Dr Alex Danso Consultant Urologist
Prostate cancer is the most common form of cancer in men worldwide (besides skin cancer), but only one in 35 men die from prostate cancer.
In the United Kingdom for example it is said to be the third commonest male cancer and over 60 000 new patients present each year.
In the United States of America over 200 000 new patients present in a year and 27 000 men die each year from prostate cancer.
There are racial differences in incidence of the prostate cancer. Prostate cancer is rare for example in Japan but very common in the US.
Moreover, African American men do have aggressive type of the disease. Black African men are especially at risk for development of prostate cancer.
There is accumulated evidence in the worldwide urological oncology literature and also known and widely accepted that black African race, black Africans and the ethnic diaspora, are at increased risk for development of prostate cancer.
Population studies of racial differences in prostate cancer have shown a higher prevalence of more advanced stage of disease at diagnosis and worse outcomes in black men in West Africa, Caribbean black men, African-Americans and Black men in the UK. Population studies in West Africa have shown even a slightly higher incidence of the disease. It is generally said that advanced stages of the disease are encountered in Africa for several reason:
a)Patients not seeking medical attention early.
- b) Lack of diagnostic capabilities.
- c) Lack of health care facilities. (patients having to travel long distances for healthcare.
- d) Lack of appropriate manpower /skills ( less than 1000urologists for 1.2 billion people!
- e) Non affordability of the costs involved.
In Zimbabwe for example in 2014 the leading cancer among Zimbabwean black men was prostate cancer. There were 2 474 cancer deaths comprising 1 192 men and 1 282 females and out of the men 10 percent died of prostate cancer (Zimbabwe cancer Registry) Therefore as they say, if you are a man of African ancestry then prostate cancer needs to be on your radar! .
As men increase in age, their risk of developing prostate cancer increases exponentially. About 6 in 10 cases are found in men over the age of 65 but from personal experience in 2017, in the first quarter a few men below the age of 50 have been diagnosed with prostate cancer. Men with relatives, father brother, son —with a history of prostate cancer are twice as likely to develop the disease.
Will I Die From My Prostate Cancer ?
If it is detected EARLY, prostate cancer is 100 percent treatable, and most men will not experience symptoms.
Are all the prostate cancer the same type ?
No there are differences.
There are three broad categories that we encounter.
- a) The high risk prostate cancer (aggressive).
- b) The intermediate risk cancer (mid aggressive).
- c) The low risk prostate cancer (less aggressive).
Some of the low risk cancer are so indolent that they may not need aggressive treatment or sometimes treatment at all.
However, they will need monitoring and therefore a discussion with your caregiver(the oncologist or the radiologist will help you determine what needs to be done and what type of treatment is required.
Also there are stages of the disease:
Stage 1: Disease is small and superficial and localised and can be seen only with microscope.
Stage 2: Disease is bigger but still confined in the prostate
Stage 3: Disease is not confined but is distorting the prostate capsule/covering and is outside the prostate.
Stage 4: Disease has gone beyond the prostate organ into surrounding tissue/organ.
What Are The Symptoms For Prostate Cancer
There are no early warning symptoms because for many years the disease can remain silent.
Symptoms include: A need to frequently urinate especially in the night, a need to urgently urinate difficulty in starting or stopping urination, weak urinary stream, painful urination, painful ejaculation blood in the urine or ejaculation backache, lower backpain, pelvic pain .
These are the same symptoms you can have for non Cancerous prostate disease so the symptoms do not condemn you to prostate cancer at all costs. These urinary symptoms do not mean you have prostate cancer. See your care giver who will examine you and perform tests to ascertain what is happening to you.
- More aggressive type surgery, radiation, hormone therapy, and chemotherapy can be used to treat prostate cancer. Some men choose to delay treatment, which is called watchful waiting.
- Digital rectal examination (DRE): A doctor inserts a lubricated, gloved finger into the rectum and feels the prostate. A DRE can sometimes detect an enlarged prostate, lumps or nodules of prostate cancer, or tenderness from prostatitis.
- Prostate-specific antigen (PSA): The prostate makes a protein called PSA, which can be measured by a blood test. If PSA is high, prostate cancer is more likely, but an enlarged prostate can also cause a high PSA.
- Prostate ultrasound (transrectal ultrasound): An ultrasound probe is inserted into the rectum, bringing it close to the prostate. Ultrasound is often done with a biopsy to test for prostate cancer.
- Prostate biopsy: A needle is inserted into the prostate to take tissue out to check for prostate cancer. This is usually done through the rectum.
- Prostate Cancer Treatment
- Prostatectomy: Surgery for prostate cancer, called a prostatectomy, removes the prostate with the goal of removing all the cancer.
- Radiation therapy: Radiation kills prostate cancer cells while minimising damage to healthy cells.
- Radioactive seed implants: Instead of radiation pointed at the prostate from outside the body, radioactive seeds can be implanted into the prostate to kill cancer cells.
- Cryotherapy: Cryotherapy involves killing prostate cancer cells by freezing them.
- Hormone therapy: Prostate cancer cells grow in response to hormones. Hormone therapy helps block that effect.
- Chemotherapy: When prostate cancer is advanced, chemotherapy may help reduce the cancer’s spread.
- Watchful waiting: Since prostate cancer is often slow growing, some older men and their doctors hold off on treatment and wait to see if the cancer appears to be growing.
- PSA: When your PSA is high and the digital rectal examination indicates a hard nodule in the prostate, your Urologist will request for a transrectal ultrasound scan. This transrectal ultrasound is an investigation in which the image of the prostate is assessed through the rectum by ultrasound scan.
Through the transrectal ultrasound scan a needle guided biopsy is performed. It is through this biopsy that tissue will be obtained for diagnosis.
A histological diagnosis describing the nature of cancer and the architecture of the majority of the tissue will help assign a score (Gleason Score).
It is the gleason score and the PSA combined that will determine whether you have an aggressive disease or a non aggressive disease .
The PSA is a guide only but very useful when treatment has been instituted it tells whether treatment is effective or not .
However, an initial elevated PSA gives an indication and a suspicion that the prostate is diseased
A high PSA can be an indication of an enlarged prostate , an infected prostate or a prostate cancer .
Whilst it is noted in many places that PSA of 0–4ng/ml (nannogram per millilitre) is normal, there is strictly no normal PSA because about 20 percent of PSA below 4 still have shown patients to have Cancer of the prostate.
- Following diagnosis of prostate cancer, as a guide to the
- extent of diseas e and to plan optimum treatment, staging
- investigations with computerised tomography (CT) scan,
- magnetic resonance imaging, (MRI) or bone scan may be required.
- The available management approaches are observation.
- (Watchful waiting, deferred treatment or active surveillance);
- Radical curative treatment by surgery (radical prostatectomy);
- Or radiotherapy (radical radiotherapy using external beam or
- Brachytherapy), palliation with hormonal treatment,
- Chemotherapy or radiotherapy and newer approaches such as
- So-called focal therapy (cryotherapy and high intensity focused;
- Ultrasound, HIFU,)
Who should go for prostate cancer check and at what age?
Since prostate cancer afflicts the majority of men after 65 years of age it would be ideal for men over 50 years of age to start the process of getting checked. However, sometimes we find men below 50 years with prostate cancer.
What is the best Treatment for me? It is appropriate to discuss this with your doctors (urologist and oncologist.
What are the side effects of the Treatments?
After radical radiotherapy and rdical Prostatectomy, one would may develop erectile dysfunction (impotence) and incontinence (inability to control the urination for a few months) These are temporary.
What treatment modalities are available in Zimbabwe ?
Most of the treatment modalities are available in Zimbabwe. Robotic Surgery is not a vailable
Some Notable Statistics:
About one in seven men will be diagnosed with prostatic cancer in his life time
Men of African ancestry are more likely to be diagnosed with more deadly forms of the disease .
One in three men whose fathers or brothers had prostate cancer will be diagnosed with the disease
Prostate cancer when diagnosed early is curable Prostate cancer diagnosis is not equivalent to death sentence .