Prostate cancer: The curse of men


HARARE – She had warned me for two decades when it finally happened. I expected her to be all over me with “I told you and you didn’t listen”, but she was modest about it.

She only said:” If you had listened, you wouldn’t be going through all this pain. I thanked her but she retorted: “Don’t thank me, I can’t reduce the pain now.”

When I turned 40, many years ago, my wife advised me to get regular checks on my prostate gland, an organ the size of a walnut only found in men.

The gland, lies just beneath the bladder. The urethra, the tube that empties urine, runs through the middle of the prostate.

She said every man over 40 was a candidate for an enlarged prostate gland.

But something put me off.
When I asked her how the test for an enlarged gland was done, she said a doctor would have to insert a gloved finger through the anus into the rectum to feel the back of the gland.

I never answered her and I didn’t go anywhere, but now I had to face the consequences.

It all began happening late on a Wednesday evening.

I felt feverish and thought I was getting a cold.  By the time I drove home from the office and had supper, I was shivering.

My wife (thank God for her profession) brought a thermometer which until then had been used on my grandchildren. My body temperature had risen to 38.7C. The normal body temperature is 37C.

She gave me some paracetamol tablets to bring down the temperature and I lay down for the night.

I thought I felt better the following day, but when she returned home from work, she found the temperature was even higher — 39.4C. She dragged me “kicking and screaming” to Chitungwiza’s South Medical Hospital.

After filling in the medical forms, and having my blood pressure and temperature recorded, I waited to see a doctor who ordered an intravenous injection.

I was sent to the observation room for two hours to wait for my temperature to drop. It did.

I saw the doctor again and was told to leave my blood and urine samples at the lab. He prescribed a  powerful antibiotic which I thought was going to be my panacea. I was wrong.

Friday began well. I went to buy the drug and found it after visiting several pharmacies. I was to take the pills with a lot of water.

Nothing much happened until late on Saturday night when the volume of water I had been drinking gave me the urge to wee. I couldn’t.

I tried every trick in the book, while my wife was fast asleep, without success. I couldn’t wake her up to tell her I couldn’t wee. Could I?

Come Sunday morning, the problem seemed to ease. I could wee but in dribs and drabs which helped to ease the bladder pressure. I was not looking forward to the night so I asked my wife to take me to South Med Hospital so we could see the blood and urine results.

I was now concerned and suspected the worst.

When the results were taken to the doctor, he said, there was nothing wrong and that I should continue drinking my medication.

My wife told me after we had left she would book an appointment with a urologist first thing on Monday morning. She was not happy with the creatinine levels in my urine — the levels measure kidney function.

The urologist agreed to see me before noon. I phoned my editor to inform him I was not well. 

“Vharufu yam’dhara ya siza,” “The old man’s valve has ceased”, I said as we laughed and hung off before I headed for the city.

After the formalities, I entered the urologist’s consultation room and he immediately ordered me to his couch. He later said my gait had betrayed me.

Within minutes he had inserted a catheter into the bladder through the urethra and drained almost 2 litres of urine. I was relieved.

Using a chart on the wall, he explained what was happening and what was to be done going forward.

He ordered X-rays and cat scans to determine the size of the gland and blood and urine tests.

For the scans, I had to drink eight cups of cold water to inflate the bladder so that the gland could be viewed.

Within 15 minutes I had quaffed the required number and I waited for another 15 minutes for the water to arrive at its destination.

When I was called in, it was discovered my catheter had not been clipped.

I was sent back to drink four more cups. I gulped them down like a thirsty drunkard and joked they should fill the water coolers with booze for those of us who enjoy their drinks.

I bet some people would go out on their fours instead of using only the lower limbs.

Since it was now after 4pm, we returned home.

A friend in his 40s who lives nearby dropped in the evening after he had heard I was not well.

As I escorted him to the gate, he told me he had been to give a specimen to his urologist after he passed blood in his urine.

As he was about to leave, he asked me a question that puzzled me. Have you weeded the garden in preparation for the op?.

After seeing the blank expression on my face, he pointed to where the garden was and we both burst out laughing and parted. As he walked away he said: “ I had to weed mine too.”

When I  saw the urologist on Tuesday, he explained the content of the results. The prostate was enlarged and he had to go in to reduce it. He explained the prostate commonly becomes larger in older men.

The medical term for the enlargement prostate is prostatic hyperplasia (BPH), I was told. The prostate enlarges gradually after the age of about 50. By the age of 90, about 9 in 10 men have an enlarged prostate.

As the prostate enlarges it may cause narrowing of the first part of the urethra. This may partially obstruct the flow of urine and lead to obstructive symptoms such as:

Poor stream: The flow of urine is weaker, and it takes longer to empty the bladder.

Hesitancy: You may have to wait at the toilet for a while before urine starts to flow.

Dribbling: Towards the end of passing urine, the flow becomes a slow dribble.

Poor emptying: You may have a feeling of not quite emptying your bladder.

The enlarged prostate may also make the bladder irritable, which may cause:

Frequency (passing urine more often than normal). This can be most irritating if it happens at night.

Getting up several times a night is a common symptom and is called nocturia.

Urgency: This means you have to get to the toilet quickly when you need to go.

Usually the symptoms are mild to begin with. Perhaps a slightly reduced urine flow, or having to wait a few seconds to start passing urine.

Over months or years the symptoms may become more troublesome and severe. Complications develop in some cases.

He explained the enlarged prostate does not always cause symptoms. Only a quarter to a half of men with an enlarged prostate will have symptoms.

Also, the severity of the symptoms is not always related to the size of the prostate. It depends on how much the prostate obstructs the urethra.

To solve, my problem, he was going to perform a Transurethral resection of the prostate (TURP) on me — a common operation  for an enlarged prostate.

Under anaesthetic, a rigid cystoscope was to be inserted through the urethra into the bladder.

A cystoscope is a narrow tube-like telescope through which small instruments pass to allow the operation to be carried out. A semicircular loop of wire has an electrical current passed through it.

It is this loop that sticks out from the end of the cystoscope and cuts out small chips of prostate that are then washed out at the end of the operation.

This operation nearly always gives good relief of symptoms. 80-90 percent of men after this operation will have retrograde ejaculation, which is when semen goes backwards into the bladder at climax producing a “dry” orgasm. Impotence and incontinence are rare complications after a TURP.

I was to report at the Avenues Clinic at 6.30am the following day after having breakfast and I was going to be operated on at three in the afternoon. I checked in as instructed and was given a bed in Ward 4b, ready for the op.

My heart was racing when they came for me at around 4pm. After checking my blood pressure, I was given a pill which made me a lot more relaxed.

It felt strange being pushed on a hospital bed to the lift and the theatre upstairs.

I only felt a sting in my back as the anaesthetic was applied epidurally — through a space in the spine to numb the lower part of the body from the waist down.

I could see the surgeon working on me while the anaesthetist looking on.

He was through after about an hour and I was sent to the high dependency ward with fragments of my prostate in a bottle with the preservative formalin. I tried to move my legs but they felt like lead.

Then began the three hourly ritual  to check my blood pressure, sugar levels and being given pain killers.
An occasional injection to prevent vomiting would also be administered.

I was sent back to Ward 4 B on Friday morning and was discharged by Sunday afternoon.

When I went for the results a week later, I was told the prostate was not cancerous but was put on a month’s medication. I was told to periodically get a blood test used to detect a substance made by the prostate called “prostate-specific antigen” (PSA).

But researchers say many men with a mildly elevated PSA do not have prostate cancer, and men with prostate cancer may have normal levels of PSA.

It is said black men are three times more likely to develop prostate cancer than white men. Researchers are looking at what may be the cause of this increased risk, but genes probably play an important role.

Many men over 70 have prostate cancer, even though most of them will never have it diagnosed or have any symptoms.

In the majority (80 percent) of cases, this is a slow-growing cancer and it may stay undiagnosed because it never causes any symptoms or problems.

In the other 20 percent of cases, the prostate cancer cells can grow quickly and move outside the prostate, spreading the cancer to other parts of the body, such as the bones.

The risk of getting prostate cancer gets higher as one gets older.

Most men diagnosed with the condition are over 50. However, survival rates of newly diagnosed prostate cancer patients have improved from 30 percent in the 1970s to 80 percent according to research results.

If one’s father or brother is diagnosed with prostate cancer, the risk of getting the disease is two-and-a-half times higher compared to the average man.

The risk increases to 4.3 if the relative was diagnosed before the age of 60.

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