The Independent Uganda: You get the Truth we Pay the Price
By Flavia Nassaka
The best ways to mark `Movember’ – the prostate awareness month
November is every man’s month. It is ‘Movember’ – Prostate cancer awareness month. The Movember Foundation started in 2004 in Melbourne, Australia set aside November as a month of raising awareness for prostate cancer – detection, treatment and prevention among men in the United States. Eleven years later the idea has caught on globally, including in Uganda which is recording increasing cases of prostate cancer patients.
And as you possibly know, virtually all men above the age of 40 years are required to pay special attention to special glands in their body called the prostate.
It is a small but very important organ in the male reproductive system. Usually about the size of the top phalange of average man’s thumb, it is found below the bladder, above the penis, and in front of the rectum. Normally it secretes fluid during ejaculation that nourishes and protects sperm. Which is why every man needs to ensure their prostate stays healthy for as long as possible.
Dr. Fred Okuku, a prostate cancer lead researcher at the Uganda Cancer Institute in Kampala, says one way to maintain prostate health is through general body exercise. Published scientific evidence shows that regular and vigorous physical exercise prevents some cancers, and can also reduce the incidence of cancer by 30–70%. Other doctors recommend consumption of certain foods and avoidance of others.
Mainly, it appears, eating fruits and vegetables is a good way to tackle prostate trouble. These contain large amounts of cancer-fighting and inflammation-reducing substances like vitamins, polyphenols, antioxidants, minerals and natural fiber. Most men do not consume the recommended daily intake of fruits and vegetables. So eat lots of cruciferous vegetables (including broccoli and cabbage), tomatoes, mushrooms, oranges, lemons and other citrus fruits, avocados, apples, and berries.
Still on diet, beans and nuts are also said to suppress the growth of many kinds of cancer. Same with green tea (which is a strong antioxidant), and whole grains (brown rice, oatmeal, maize meal, and millet).
On the flip side, consume less of red meat, dairy products and animal fat. Beef, pork, and lamb are particularly tied to aggressive prostate cancer. Also limit sugary drinks and drink lots of water.
Prostate diseases
In the end, however, the prostate gland gets enlarged in virtually all men above the age of 50 years. There is a bit of disagreement among medical experts regarding when to test or not for prostate disease. However, men in their 40s and 50s are encouraged to periodically check since with early detection, treatment is possible.
Dr. Noleb Mugisha, another oncologist at the institute, says 85% of men with prostate disease will die of other causes without knowing that they had it. He adds that in screening for the disease, the first priority goes to the 15% who have a family history of the disease, those with problems passing urine by either having frequent urination or pain and those with low back pain.
The prostate enlargement is usually benign, meaning it is not harmful. In some advanced cases, it may cause a complete blockage of the urinary function.
In other cases, and added to those complications of the enlarged prostate, it can become cancerous. In fact, scientists say, almost all men above the age of 80 years will have cancer cells in their prostate. It is thought that virtually all men with circulating androgens (hormones) will develop microscopic prostate cancer if they live long enough. “Certain changes in the chemical that make up our genes can cause normal prostate cells to grow abnormally and form cancers. Cancer can be caused in part by DNA alteration that turn on oncogenes (cancer causing genes) or turn off tumor suppressor genes,” says Okuku.
He says it is the most common cancer among men and its incidence rate is increasing at 5.2% annually mainly among men between the age of 60 and 70 years. Statistics at the Institute indicate that every year more than 1500 patients are diagnosed with it.
Okuku says one in ten men has the disease in any particular form by 60 years and the disease is the leading cause of cancer related death among men. He adds that DNA changes can either be inherited from a parent or can be acquired during a person’s lifetime. Inherited genes may cause about 5% to 10% of prostate cancers. Most DNA mutations related to prostate cancer seem to develop during a man’s life rather than having been inherited.
Treatment
Dr. Mugisha explains that every time a cell prepares to divide into two new cells, it must copy its DNA and that the more quickly prostate cells grow and divide the more chances there are for mutations to occur. Therefore, anything that speeds up this process may make prostate cancer more likely.
But he adds that unlike other cancers, prostate tumors grow slowly and there are virtually no symptoms until the disease has progressed and is affecting other parts of the body. When that happens treatment is inevitable.
Dr. Okuku says in early stages, 1 and 2, surgery can be employed. He says other treatments like immunotherapy, ultrasound doses, and hormone injection can help.
“But the problem is men report very late when there’s totally nothing we can do to help,” he says He says there is an age at which one starts developing an enlarged prostate, at this age an investigation to tell what they are up to is necessary to show whether they may be having cancerous cells or not. He says it’s always important to do tests on advice of a doctor to enable them choose the best test depending on one’s symptoms. He says, for example, that a common prostate cancer screening technique – the prostate Specific Antigen (PSA) which is a protein test to indicate presence of prostate tumors, can at times show that one is normal whereas they are not.
The other problem is that prostate cancer remains a less focused on disease by experts. While cancers like that of the breast and cervix have seen major breakthroughs in treatment and prevention including vaccination, prostate cancer has not seen any such breakthrough yet it’s fatal when not treated early. Its management also involves a lot of physical and economic strain.
The treatments so far available are too expensive to justify the extra months of the life they bring. A pharmacist in Kampala told The Independent that a single dose to stabilise the tumors and control pain costs about Shs1 million per month and a full dose lasts two years. That is a cool Shs24 million bill. Meanwhile, Dr. Okuku says, exercise remains just as important during treatment as it was during prevention.
