The beginner’s guide to understanding prostate cancer

Four years ago, Raphael Omondi’s older brother was diagnosed with prostate cancer. He had been complaining of trouble urinating with burning sensations from time to time. This had gone on for a couple of years. He attributed his health problems to bacterial infections. “He would buy antibiotics and the problem would go away for a while. At one point, he suspected his wife was unfaithful and was the cause of the recurrent ‘bacterial infections,” says Raphael.  What he did not know was that his prostate gland was growing malignant. “A pharmacist recommended a prostate cancer test but he refused. According to him, prostate cancer was a problem of sexually inactive men,” says Raphael. By the time he took the test four years ago, cancer had spread too far. He oozed pus and blood during urination and could no longer achieve an erection. “He was told the tumor had invaded the seminal vesicles and he would be put on a combination of radiation and hormonal therapy treatment,” says Raphael. Two years ago, in April 2019, he succumbed to cancer.

Raphael’s brother is not an isolated case. Men prefer not to go for prostate cancer screening due to myths and misconceptions that cloud it.

Here, we demystify this cancer and how it is diagnosed.

What is it?

According to the National Guidelines for Prevention and Management of Cervical, Breast, and Prostate Cancers by the Ministry of Health, prostate cancer occurs when cells of the male reproductive gland located at the bottom of the bladder multiply abnormally and in an uncontrolled manner. The most common signs of prostate cancer include increased urination, burning sensation during urination, poor or unsteady urine flow, and blood or pus during urination. Other key signs include pain during ejaculation, difficulty in getting an erection, distended bladder, and urinary retention. Physician Dr. Patrick Hiuhu explains that the prostate is a small gland that makes part of the male reproductive system. “It is the size of a walnut and is located just below the bladder and in front of the rectum. The prostate surrounds the urethra. The seminal vesicles are attached to each side of the prostate,” he says.  Together with seminal vesicles, the prostate secretes a fluid that forms part of the semen. This aids in sperm movement during ejaculation. Most prostate cancers are diagnosed as adenocarcinomas or cancers that start in the cells of the gland. In most cases, prostate cancer starts in the prostate gland before spreading to the seminal vesicles.

The risk factors

Prostate cancer mainly affects men who are 40 years or older. National guidelines on prostate cancer from the Ministry of Health show that cancer risk grows rapidly after the age of 50, and by age 65, at least two out of three reported cases will be men who are over age 65. By the age of 70, at least 80 percent of men will have developed prostate cancer.  According to the guidelines, other risk factors include having a family history of prostate cancer, eating a poor diet, especially meals with inadequate micronutrients such as vitamin E, zinc, selenium, and chronic prostate infections or regular sexually transmitted diseases.

Diagnosis

Most prostate cancers are detected during screening with a Prostate-Specific Antigen (PSA) blood test, a Digital Rectal Exam (DRE), and the Transrectal Ultrasound (TRUS). The PSA blood test is mainly done on men without symptoms of prostate cancer. “With TRUS, a small probe that is about the width of a finger is usually placed in the rectum. TRUS is commonly used when the patient has high PSA levels or an abnormal digital rectal exam result,” says Dr. Hiuhu.

Screening fees

According to the Kenya Medical Practitioners and Dentists Board, fee guidelines for prostate cancer tests average between Sh. 2, 100 and Sh. 3, 600. The cost of screening will range between Sh. 2,000 and Sh. 5,000 depending on the hospital a person chooses. For men looking to take the tests, prostate examinations should only be done at level E and F specialised laboratories which are certified by the Kenya Medical Laboratory Technologists and Technicians Board.

How to cope

You may feel angry, resentful, hopeless, afraid, and uncertain. Dr. Hiuhu says that depressive tendencies are also common among patients who misconceive and equate cancer diagnosis with a death sentence. “As the patient gets bombarded by all these feelings, they can easily stay away from eating healthy, seeing a professional counselor, and remaining as active as possible,” he says. As you undergo treatment and therapy, and for your body to respond positively, sticking to a healthy and balanced diet is paramount. You can see a psychotherapist who will assist you manage the stress, accepting the diagnosis, and staying fit for treatment. “There are support groups for prostate cancer survivors where information and rehabilitative therapy resources are shared. Join them,” he says.

Insurance

Treatment for all types of cancers is costly in Kenya. You may have seen families hold fundraisers or sell their property to offset bills or fund treatment. Health insurance with a good package can save you and your loved ones from additional stress.