A disease by any name is already numbing enough. But besides the incurable lot, there are those that are so silent yet deadly. You will hardly know or feel it is eating you badly until the signs and symptoms start showing. Prostate cancer ranks high among these diseases.

Mayo Clinic defines prostate cancer as the type of cancer that occurs in a man’s prostate — a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

Sadly, the number of people suffering from prostate cancer has lately been on the rise. Men are advised to visit doctors for frequent checkups and digital rectal examination plus blood testing for prostatic specific antigen (PSA), the Director of Medical Imaging Services at King Faisal Hospital Rwanda, Dr Emmanuel Rudakemwa, says.

The latest data from Prostate Cancer Africa indicates that about 100 Rwandan men are diagnosed with the disease each year, with many dying from the cancer.

"People get to know about it in its advanced stage but what I know it is on the increase,” Rudakemwa, says. 

According to Dr. Faustin Ntirenganya, an oncoplastic and reconstructive surgeon at Kigali Teaching University Hospital (CHUK), prostate cancer comes from a combination of risk factors like age, diet, obesity, race and heredity. "The more you are exposed to risk factors, the bigger the chance of developing prostate cancer,” he says.

Also, consumption of tobacco and alcohol increases the risk of getting cancer. Furthermore, prostate cancer is more prevalent among men above the age of 50 and black men, according to research.

Ntirenganya points out that prostate cancer develops slowly and symptoms are often not obvious. Two-thirds of the patients do not present evident symptoms, he says.

Dr Rudakemwa says if not treated, prostate cancer follows a natural course, starting as a tiny group of cancer cells that can grow into a full-blown tumor.

Genetic disease

Scientists say prostate cancer is at times genetic.

"Although it is sometimes genetic, this cannot stop people from going for frequent tests mainly men aged 50 and above,” Dr Rudakemya says.

The early signs of prostate cancer are urinary tract infection, burning pain on urination, frequent urination, especially with fever, not urinating or urinating very little despite drinking enough fluid; producing little urine despite straining; pain due to a full bladder, deep bone pain, especially in the back, hips and thighs.

Pain of the spinal cord on compression may be the first sign of prostate cancer. It occurs when the cancer has spread to the vertebrae of the spine and tailbone region. The weakened vertebrae can fall down on the spinal cord.

In its earliest and most curable stages, prostate cancer has no symptoms at all and, according to medics, the key to the effective management of the cancer is early detection, using regular physical examination and simple blood tests.

Medical specialists say that prostate cancer grows in stages:

Stage I: Prostate cancer is microscopic; it can’t be felt on a digital rectal exam and it isn’t seen on imaging of the prostate.

Stage II: The tumor has grown inside the prostate but hasn’t extended beyond it.     

Stage III: Prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.

Prostate cancer grows locally within the prostate and grows for many years which make it extend outside the prostate. This can be in three ways through growing into neighbouring tissues, spreading through the lymph system of lymph nodes and lymph vessels, traveling to distant tissues through blood, stage IV prostate cancer commonly spreads to lymph nodes, the bones and liver.

Because of the proximity of the prostate gland to the bladder and urethra, prostate cancer may be accompanied by a variety of urinary symptoms. Depending on the size and location, a tumor may press on and constrict the urethra, inhibiting the flow of urine. This can result in burning or pain during urination, difficulty urinating, or trouble starting and stopping while urinating, more frequent urges to urinate at night, loss of bladder control, decreased flow or velocity of the urine stream, or blood in the urine.

Consequently, prostate cancer may spread to nearby tissues or bones, and may press on the spinal nerves.

Other prostate cancer symptoms include blood in semen, erectile dysfunction, and painful ejaculation, swelling in legs or pelvic area, numbness or pain in the hips, legs or feet, and bone pain that doesn’t go away, or leads to fractures.

Risky behaviour

To reduce the risk of prostate cancer, doctors recommend avoiding of risky behaviour such as having multiple sexual partners and sharing contaminated needles, which can lead to infections (hepatitis B and C, HPV, HIV, etc.) that may increase risk for certain cancers.

Edwin Gatabazi, 51, is suffering from the cancer. He says he did not know he had the cancer until he went for medical check-up after experiencing horrible pain while urinating.

"It all came as a shock to me. I was transferred to Central University Teaching Hospital of Kigali from the local hospital. I was operated on and a tube was inserted into my urethra,” he said

Dr Pacific Muhinzi, of Rwanda Military Hospital, Kanombe, warns that people should stop the habit of only seeking treatment when the cancer has reached advanced stage. He said this reduces chances of survival.

According to the recent report from Rwanda Biomedical Centre prostate cancer covers 9.4 per cent in men.

Ray of hope

Meanwhile last week, interantional media reported that a study had concluded that prostate cancer treatment could be transformed by drugs that are already on hospital shelves.

Dr Iain Frame, director of research at the charity Prostate Cancer UK, hailed the British and US research as ‘incredibly exciting’.

Researcher Johann de Bono, of the Institute of Cancer Research in London, said it opens up a new era of treatment, in which men will be given drugs tailored to their tumours.

Dr Iain Frame, of the charity Prostate Cancer UK, described the research published in the journal Cell, as ‘incredibly exciting and ground breaking’.

He added: ‘It suggests for the first time the list of genetic mutations to search for in order to build up a blueprint of a man’s prostate cancer once it has spread.

‘This could provide the information about the best routes of attack in each individual case, which is crucial if we are to reduce the number of men dying needlessly from this disease.’

However, it is not clear when that breakthrough will take shape in Rwanda.