PROSTATE is a glandular organ found in men only. It’s located in the pelvis just below the bladder. The urethra passes through it from the bladder to the penis as it transmits urine to the outside world.
The main function of the prostate is to produce seminal fluid which is essentially the food and transport media for sperms during ejaculation. So prostate symptoms are mainly due to the effects on the urethra.
Now when there is prostate cancer, the cells of the prostate gland become abhorrent and infiltrate local structures and also can spread to distant organs. At times there is just proliferation and enlargement of the prostate gland without tissue invasion, a condition called benign prostatic hyperplasia. Benign prostatic hyperplasia simply means the prostate is enlarged, but it’s not cancerous.
Prostate cancer affects men after the age of 50 years mainly. Annually, it affects about 1,2 million men and approximately 400 000 of those affected die from the condition.
The main risk factors for prostate cancer are age, that is, the older you are the higher your chances of suffering from it; family history, that is, if you are born in a family where there is a history of prostate cancer then your chances of developing it are high; and race — it affects more blacks than Caucasians. Obese individuals have been proven to have a higher incidence of developing prostate cancer.
Men who eat a lot of fruits and vegetables have a less incidence of developing prostate cancer compared to those who do not. Certain infections like STIs can affect the prostate and eventually lead to prostate cancer later on in life. It is also postulated that men who indulge in sexual activities more have a lesser chance of developing prostate cancer.
The signs and symptoms of prostate cancer have to do with the pressure effects the prostate will exert on the urethra initially. None the less please note that early prostate cancer has no specific symptoms. And the symptoms are generally similar to benign prostatic hyperplasia. The symptoms include increased frequency of urination (and the frequency is normally increased at night and we call it nocturia), hesitancy (difficulty starting to urinate), a poor stream (urine that doesn’t hit the wall), dribbling (urine that continues to dribble when you think you have finished urinating and you end up soiling your pants), hematuria (blood in urine), dysuria (painful urination) and if advanced it can give you constipation, backache and hip pain.
Because at first prostate cancer has no symptoms we encourage men to get screened for prostate cancer. Usually after the age of 40 to 45 years we encourage all men to start going for screening tests. If you are a high risk individual (say your brother or father had prostate cancer) we encourage that you start screening early and also you get screened more frequently. Screening helps us to make the diagnosis early and hence manage the condition before it spreads. As such we urge all men from 40 years of age to get screened for prostate cancer.
To make a diagnosis of prostate cancer we need to take a good history, do a thorough physical examination then conduct some tests. On physical examination one of the most important examinations we do is called a digital rectal examination. This is whereby the doctor puts their index finger into the rectum through the anus to palpate the prostate gland and feel for any abnormalities. This is a crucial examination to help guide us on the way forward so please men be cooperative when your doctor requests to do the digital rectal examination.
There are two main tests that we do to make a diagnosis of prostate cancer. Firstly we do a blood test called a PSA (Prostate specific antigen). Normal PSA is 0 to 4. If it goes up to between 4 and 20 then it’s most likely benign prostatic hypertrophy and if it goes beyond 20 then it’s most likely prostate cancer. The second test we do is an ultrasound scan of the prostate gland. If on ultrasound scan the prostate has increased in volume to beyond 40cc then we suspect prostate cancer. There are some parameters we also look at to help us have a strong index of suspicion for cancer. With these two tests we can have a strong clue as to whether there is prostate cancer or not.
To make the final diagnosis we need to take a prostate biopsy. This is whereby we put a biopsy forceps through the anus and rectum into the prostate gland and take a small piece of flesh from the prostate gland. We then send this piece of flesh (biopsy) to the lab where it’s analyzed under the microscope. Only after this do we get a histology report which is the only thing that can make our diagnosis 100%. The histology report will also tell us the type of cancer which will also guide us in management and prognosis.
After the diagnosis has been made we need to do some staging investigations to see to what extent the cancer has gone. At this point in time we have to order a bit more expensive tests like a CT scan of the abdomen and chest to see if the cancer has not spread to vital organs like the liver and lungs. We also need to do X-rays of the hip and femur to rule out any metastasis (spread) to the femur.
The last set of investigations would be blood tests to see if one is fit for operation or not. These tests now include a full blood count (FBC), kidney function test and liver function tests.
After these tests if the cancer is still in the early stages then it can be operated on and the prostate gland is removed with the cancer. At times if it has already spread we can do an orchidectomy (an operation to remove the testicles). We may also do radiotherapy and hormonal therapy.
Remember a healthy you, a healthy me to a healthy world.
Josephat Chiripanyanga is a Harare-based medical doctor.
He can be contacted on firstname.lastname@example.org