Prostate cancer is cancer that occurs in the prostate — a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men.

A man’s prostate produces the seminal fluid that nourishes and transports sperm.

Symptoms include difficulty with urination, but sometimes there are no symptoms at all.

Some types of prostate cancer grow slowly. In some of these cases, monitoring is recommended. Other types are aggressive and require radiation, surgery, hormone therapy, chemotherapy or other treatments.

The burden

2018 statistics show that prostate cancer is the third leading cause of death globally, after lung and breast cancer.

In men, prostate cancer is the second most frequent malignancy (after lung cancer) worldwide.

Meanwhile, in Rwanda, according to 2018 data from Rwanda Biomedical Center (RBC); prostate cancer is the third top leading cause of death followed by breast and cervix.

In men, prostate cancer is the first cause of death accounting for 17 per cent.

Between the years 2017 and 2018 in all referral hospitals in Rwanda, they received 1,012 and 198 cases of prostate cancer.

However, Marc Hagenimana, the director of cancer Diseases Unit at RBC, says this might not be the only cases they have, adding that this is because prostate cancer, just like any other cancers could be poorly diagnosed.

A 2018 report from the World Health Organization (WHO) indicated that in Rwanda, there are at least 700 cases.

Hagenimana says this means that the country received only a third of cases that were supposed to be diagnosed and treated.

How it comes about

At the start, Hagenimana says there are no signs and symptoms of this type of cancer — and so there are high possibilities of complications later because of delayed diagnosis.

"Prostate cancer may be asymptomatic at the early-stage and often has an indolent course that may require only active surveillance,” he says.

Since the cause of some cancers is not known, and specifically prostate cancer, there are some risk factors that can lead to it.

Findings show that with age, especially above 65, one is at a high risk of prostate cancer.

Risk factors for prostate cancer

Dr Francois Uwinkindi, the division manager of non-communicable diseases at RBC, says race is one of the risk factors for getting prostate cancer.

He says that for reasons not yet determined, black people carry a greater risk for prostate cancer than men of other races.

And that in black people, prostate cancer is also more likely to be aggressive or advanced.

Black men have a greater risk of getting prostate cancer -- and a more aggressive type, experts say. / Net photo

Another risk factor, he says, is family history, explaining that if people (men) in your family have had prostate cancer, your risk may be increased.

Also, he notes that if one has a family history of genes that increase the risk of breast cancer or a very strong family history of breast cancer, your risk of prostate cancer may be higher.

Uwinkindi says that obesity also plays a role when it comes to prostate cancer. Here, he notes that in fact, obese men diagnosed with prostate cancer may be more likely to have advanced disease that’s more difficult to treat.

Complications

Complications, Hagenimana says, include impotence, erection problems as well as metastasis, meaning that cancer can spread into other organs, especially the bones.

He further explains that prostate cancer can spread to nearby organs, such as the bladder, or travel through the bloodstream or lymphatic system to the bones or other organs.

"Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it’s unlikely to be cured,” he notes.

Another complication, he says, is incontinence, adding that both prostate cancer and its treatment can cause urinary incontinence.

However, the medic points out that the treatment for incontinence depends on the type one has, how severe it is and the likelihood will improve over time.

Prevention

When it comes to prevention, Uwinkindi says it’s difficult with prostate cancer as the causes are not well known.

However, he says one can hinder it by watching for signs and symptoms. By doing this, one can seek medical advice for screening and diagnosis early, thus preventing further complications.

"For people at high risk of developing prostate cancer, it’s better to seek medical attention in time, just to be on the safe side,” he says.

Meanwhile, Joseph Uwiragiye, the head of nutrition department at University Teaching Hospital of Kigali (CHUK), says there are some adoptive measures to prevent the risks of cancer in general, including prostate. For instance, he says, choosing a healthy diet of fruits and vegetables is important.

Also, he says, avoiding high-fat foods and choosing a variety of fruits, vegetables, and whole grains is important, as fruits and vegetables contain many vitamins and nutrients that can boost one’s health.

"Eating a healthy diet with a variety of fruits and vegetables can improve your overall health,” he says.

Additionally, the nutritionist says exercise is also important as it improves one’s overall health, helps in maintaining weight and improves mood as well.

Also, he says, maintaining a healthy weight is necessary. Here, he says, if one’s current weight is healthy, working on maintaining it by exercising most days of the week is essential. Uwiragiye says if one needs to lose weight, exercise and fewer calories consumed is the way to go.

Treatment

In Rwanda and many other African countries, Hagenimana says there is no screening for prostate cancer. Treatment is mostly done by surgery.

When in the early stages, he says surgery is done to remove the prostate; radiotherapy is available at Rwanda Military Hospital.

Sometimes, he says, a medic can provide some medication such as Abiraterone acetate.

Alternatively, Hagenimana says, there is another treatment known as hormone therapy, which is simply treatment using hormones.

He further explains that hormone therapy for prostate cancer is a treatment that stops the male hormone testosterone from being produced or reaching prostate cancer cells.

"Most prostate cancer cells rely on testosterone to help them grow. Hormone therapy causes prostate cancer cells to die or grow slowly,” he says.