Men Above 50 Should Go For Prostrate Screening

AS today marks awareness week for prostrate cancer, men above 50 have been advised to go for screening without delay, even if they are without symptoms. Screening process entails a rectal examination of the prostate by a doctor, preferably an urologist, a prostate-specific antigen (PSA) test and a prostate scan, which should be undertaken yearly.

Medical experts say the benefit of this is that cancer detected early by this method is potentially curable. The high acceptability and practice of prostate cancer screening is the reason for improved survival and low death rates from prostate cancer in the Western world.

Unfortunately, however, many Nigerians are yet to embrace screening for cancers generally, including prostate cancer. They wait until there is presence of symptoms for months or even years, by which time the cancer has spread to other organs in the body and is potentially incurable. Late presentation and, therefore, late diagnosis is the main reason mortality from prostate cancer is still very high in the country.

Since prostate cancer is not totally preventable, the message being preached is early detection, which is only possible through screening.

Dr. Rufus Wale Ojewola, a Consultant urologist, Department of Surgery, Lagos University Teaching Hospital (LUTH), and a lecturer in Surgery, College of Medicine of University of Lagos (CMUL), said the prostate is an accessory organ of reproduction found below the bladder in men. Prostate cancer is when cancer develops from the prostate organ. He said: “Prostate cancer is the commonest cancer in adult males. About one in 36 men will develop the cancer in their life time, while one in six afflicted men will die of the disease. Prostate cancer can be aggressive and lead to death, but can also be slow growing in which case, patients can live long and die of other diseases or causes like complications of diabetes, hypertension, lung diseases or even road traffic accidents or old age.”

He explained that the risk of developing prostate cancer increases with age.

“The peak incidence is in the sixth and seventh decades of life. It was rarely diagnosed in men below 50 in the past, but this has changed as younger men are increasingly being afflicted now,” he explained. “We now diagnose prostate cancer in men around 40 years. This is what we call age migration in cancer, and is not peculiar to prostate cancer alone. For example, breast cancers are being diagnosed increasingly in teenagers now. There is a racial predisposition to prostate cancer, as it is an established fact that the disease is commoner and more aggressive in blacks than whites. Men should also know that prostate cancer is curable, if detected at the early stage.”

Ojewola said manifestation of prostate cancer depends on the stage at diagnosis. In the very early stage, it might not manifest with any symptom.

He said: “It is only discovered during screening for prostate cancer. This is the commonest method of detection in the Western world, where there are organised screening programmes for men.

“If not discovered at this stage, it can then progress to manifest as lower urinary tract symptoms. These are symptoms of difficulty in passing urine like urinary frequency, nocturia (frequent urination at night), intermittent stop and start pattern of urination, urgent inability to postpone urination, applying force during urination, incomplete voiding, feeling of urine remaining in the bladder after urination or poor urinary stream. There may also be passage of blood in the urine or bloodstain in the seminal fluid.

“By the time prostate cancer is advanced, there may be weight loss, loss of appetite or generalised weakness. There may be back pains, if it has spread to the back or weakness or paralysis of the legs, if the spinal cord is involved. There may be yellowness of eye and abdominal swelling, if the liver has been involved. There may be cough, chest pains and passage of bloody sputum, if the lungs are affected. The truth is that it can spread to any organ in the body, if not discovered and treated early.

“The truth is that prostate cancer is not totally preventable, as one cannot modify established risk factors. The major risk factors are age, black race, and genetic factors, which include family history. Modifying or eliminating these factors could have helped to prevent prostate cancer. Unfortunately, none of these major factors is modifiable. For example, no man can change his age, race or family genetic factor.”

He, however, noted that there are other less important risk factors, such as the type of food consumed.

“Eating food containing less fatty components and food rich in vegetables, tomatoes and fruits have been found to reduce the risk slightly. Avoidance of smoking, including healthy lifestyles among men is generally helpful.

“Once there is presence of any of the symptoms above, there is need to consult a doctor preferably urologists, who are specialists that treat prostate diseases. “There is no need to panic or live in fear of being diagnosed with prostate cancer. This is because there are other noncancerous conditions of the prostate, which include benign prostatic hyperplasia, chronic prostatitis, and of the bladder that can also manifest as difficulty in passing urine.

“The doctor will take history around the symptoms listed above and conduct a thorough examination, especially on the prostate to determine if it is enlarged or not, smooth or rough and if rubbery or hard in consistency. Findings of irregular and hard prostate on examination may suggest malignancy. Conducting a prostate specific antigen (PSA) test is mandatory. Elevated values may also suggest cancer, however, there are other diseases that can cause elevated PSA. This is why there is need for specialist consultation to differentiate some of these conditions from cancer of the prostate.

“A transrectal ultrasound test is also necessary to give more details about the prostate organ, which is an organ hidden deep in the pelvic region of the body. With abnormality in any of these examinations of the prostate, PSA test or prostate scan is needed to perform a prostate biopsy to confirm the diagnosis. Biopsy is the process by which samples are collected from the prostate for histological examination to determine whether it is cancerous or not,” he said.

He explained that ejaculation or sexual activities, whether infrequent, frequent or excessive, has no relationship with the development of prostate cancer.

“Studies have not demonstrated a causal and effect relationship between the two,” he said. “So, it is one of the several misconceptions about the etiology or cause of prostate cancer. Other misconceptions include multiple sexual partners, sexually transmitted diseases and celibacy. None of these has been proven to predispose a man to developing prostate cancer.

“Usually, any man beyond middle age, which is 50 years, is at risk. As highlighted above, the risk increases with increasing age. However, it can occur at a younger age. And so, it is recommended that all men should undergo screening for prostate cancer from the age of 50 on a yearly basis. For those with positive family history, screening for prostate cancer should commence at 40 years of age.”