Dr Gabriel Ogah, Consultant Urologist, Ogah Hospital and Urology Centre, Fugar, Edo State discusses prostate cancer with SIMON UTEBOR
What is prostate cancer?
Prostate cancer is cancer in the prostate – a walnut-sized gland located between the bladder and the penis. Cancer in essence is a group of tissues made up of cells in a certain part of the body that grow haphazardly, uncontrollably and eventually lead to the death of the individual if not taken care of.
Is it different from the normal growth of tissues?
That is different from the normal growth of tissues like the breast of a girl that grows out of the body. It is controlled – it grows to a certain extent and once the lady is mature, the breasts stop growing and they produce milk to feed the child. They don’t continue growing, but as far as cancer is concerned, they will continue growing – they don’t stop until the person who bears the tissue dies of it. So, when this happens to the prostate, we call it prostate cancer.
What are the causes of prostate cancer?
Nobody knows the causes of any cancer for that matter. Nobody can tell you they know the cause of cancer. Scientists don’t know – we are still searching but we do know there is a certain pattern – there are people more likely to have cancer than others. There are certain conditions that when present predispose certain people to cancer. So, we talk about predisposing factors.
What are those predisposing factors?
One of the predisposing factors is age. If you between 20 and 40 years old, you are not likely to have prostate cancer but if you are between 60 and 70, you are very much likely to have it. If we were to do autopsy on 50-year-olds that died, you would find that only about 20 per cent of them or lower would have prostate cancer, but if you perform autopsies on those who died between ages 70 and 80, at least 50 per cent of them would have been found to have prostate cancer.
Apart from age, what are other predisposing factors?
It is also related to family. If your elder brother, father or uncle has had prostate cancer, you are more likely to have it than people whose family never had prostate cancer.
It is also related to diet. It is known that people who take a lot of fat have the highest risk of having prostate cancer more than others. It is also related to obesity – people who are obese have a higher incidence. It doesn’t mean that if you are obese, you must have prostate cancer. It doesn’t mean if you eat a lot of fat, you must have prostate cancer, it is just that you are predisposed to it just like a student who doesn’t read for exams is more likely to fail than those who read. So, someone who takes a lot of fat or is obese is more likely to have prostate cancer than those who don’t.
Again, agricultural pesticides are also contributory. A research was done in the United States where they found out that certain herbicides used on farms are absorbed by the soil, especially as the herbicides will go into the crops and when people eat the crops, it predisposes them to cancer.
There is also a genetic predisposition. Apart from family, people who have certain prostate cancer genes in their bodies (are also prone).
Another predisposing factor is radiation used for warfare. For instance, during the Vietnam War, lots of cluster bombs were used. The radiation from such bombs predisposes people to prostate cancer. For instance, the American warplanes were spraying the whole of the forest with herbicides that could destroy the leaves so that soldiers could not hide under the trees. They found out that a lot of Americans who retired from the Vietnam War had a very high incidence of prostate cancer because those herbicides were absolved by the American soldiers who went to the area. Right now, a lot of them now have prostate cancer.
Is it true that race is also a predisposing factor?
Few Asians have prostate cancer compared to the rest of us. For every three blacks and for every two whites, only one Asian will have prostate cancer. In order words, the incidence of prostate cancer is three times more in blacks than in Asians and twice more in whites than in Asians. So, when you talk of race, the ratio for black to white to Asian is 3:2:1.
What is the nexus between regular sex and prostate enlargement?
Another interesting thing which was found out by a research in America a few years ago is that people who tend to have sex regularly have 20 per cent less incidence of prostate cancer than others. It further states that if someone has sex and ejaculates 21 times in a month, the person has 20 per cent lower incidence than people who have sex irregularly.
Also, when people are castrated, especially in those days when some kings used to have a lot of wives in some areas, a lot of men who took care of their harem were castrated. Castrated people hardly even have prostate cancer because they don’t have testes. It is believed that the over 18 million slaves that were taken from Africa to the Arab world were all castrated; that is why you don’t have descendants of black people in the Arab world. When people are castrated, their prostate will shrink and they hardly ever have prostate cancer.
It is also said that prostate cancer can cause impotence and inability to urinate, what is your take on that?
Yes, of course, it does so indirectly, not directly. If someone has prostate cancer, he can be impotent. If the cancer has grown to the extent that it has affected the nerves that control potency, of course, you can have impotency, but I can tell you that it is not the commonest cause of impotency. If it is too big, it can block the urination – but indirectly.
How is it cured?
It can be managed.
Are you saying it can’t be cured?
In some cases, it can be cured. In this instance, cure has to be defined. If someone has prostate cancer and one is able to manage it such that it no longer disturbs one in any way, if one doesn’t die from it, and dies from other conditions, we will say it has been cured. Even if the person still has the cancer, and it is not responsible for the person’s death, it is not reducing the person’s quality of life, it is not leading to death, we call it a cure. It is not like having an appendix and removing it – you have cured it. For prostate cancer, as long as it does not disturb, it is cured. So, we can say it is curable when it is discovered early and managed accordingly. You know, one of the natures of cancer is to grow in one place and travel to different parts of the body. It is like a terrorist – they will be active in one place – have a cell, go and hit different parts. Therefore, prostate cancer will be growing in the body and sending messages (some cancer cells) to the bones, liver, and other parts of the body. When it has done that, you can no longer cure it, but you can manage it so that the person’s life is not terribly affected. So when it is early, it is potentially curable but when it is late, it is incurable and it can be managed.
What is the situation like in Nigeria?
The scenario in Nigeria and many developing countries is that the case of people that have prostate cancer come late and it becomes difficult to be cured. They first of all go to churches, pray over it, have vigils or ask friends in office or in the village meeting for solution. Those ones will tell them to go and take unknown medication. They will keep on delaying it until they start losing weight and urinating blood. Then, they finally remember they should see the doctor, by which time it is too late.
But what happens in advanced countries, such as the US, Finland, Japan, UK, and so on, is the opposite of that. They report the case early and the majority of them are cured. In fact, the incidence of deaths from prostate cancer in America is going down, whereas in Nigeria it is rising.
What is the difference between prostate cancer and prostate gland enlargement?
The ordinary enlargement, which is called benign prostate enlargement, grows gradually – it does not commonly kill someone except it is complicated. When it is very huge, it will then block urination and can eventually destroy the kidneys because urine can’t come out, so it continues to stay. It continues to retain the urine it has produced, therefore, the kidney will be destroyed and the person will eventually have kidney failure. For that reason, the person will die, but ordinarily, it does not kill except it is complicated. So, it is benign; it is just like a lady that has a lump in the breast. If you check it and it is not breast cancer but a lump, you remove it. That is how ordinary enlargement is. When someone has a lump in the prostate, you remove it – it doesn’t cause any other problem. Therefore, prostate enlargement is better than prostate cancer and it is commoner.
How is prostate cancer diagnosed?
The patient who has the problem will complain that he is passing urine frequently and can’t sleep at night. Maybe if he goes to a board meeting, he will leave the board meeting five times to urinate and he has to rush at times because if he doesn’t, he will wet himself. When such a person gets to the toilet, he will wait for a long time. You need to see some old men. You go and urinate at the same time and when you are done, some of them will continue to be there.
When he thinks he has finished, some of it is still left behind and the commonest cause is seen in old men bedwetting. They sleep and don’t know when the urine comes out. When a person gives a story like that, the doctor will examine him and stick his finger into his back passage (anus). You will find that the prostate usually is enlarged. If it is ordinary enlargement, it will be smooth, but if it is cancer, it is hard and stony. Then for ordinary enlargement, you can just diagnose it by examination with your finger and taking the history, whereas to confirm someone who has cancer, you must take a small piece from it with a needle. It is called biopsy. You take little particles of cell or tissues from the prostate and send the sample to a pathologist who will examine it on the microscope. He has to confirm he has seen cancer cells because cancer cells don’t look like ordinary cells, they have certain features which will make the pathologist know it is prostate cancer. When he brings the result and says it is prostate cancer, you know it is cancer, whereas the other one that is ordinarily enlarged, you don’t need a pathologist to tell you. Punch