Prostate cancer is affecting a lot of men so it’s time to talk about it. EVERY man has one, it’s important to their sex life, yet few men know anything about their prostate or what can go wrong with it. The prostate is a small gland in the pelvis found only in men. About the size of a walnut, it is located between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.
Prostate cancer in Zimbabwe
According to the Zimbabwe cancer registry 2011 annual report, prostate cancer was the leading cause of cancer among Zimbabwean black men accounting for 16.5% of the new cancers registered in 2011. The report went on to say that prostate cancer is now undisputedly the most frequently occurring cancer among Zimbabwean men of all races. This message is sadly true to my family as we lost a very dear member of our family due to prostate cancer. As I write this article my prayers and thoughts are with everyone that has lost a loved one from any type of cancer.
Prostate cancer in the UK
I work in the UK National Health Services and prostate cancer is the second most common cause of cancer death in men in the UK. Each year 35,000 men are diagnosed with prostate cancer and 10,000 die from the disease. It is less common in men under the age of 50 years.
Causes of prostate cancer
These figures are a cause for concern but we need to look at the causes of prostate cancer. The causes of prostate cancer are largely unknown. However, a number of things can increase one’s risk of developing the condition. The chances of developing prostate cancer increase as one gets older. Most cases develop in men aged 50 or older. For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are at slightly increased risk as well. It is thought that lycopene-rich foods are best in protecting one from the disease. Lycopene is an antioxidant that is commonly found in fruits and vegetables that are red in colour like tomatoes, watermelon and guavas. Chillis of all sorts are also lycopene powerhouses.
Diagnosing Prostate cancer
There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy (taking a piece of the prostate and testing it for cancer). The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer.
What is PSA?
PSA is made by the prostate gland and some of it will leak into the bloodstream depending on age and the health of the prostate. A raised PSA may mean that one has prostate cancer. However other conditions which are not cancer do cause raised PSA such as enlargement of the prostate, urinary infection and prostatitis. This test has problems in that 2 out 3 people with raised PSA will not have prostate cancer and the test can miss prostate cancer.
PSA test is sensitive to a lot of things hence the need to follow the instructions carefully otherwise one will get high levels due to not following the right procedure of testing. One should not have PSA testing if they have urinary infection, has ejaculated in the last 48hrs, exercised heavily in the last 48hrs , had a prostate biopsy in the last 6 weeks or had a digital rectal (anal) examination in the previous week.
What should one look for in order to see a doctor about this prostate cancer?
Prostate cancer usually develops slowly, so there may be no signs resulting in one having it for many years without knowing. Symptoms often only become apparent when one’s prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, one may notice things like an increased need to urinate, straining while urinating and a feeling that the bladder has not fully emptied. However, these signs do not mean one has prostate cancer. It is more likely they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
Because of the problems highlighted above men in UK are not routinely offered PSA tests to screen for prostate cancer as results can be unreliable. However PSA testing is offered on an individual basis after a full discussion with your doctor. A lot of research is currently taking place to come up with evidence based screening that is also safe because raised PSA levels also cannot tell a doctor whether a man has life threatening prostate cancer or not ( the one that can kill you and the one that won’t.). This means that a raised PSA can lead to unnecessary tests and treatment.
What is the take away home message about prostate cancer?
I have tried to present the facts to you and I apologise if l have confused some of you but the “take away home” message to my fellow Black Zimbabwean men is that prostate cancer is on the rise but rare below 45 years of age. If your father or brother was diagnosed with prostate cancer then you are at high risk of developing it. I suggest that if you have family history of prostate cancer and you are above 45 years then you must see your doctor to discuss screening options available regardless of whether you have symptoms or not.
Your doctor should be able to clearly discuss with you the advantages and disadvantages of the tests allowing you to make an informed decision about your situation. If you do not have family history of cancer and have symptoms such as constant urge to rush to the toilet to pass urine, passing urine more often than usual, especially at night and difficulty in passing urine then you should see your doctor for further tests. If you do not have family history and do not have symptoms either, but you are now worried after reading this article, l suggest that you also see your own doctor for further discussions.
If you are found to have prostate cancer, how then is it treated one may ask.
For many men with prostate cancer, treatment is not immediately necessary. If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
Sadly some people are being diagnosed at a later stage when cancer has already spread. In these situations the relatives and doctors can feel hopeless but having worked in a hospice myself, I feel passionate about end of life care that we are delivering to our loved ones in their last days on this earth. No one should be allowed to die in pain.
We may not be able to cure the cancer but we should guarantee to relieve pain and I know that it can be done. Family members need to work with doctors and pharmacists to get the best pain killers. There is need for education to both doctors and the public about the safe use of strong pain killers . This will make sure that people with cancer can die with dignity and pain free.
This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.
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