That prostate cancer kills 26 men in Nigeria daily, is a dramatic increase from the daily figure of 14 men recorded six years ago. Its equally deadly sister breast cancer kills 40 women in Nigerian daily, up from the daily figure of 30 women in 2008. Many women are having mastectomy surgery to remove all breast tissue from a breast as a way of treating or preventing breast cancer.
The media were recently awash with the news of a Hollywood actress, Angelina Jolie, who had preventive mastectomies when tests showed that she “has increased risk of breast cancer due to genetic alteration”. Observers often ask certain questions: Should men also start having prophylactic prostatectomy the removal of the prostate tissues? Should they first worry about death or their sex life in considering treatment for prostate cancer?
Is prostatectomy the simplest way of lowering the chances of contracting prostate cancer, whether there are signs or no signs?
For most men, when asked such questions, their answer was an emphatic “No”: they would never contemplate having prostatectomy under any circumstances. The prostate is a gland found only in males; it is located below the urinary bladder and in front of the rectum. Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. The National Cancer Institute says that prostate cancer is found mainly in older men with symptomatic signs, including weak flow of urine or frequent urination and trouble starting the flow of urine. Other signs include trouble emptying the bladder completely; pain or burning sensation while urinating and blood in the urine or semen.
A 40-year-old medical doctor, Dr Israel Adelaja, vowed that he would never have a prostatectomy and he would not recommend it to anyone. “As an African man, your manhood is your pride. So, why would I want to risk impotency and infertility just to limit the risk of contracting prostate cancer? “The prostatectomy does not completely eliminate the risk and so, I won’t recommend it,” Adelaja said.
Also, Mr Johnson Iyiola, a 38-year-old journalist, said: “I would rather have prostate cancer, which I know can be cured if detected early, than choosing to become impotent. Otherwise, let the cancer kill me.” An artisan, Ojo Ishola, 24, said that his manhood was all he had going for him.“If all else fails, even if I don’t have money, my manhood must never fail me. It is my confidence.“Besides, I am an African and I take pride in my manhood, which is necessary to procreate,” he said.
However, 36-year-old Dayo Olaoye, an IT consultant, has a different opinion.
His words: “If prostatectomy would mean prolonging my life, why not? Besides, I already have children and I want to live to see them succeed.” Funny enough, women are not left out of the debate. When asked if she would want her husband to have a prostatectomy, Mrs Biola Aribigbe, a 34-year-old banker, categorically said that she would never endorse it.“First of all, why use a fire extinguisher when there is no fire.“Anything can kill him; an accident, more likely than prostate cancer, can kill one,” she said. A 25-year-old student, Miss Victoria Reuben, said that prostatectomy “can affect a man’s ability to perform in bed and that will take out the fun from the marriage.“Sex is an essential part of marriage, like money and communication, and I would not want to cheat on my husband.
“No! I would not like him to have prostatectomy; we will consequently seek alternative treatment.”
However, a cancer expert, Prof. Aderemi Ajekigbe, said that having one’s prostrate removed did not necessarily mean that the prostate cancer had been eliminated completely. Ajekigbe, who is the Head of the Department of Radiotherapy and Oncology, College of Medicine, University of Lagos, said: “Prophylactic prostatectomy doesn’t mean you are safe from prostate cancer. “Even if we do take the prostate out, there is still a chance that you have already developed the cancer,’’ he added. He said that prostatectomy might cause complications like impotency and erectile dysfunction.
Ajekigbe said that while castration was a sure way of not developing prostate cancer, it also meant robbing a man of his ability to procreate.“Although prostate cancer is the most commonly diagnosed cancer in men, its incidence is still not as high as breast cancer.“Studies reveal that cancer of the prostate never occurs in eunuchs. The mere fact that you are a man predisposes you to having prostate cancer,” he said.“Besides, the management of cancer is multidisciplinary, not only one. Besides, if the cancer has spread, it may need chemotherapy, radiotherapy hormonal therapy,” he added. Ajekigbe stressed that prostate cancer was a hormonal dependent cancer like breast cancer and ovarian cancer.
He said that age was another risk factor in prostate cancer, as the disease was common among men who were over 50 years of age. He advised that men that were over 40 years of age should have their Prostate Specific Antigens (PSA) done yearly so as to ensure early detection of the disease. “The normal value of PSA should be between 0-4 and if a rising value is noticed through screening, it might indicate a problem. Then, further tests can be done and prostate cancer can be detected early. “Most cancers, if detected early, are treatable but late presentation can be disastrous. Early detection is very important for successful treatment outcomes and also for survival,” he said. Prostate Specific Antigens (PSA), according to the National Cancer Institute, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. However, Ajekigbe said that there were a lot of things within the people’s control that could be done to minimise the risks of developing prostate cancer. “A healthy diet and plenty of physical activity and a healthy weight will help.“You should incorporate eating vegetables and fruits into your daily diet and you should consume a little of everything,” he said.
A professor of pathology, Prof. Maarten Bosland, also conceded that prostatectomy could induce several complications, adding that the operation was long and hazardous, unlike that of mastectomy.
He said that while BRACA Gene 1 or 2 gene mutations increased cancer risks, prophylactic prostatectomy appeared to be the best option for those with genetic alterations.
He, nonetheless, added that he would not recommend prostatectomy. Bosland of the Department of Pathology, College of Medicine, University of Illinois, in the U.S., was recently in Nigeria for an inaugural lecture organised by the Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, on prostate cancer. He underscored the need to be mindful of the fact that pre-emptive surgeries could not eliminate the risk of prostate cancer completely, adding, however, that certain lifestyle choices might guard against the development of the disease.“I would never recommend prophylactic prostatectomy, as I have seen many people who had complications after the surgery.
“It is a hazardous operation and different from mastectomy which is a less hazardous operation.“It may cause urinary incontinence (not being able to control urination); damage to the urethra and the rectum, urinary flow difficulties and other surgical complications,” he said.Bosland said that prostatectomy could also cause erectile problems.“Erectile problem is a serious side-effect of prostatectomy, as the nerves that control a man’s ability to have an erection lay next to the prostate gland. The nerves are often damaged or removed during surgery,” he said. While conceding that there were no known specific causes of prostate cancer, Bosland said that certain factors like family history; genetics and high fat diet, increased the chances of developing prostate cancer.
“Age, as a determining factor, isn’t really specific because the problem is that even in a man that is 25 or 30 years old, there is a 30-per-cent chance that he has a small cancer in his prostate. “Whether the cancer becomes aggressive early on or not is unknown,” he added. Bosland said that the management of prostate cancer in black men and white men might not be so different if they had equal access to health care.
He said that early detection and treatment could, therefore, reduce the mortality rate of prostate cancer in black men.“In the US, there is a notion that prostate cancer in black men is higher and more advanced than in white men; this may be because of the late presentation of the condition at hospitals.“However, when black men and white men have equal access to health care, they tend to have similar mortality rates. That suggests that, may be, the difference is not so big.“But if access to healthcare is different, it may be three times higher in black men,” he added. Sharing similar sentiments, the National Coordinator, Committee Encouraging Corporate Philanthropy (CECP), Dr Abia Nzelu, attributed the high mortality rate of prostate cancer to its late presentation at appropriate hospitals. She said that lack of awareness and weak health system also contributed to the high mortality rate. “We are not doing enough to counter this situation. Most men report the cancer late, particularly when the symptoms have reached an advanced stage; this is largely due to their ignorance and they die unnecessarily.
“Death from prostate cancer is preventable but we are not seeing more survivors because of the dearth of facilities like comprehensive cancer centres,” she said.
Nzelu, nonetheless, said that the people’s adoption of healthy lifestyles, regular physical exercises and right eating habits could limit the risk of contracting cancer..
She also said that routine screenings would ensure early detection of the disease and “early detection ensures greater survival chances”.
She, nonetheless, conceded that even some affluent Nigerians failed to survive prostate cancer in spite of the fact that they had access to quality treatment abroad, attributing the development to the late presentation of the condition at hospitals.
“Recently, the media were awash with news of several cancer-related deaths, especially of very important and well-known personalities.
“However, when the late Nelson Mandela had prostate cancer at the age of 83, all aspects of his diagnosis and treatment took place in South Africa,’’ he added.
Nzelu called for the collaborative efforts of corporate bodies and well-meaning Nigerians to bridge the perceptible funding gaps in the establishment and management of comprehensive cancer centres to reduce the mortality rate.
“Many Nigerians have no access to basic cancer screening, much less optimal cancer treatment.“We have no single Comprehensive Cancer Centre (CCC), which costs about 63 million dollars to establish, and a Mobile Cancer Centre that costs about 600,000 dollars to set up.“Radiotherapy, which is one of the essential equipment needed to manage cancer cases, is not available in most tertiary hospitals in Nigeria.“Many of the cancer centres in other countries are funded through donations and charity; we can do the same in Nigeria, it is not beyond us,” she said. However, Prof. Oluyemi Akinloye of the Department of Clinical Chemistry, College of Medicine, University of Lagos, said that the lack of a national database had affected prostate cancer care in the country.“Specifically with prostate cancer, even though the same thing applies to most of the other cancers, there is a lot of genetic diversity. Our genetic makeup is completely different from that of the Caucasians.“Most of the information we have currently are from the developed world; from the Caucasians.“For us to have a complete understanding of the pathogenesis of the problem and be able to address it, we need to look at it globally because it is a global problem really,” Akinloye said.
All said and done, the provision of adequate screening and management facilities for prostate cancer and others will not force people to resort to adopting such extreme measures as voluntary castration and prostatectomy.
Akanni is of News Agency of Nigeria .
Bukola Akanni
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