common and most deadly cancer with 32·8 cases and 16·3 deaths per 100,000 men. Prostate cancer is to men what breast cancer or cervical cancer is to women. It has the potential to grow and spread quickly, yet, awareness amongst men and the general population towards screening low.

“Early detection saves lives. Almost 100% of men diagnosed with prostate cancer in early stages are still alive, five years after diagnosis.”

Medical experts, however, advocate early presentation for diagnosis and care, saying this could help prevent, and improve the survival rate for the disease.

Prostate cancer is the growth of tumours in the prostate gland. Only men have a prostate which is a walnut-sized gland between the rectum and the penis and creates a fluid to be mixed with sperm to create semen.

Symptoms of prostate cancer include trouble urinating, decreased force in the stream of urine, blood in semen, discomfort in the pelvic area, bone pain as well as erectile dysfunction.

Findings reveal that a large number of Nigerian men who were diagnosed of prostate cancer, presented late at stages III or IV, when the prostate cancer has spread to other vital organs of the body.

Health-Panorama gathered that there is still a lot of ignorance about the disease and inadequate treatment facilities and equipment in Nigeria. Lack of finances for proper treatment also leaves patients and their families suffering untold hardships.

Dr Habib Muhammad of the Radiotherapy unit, Lagos University Teaching Hospital (LUTH), said, “When prostate cancer is detected and managed early, people usually respond to treatment. It is very important to go for screening to detect it, especially as one approaches the age of 40,” He said any good public or private laboratory could conduct a test to detect prostate cancer, adding that an easy test to do is Prostate-Specific Antigen (PSA) where blood samples are taken from a man at the laboratory. Other tests like digital examination, ultrasound of the pelvis to see the nature of the prostate can be done.”

The Executive Director, Project Pink Blue, a cancer organisation focused on cancer awareness, screening and support services, Runcie Chidebe, said the burden of prostate cancer in Nigeria is huge and the country continues to lose mentors and older people to this disease.

He said, “Once prostate cancer hits a man in a family, the entire home is affected. The burden is so huge that it drains everyone around the patient – psychologically, financially and otherwise. There is an increasing burden of cancer phobia among family members of any man who has been diagnosed of prostate cancer; families who lost someone to prostate cancer become afraid and continue to see any symptom of any illness as cancer.”

He said low awareness and unavailability of a national screening programme has been a factor for late diagnosis of prostate cancer in the country.

“To reduce the burden of prostate cancer, I would like to see a Nigeria where once a man is 40 years old and above, he is mandated to run a prostate-specific antigen (PSA) test at every visit in any hospital.

“This way, we can catch abnormal PSA levels on time and tackle prostate cancer at early stages. What we have in Nigeria is opportunistic screenings, a situation where non-governmental organizations, churches and other organizations host medical outreaches and men are screened randomly and possibly present some abnormalities,” Chidebe said.

He said the prostate cancer incidence is increasing and the awareness on the disease is really low, “hence there is a need for conscious actions to create awareness and save our men from prostate cancer in Nigeria.”

What are the risk factors?

A Professor of Public Health and Community Medicine at the University of Benin Teaching Hospital, Benin City, Prof. Omokhoa Adeleye, said the risk factors for prostate cancer are black race, being above 40 years, positive family history and high-fat diet.

Adeleye said other risk factors are high serum androgen (sex hormones) levels and prolonged sexual abstinence in middle-aged adults.

Muhammad explained that, “As you age, the likelihood of prostate cancer also increases. It is commoner among blacks and family history also increases the chances.”

Also, a Consultant Urologist at Enugu State University Teaching Hospital, Parklane, Enugu, Dr Bun Eze Eze, explained that since only men have prostate glands, that factor predisposes a man to the illness

He said age is another risk factor. “In Nigeria, majority of patients we diagnose are people usually over 60 years or over 70 years old. So the longer a man lives, the more likely he’s going to have prostate cancer.”

He said the disease tends to run a more aggressive cause in blacks than in whites, adding that another important risk factor is genetics or hereditary factors. “The fact that you have a relation who has had prostate cancer increases your risk of having it.”

He added that people who eat more of vegetables and fruits tend to be less obese and have less risk for prostate cancer than people who eat more animal protein such as beef, red meat – who are usually more obese than the general population.

Any treatment?

Prof. Omokhoa Adeleye said treatment for prostate cancer includes psychological support, and prostatectomy (a surgical procedure for the partial or complete removal of the prostate), and radiotherapy (a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumours) during the early stage of the disease.

He said treatment during the late stage is hormone therapy and bilateral orchidectomy (removal of both of the testicles) plus internal fixation if pathological fracture occurs.
He added that screening primarily PSA level tests could help prevent the disease while secondary methods are digital rectal examination, ultrasonography and high-risk individuals need immediate screening and follow-up.


Age, family history predispose men to prostate enlargement – Urologist

A consultant Urologist at the Lagos State University Teaching Hospital, Ikeja, Dr. Oluwaseun Akinola, has said age and urinary symptoms are some of the risk factors for prostate enlargement.

In an interview with Health-Panorama, Akinola said the exact reason for prostate enlargement remained unclear.

He said, “There has not been any particular thing that has been identified to cause it. We do know that it runs sometimes in families, so there is some genetic component. We also know that it happens to a lot of men as they grow older. It can go to a point where it starts causing problems, when there is some degree of blockage. Initially, the bladder might compensate for all the blockage; the inner lining starts getting a little more sensitive.

“People without a family history can also get it. We believe there are some degrees of imbalance of hormones, but the exact mechanism remains unclear.

“The older a man grows the more likely he can have prostate enlargement. The normal prostate is about 25 grammes or the size of a walnut. But over time, it can grow big, up to 200 grammes. In some people it never changes.

“Men must know that when they develop urinary symptoms, when they start to urinate more often than before, waking up multiple times at night to urinate, having difficulty while urinating, intermittency in the flow of the urine; those are all symptoms that suggest that something is going wrong with the prostate. Most times it is an enlargement but it is also important to check because sometimes cancer can also present in a similar way. Early detection will save a lot.”

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