Prostate cancer – A 'forgotten' disease, silent assassin

By Simbarashe Msasanuri

THE advent of the Human Immunodeficiency Virus (HIV) about two decades ago, did not only send shocking waves within the medical sector but rendered scientists useless as they battled in vain to find a permanent solution to a problem that has crippled the society, threatening human extinction.

Though HIV/AIDS is the number one enemy, especially for poor countries and with much emphasis and effort directed on it, there are diseases such as cancer, malaria and cholera just but to mention a few that are claiming a considerable chunk of the world population.

There are other 'forgotten' diseases like prostrate cancer that are proving to be silent assassins as they continue to kill a lot of people worldwide. Statistics have it that one man dies after every 13 minutes in the world due to prostate cancer and according to the American Cancer Society – ACS 2008, it is projected that “one man in six men will get prostate cancer during his lifetime”. Of all men diagnosed with cancer each year, more than one fourth has prostate cancer.

All these deaths, however, can be avoidable if early tests and diagnosis are conducted especially in men over the age of 50. There are two tests that can be performed quickly and easily in a physician’s office which are the Prostate-Specific Antigen (PSA) blood test, and the Digital Rectal Exam (DRE). After these tests, in order to really confirm that one has prostate cancer, a physician may require other tests such as ultrasound and needle biopsy.

It is against this background that prostate cancer patients in Tanzania have requested the government to reduce the costs people are charged to undergo an SPA which ranges between 25,000/- and 50,000/-.

Addressing a two-day National Conference on Prostate Cancer in the city recently, the conference coordinator, Dr Emanuel Kandusi, said the disease had affected many men at the age of 50s and above and most of them could not afford the diagnosis cost.

He called on the government to offer free check ups to all men above 50 years to have PSA to determine whether they were affected or not. He added that diagnosis results would help them get treatment and counselling on safe living in case they are affected.

“It takes eight to ten years for the disease to show signs and it needs urgent treatment that is why we are requesting the government to offer free diagnosis so that men would understand their status early,” he said.

Dr Kandusi said the conference which was being held under the umbrella of “Tanzania 50PLUS Campaign aims at creating awareness on the effects of prostate cancer and to educate them on the preventive measures.

A survivor himself, Dr Kandusi, said the first cancer cell started to develop in his prostate at the age of about 51 (1997).

“Even though I had a habit to do medical check-ups yearly, no doctor asked or suggested to me to do a prostate cancer screening,”added Dr Kandusi who is also the Campaign Coordinator of Tanzania 50 Plus Campaign.

“And, even in 2007 when I started getting warning signs such painful and burning sensation when urinating, the doctor ordered for a routine check-up just to be cleared NAD. Of course prostate cancer cannot be detected through urine routine check-ups! It wasn’t until sometime July 2008 when things went to the worse that the doctor ordered for a PSA test which gave a score 100ng/ml (normal is 0-4 ng/ml).”

The doctor says he was alarmed and did a DRE test and later needle biopsy which confirmed “I had an advanced prostate cancer. Most of 2008 was miserable for me. I couldn’t work; I lived through hand-outs from my relatives and friends.”

“In pains and agony, hopeless and despair, I had to fly to Indraprastha Apollo Hospital, New Delhi, India. After thorough check-ups my really PSA score was found to be 4517 ng/ml and an advanced adenocarcinoma (cancer) of the prostate Gleason’s Grade 8 (4+4).

“The team of doctors suggested two therapies - surgery or hormone therapy by injection. I opted for surgery. After surgery I am now under medication taking one Bicalutamide Tablet 50 gm daily. I wish my prostate cancer was discovered early. The Chinese proverb says, ‘To know the road ahead, ask those coming back’. I am the one coming back and so share my experience”.

“With this testimony I now urge my fellow men if you are approaching or you are over 50 years of age, please see your doctor for medical check-ups which should include prostate screening and urge medical doctor to suggest prostate screening to their 50 plus patients.

Opening the conference, the Assistant Director for Non Communicable Diseases in the Ministry of Health and Social Welfare, Dr Pascience Kibatala said the govt was aware of the problem and was doing all what it can to solve it.

“We know how the disease affects the society but it needs a lot of money to offer free diagnosis to our people. But it is our strategy to find a lasting solution as the number of affected people increases due to increased life expectancy which is above 50 years,” he said.

He said the ministry was providing financial support to NGOs dealing with prostate cancer control because they know the disease is preventable and treatable.

Diagnosis fees for some hospitals in Dar are as follows: Aga Khan – 38, 500/-, Regency – 33,600/-, TMJ- 30, 000/-, Mission Mikocheni – 25,000/- and Muhimbili National Hospital- 40, 000/-.

According to Wikipedia website, prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes.

“Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.

“The term 'cancer' refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process.”

Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumours. A prostate gland is found in male mammals only. It is the most common form of cancer amongst men who are over 50 years old; it causes the second highest number of deaths among men diagnosed with cancer (after lung cancer).

A recent survey demonstrates that men under the age of 40, the chance of getting prostate cancer is about one in 100,000. For men aged between 70 and 74 years old, the chance rises to 1,326 in 100,000.

The most common sites for prostate cancer to metastasize are the seminal vesicles, the lymph nodes, the lungs, and various bones around the hips and the pelvic region. Metastasis is the process by which cancer cells travel from one part of the body to another. The effects of these new tumours are what can cause death.

Warnings for prostate cancer are evident, the symptoms include weak or interrupted flow of urine, inability to urinate or difficulty in beginning to urinate, difficult holding back urine, frequent need to urinate, especially at night, and bed-wetting.

Also urine flow that is not easily stopped, painful or burning urination, burning sensation when urinating, difficulty in having an erection, painful ejaculation, blood in urine or semen, continuing pain in lower back, pelvic, or upper thighs and loss of appetite and weight.

The first step in diagnosing prostate cancer is usually a digital rectal examination. In a digital rectal examination, a doctor places a gloved, lubricated finger into the patient's rectum. The doctor feels for lumps in the prostate.

If the doctor detects a lump, additional tests may be necessary and the first test may be a blood test. The purpose of a blood test is to search for a particular chemical associated with prostate cancer. This chemical is called prostate-specific antigen (PSA). PSA occurs naturally in the blood, but it occurs in much higher amounts if prostate cancer is present.

Looking at these symptoms many elders become shy, are reluctant to get tested, for fear of stigma as they associate such symptoms with that of sexual transmitted diseases (STD). Many turn to the hospital when the disease has advanced.

It is imperative for men over 50 years of age to undergo testing for prostate cancer at least once per year. And the reality is that the earlier the cancer is detected, the better the chances of making recovery.

It is good news , however, that prostate cancer is treatable though there is no 'one size fits all' treatment for it, so each man must learn as much as he can about various treatment options and, in conjunction with his physicians, make his own decision about what is best for him.

Consultation with all three types of prostate cancer specialists, a urologist, a radiation oncologist and a medical oncologist, will offer the most comprehensive assessment of the available treatments and expected outcomes.

The two most common forms of treatment for early prostate cancer are surgery and radiation. Surgery involves the removal of the prostate gland. In addition, a sample of the lymph nodes near the prostate is removed. This sample is then tested to see whether the cancer has spread.

Removal of the prostate also involves removal of the seminal vesicles that lie next to it. The seminal vesicles are the organs that make semen. Since they are usually removed along with the prostate, the patient usually becomes sterile as a result of the operation.

Though the campaign, 50 PLUS, was initiated by the Centre for Human Rights Promotion (CHRP) with the primary goal of reducing the sufferings and deaths caused by prostate cancer through education, awareness, dissemination of information on the disease; encourage check-up; extend support, care, treatment and capacity building, more still needs to be done.

This is a challenge to the government and other stakeholders to chip in and curb this silent assassin by encouraging and availing resources for Tanzanian men to regularly undergo prostate cancer screening.