What you need to know about prostate cancer

BY LYDIA ATIENO Mukiza (not real name) had for close to a year experienced difficulty passing urine but took it lightly and never cared to get checked for possible complications. While attending a medical camp on cancer last year, it occurred to him that what he had long taken for granted as a ‘none issue’ could actually be a sign of a serious medical problem. Days later when he went for a check-up, he was indeed told that he had early traces of prostate cancer. Mukiza is not alone. A number of men today risk catching prostate cancer, but never bother to get tested. Medical experts advise that knowing how to identify the early-onset signs and symptoms of prostate cancer is critical. It could mean the difference between having to undergo invasive radiation treatment and surgery (and suffering through a laundry list of side effects in the process), or making simple dietary and lifestyle changes now to nip this cancer in the bud and stop it from growing and spreading. How big is the problem? One of the reasons why the disease is on rise, medics say, is because people still don’t go for regular check-ups and screening. According to WHO and International Agency for Research on Cancer, prostate cancer is the fourth most common cancer in both sexes combined and the second most common cancer in men. An estimated 1.1 million men worldwide were diagnosed with prostate cancer in 2012, accounting for 15 per cent of the cancers diagnosed in men, with almost 70 per cent of the cases (759,000) occurring in more developed regions. According to Francoise Uwinkindi, the director of the cancer unit at RBC, in Rwanda, WHO estimates 536 new prostate cancer cases per year, but figures from local hospitals show that around 100 cases are diagnosed every year. Jean Paul Balinda, the cancer diseases senior officer at RBC, says the incidence of prostate cancer rises with age. “Clinically, carcinoma of the prostate is most often detected in men older than 60 years. The likelihood of detection is nearly 40 times greater for men older than 65 than for men younger than 65. Only about 1 per cent of prostate cancers are detected in men younger than 50 years,” he says. What are the risk factors? According to Uwinkindi, nearly 60 per cent of all prostate cancers are diagnosed in men over the age of 65. However, although age is the biggest contributor to prostate cancer, there are also other factors. He says when one has a family history of prostate cancer; they are likely to develop the disease as well. “About 25 per cent of men with prostatic carcinoma have a known family history. The degree of risk is related to the age of the relatives at diagnosis and the number of relatives affected,” he says. Further, Uwinkindi notes that men with either a father or a brother with a diagnosis of prostate cancer have an approximately 2–3 times greater risk of developing prostate cancer than men without a family history of the disease. “The greatest risk, with an 11-fold increase, is that for the father or the brother of a man diagnosed at about age 40 with prostate cancer, with an additional first-degree relative who has prostate cancer,” he says. Genetic factors also make a major contribution to prostate cancer susceptibility, according to him. To reduce the risk of prostate cancer, Rene Tabaro,a nutritionist at King Faisal Hospital, says one should try to live healthy by staying away from unhealthy lifestyles and sticking to a healthy diet. For instance, he mentions that one can choose a low fat diet, eat more plant-based fat than animal fat, increase the amount of fruits and vegetables they eat each day, engage in regular physical activity, as well as eat more fish than red meat. How to tell the signs According to Francis Kazungu, a general practitioner in Kigali, most men with early prostate cancer don’t have any signs or symptoms. One reason for this, he says, is the way the cancer grows. “One will usually only get early symptoms if the cancer grows near the tube they urinate through (the urethra) and presses against it, changing the way they urinate,” he says. However, because prostate cancer usually starts to grow in a different part of the prostate, Kazungu says early prostate cancer doesn’t often press on the urethra and cause symptoms. On the other hand, Balinda points out that if one notices changes in the way they urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem, but its recommended to go for check-up to find out the exact problem. He adds that symptoms such as difficulty starting to urinate or emptying the bladder, a weak flow when one urinates, a feeling that the bladder hasn’t emptied properly, dribbling urine after you finish urinating, needing to urinate more often, especially at night and a sudden urge to urinate which sometimes leaks before one gets to the toilet, are alarming signs of prostate cancer. Therefore, seeking medical support becomes necessary to get early treatment. Treatment options Uwinkindi says depending on the situation, the treatment options for men with prostate cancer varies. For instance, he says expectant management (watchful waiting) or active surveillance is one of the treatment options. Here, he explains that because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) might never need treatment for their prostate cancer, especially when it is not causing problems. Another option according to Uwinkindi is surgery, which is a common choice in trying to cure prostate cancer if it is not thought to have spread outside the prostate gland. “The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles,” he says. Radiation therapy is another option for treatment of prostate cancer, where an external beam radiation is used, he adds. Balinda says cryotherapy is also used when it comes to treating prostate cancer. He explains that this is the use of very cold temperature to freeze and kill prostate cancer cells. Other treatment options include hormone therapy, which is also known as androgen deprivation therapy (ADT) or androgen suppression therapy. “The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from affecting prostate cancer cells,” he says. Just like any other types of cancers, Uwinkindi says chemotherapy is as well used in treating prostate cancer. “Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment potentially useful for cancers that have spread (metastasised) to distant organs,” he says.