Daring prostate cancer

According to Dr Leonard Odoi, a specialist surgeon and urologist at Nakasero Hospital, the prevalence rate of this cancer in Uganda among men with an age-standardised incidence rate of 42 per 100,000

According to biomedcentral.com, about 90 percent of men with prostate cancer are diagnosed when the disease is in an advanced stage.

Signs and symptoms may include erectile dysfunction, painful or frequent urination, and blood in urine or in semen. However, Dr Odoi warns that these symptoms are non-specific and may be the same for some infections such as the urinary tract infections, inflammation of the prostate or even Benign prostatic hyperplasia (BPH)  which is also known as an enlarged prostate.

In the early stages of the disease, there are no signs and symptoms. By the time one starts to feel the symptoms, the disease has been around for some time. 

It is therefore important that men above 50 years should annually go for routine screening because early detection saves lives.

The experience

Emmanuel  Ngobi Kasundhe is a four-year prostate cancer survivor. In 2018, he fell sick and could not pass out urine.  His children took him to a nearby clinic in Buyende but becasue they could not handle the situation, they referred him to Kamuli Main Hospital. 

"The doctor immediately put a catheter in his urethra to help him pass out urine. Earlier, he had complained about lower back pain and upon  historical assessment, the d octors suspected he had prostate cancer," says Denis Mutagaya, one of his sons.

A biopsy was done on Ngobi  who was 56 years at the time and a week later, the results confirmed that he had the cancer.

Luckily, Ngobi's cancer was caught early and had not spread to other parts. "The doctor said that he needed an immediate surgery to prevent the cancer from spreading,"Mutagaya says.

At the Uganda cancer Institute, Mutagaya asked a friend who recommended Dr Leonard Odoi for a urologist that would treat his father. Ngobi had to do more tests but when his surgery to remove the prostate was scheduled, his blood pressure rose.

"The surgery was delayed for a week while the doctors managed his blood pressure.  He stayed in the hospital for a week after the surgery and thereafter went home," Mutagaya recalls.

He was then brought back to hospital and assessed to see if there were any more cancer cells and there were none. He was brought for review every three months for the first year; twice a year for the second year and from this time he was declared cancer free in the third year.

According to Mutagaya, prostate cancer might be running in their family since his grandfather also died in 2019, after failure to pass out urine.

Ngobi's stage of cancer only required a surgery because it was diagnosed at an early stage.  He is now cancer free and leading a normal life even after suffering from the cancer.

The risk factors

Age is the greatest contributing factor when it comes to prostate cancer. The genetic predispositions of some men may contribute to a higher risk of developing prostate cancer.

“If your first degree relatives such as parents or uncles have had prostate cancer, you are very likely to develop it. It is recommendable that in such a case, once a man turns 40, they should start going for their annual screening for the cancer.”

The people of the African decent have the highest number of people with the cancer globally compared to other races. 

Also, environmental factors, such as diet, lifestyle, and exposure to toxins, which may play a role in the development of prostate cancer.

Diagnosis

It is important to note that diagnosis starts with a clinical evaluation where the doctor will take your medical history and include the signs and symptoms. 

Physical examination, one of the major diagnostic process can be done as a digital rectal examination. Although many men think this as uncomfortable, Dr Odoi says, “With counselling, proper communication and lubrication, no one should feel the discomfort or pain. The prostate is located just below the bladder and in front of the rectum. With the examination, the doctor should be able to feel the prostate to know if it is normal or not.”

The doctor can also recommend a laboratory test known as the Prostate Specific Antigen (PSA) test from a blood sample. This test costs about Shs50,000 depending on where you do it.

Imaging using the ultra sound scan, trans-rectal ultra sound scan gives clearer results than a PSA but it is more expensive. A magnetic resonance imaging (MRI) is a lot more accurate put one has to incur a cost of Shs500,000 for it. 

However, all the above are only screening tests that are non-confirmatory. From the above tests, if the index of suspicion is high, then a biopsy, which is a confirmatory test is usually recommended.

The challenges

Uganda has a health system that is just growing according to Dr Odoi. “One of the challenges that are hindering the implementation of effective screening programmes to manage prostate cancer is the limited resources for screening,” he says.

He adds that, “There about 30 urologists serving the whole country and 90 percent of them are based in Kampala in the national referral hospitals or in private practice. The PSA test or MRI scan is expensive for an average person and are not readily available everywhere.”

Men naturally have a poor health seeking behaviour. It is also, important to note that it is uncomfortable to evade some parts of our bodies. A combination of these factors are some of the reasons why many men go to hospital when this cancer has already advanced. 

Besides the distance that people have to travel in search for cancer care and treatment, the treatment of cancer is generally expensive and drains the family and government resources which include the cost of treatment and associated expenses such as transport and accommodation. 

Other cancers

Men are also susceptible to breast cancer, bladder, kidney and oesophageal cancers. During this month of November, men should wake up and look out even for other cancers like testicular cancer which presents as a painless swelling of the testes. It affects men of all age groups but can be detected through self-examination. 

Cases of cancer of the penis are also increasing in Uganda according to Dr Odoi. “This usually present with painless wounds on the penis that do not heal. Men who have such wounds should seek medical help and avoid self-medication.”

“I urge women to care for the men in their lives by encouraging them to go for prostate cancer screening. There are urology services at Mulago Hospital, Nsambya, Nakasero, Rubaga, Soroti, Mbarara and Gulu,” he adds.
Prostate cancer is a significant health issue in Uganda, with rising incidence rates and unique challenges.

By addressing these challenges through increased awareness, improved access to specialised care, and ongoing research efforts, there is hope for better outcomes for individuals affected by prostate cancer in Uganda.