By: Janine De Nysschen
We recently had our annual financial audit process and shared our offices with esteemed members of a prestigious audit firm. In opening up all areas of our business for their scrutiny and access, we also generously gave them the keys to the unisex executive bathroom. It turns out that while the audit firm may pride itself on paying attention to detail, its male staff have decided trouble with their direct aim. As a woman who shares a bathroom with executive men I have long overcome the challenge of toilet seat up or down. But I do draw a line at unnecessary sprinkles all over the seat and floor!
It was while I was cleaning up yet another series of yellow splotches that I had an epiphany worth sharing.
I work in a private cancer centre. And, every month, when I review our cancer statistics, it’s clear that prostate cancer is one of the most common cancers that we treat in men here in West Africa. More specifically, when I look at the profile of the men we’re treating, they are mostly over the age of 50, and many of them are in business roles – more often than not, they are business executives.
However, it is also very apparent from our data that many men in West Africa leave their prostate cancer until a late stage before they come for treatment. This is unfortunate, because, prostate cancer can be managed and cured. Moreover, the earlier you are diagnosed and seek medical treatment, the less likely you are to experience the side effects that men most fear: incontinence or erectile dysfunction.
The prostate is a gland that only men have that surrounds the urethra – the tube that empties urine from the bladder – and which produces a fluid that forms part of a man’s semen. It’s an integral part of the male reproductive system.
Here’s why knowing about prostate cancer is important: Research shows that African men suffer from a disproportionate greater incidence of prostate cancer than any other men in the world. In fact, United Kingdom (UK) studies found that African men are 2 to 3 times more likely to develop prostate cancer than their Caucasian counterparts, and 30 percent more likely to die from it. Other studies have found that in African men, prostate cancer has different tumour biology when compared with other races, and that clinical manifestations have a more aggressive disease rate.
This racial disparity should be alarming, and one would think all African men aged 50 and above are lining up for prostate cancer screening. But I’ve just read about a study conducted in Ghana in 2014, which took over 1000 healthy men aged between 50 and 74 and screened them, and the findings were disturbing. Only 25 men out of that sample of 1037 Ghanaian men reported ever having had a PSA test – the simple blood test that screens for the amount of prostate-specific antigen. This means only 2.4 percent of these men had ever been tested for a disease that is highly likely to happen to them!
The Ghana study exposed another myth. Prostate cancer is not just an old man’s disease in West Africa – the most men who were found to be positive in this study were under 70. A total of 352 men – that’s ONE THIRD of the group – had a positive test result that required further testing or biopsies.
It’s worth sharing two more points you should know.
First, the Ghanaian men in this study were healthy. Prostate cancer doesn’t show up as a bump or lump or come with a neon sign; for all intents and purposes, healthy African men can have high PSA results.
My second point is about understanding why prostate cancer screening is important from a treatment perspective. A high PSA score does not automatically mean you’ll need prostate surgery. Chances are your doctor will explore one of the other non-invasive treatment options first. Many men diagnosed with localised prostate cancer can live on a treatment regimen for many years and lead healthy active lives.
So, how is prostate cancer treated? Once you have been screened and you are aware of your prostate status, each case is handled based on certain treatment indicators. The specialists who will give you the best advice are a urologist and an oncologist. They will look at the type of therapy you need, as well as your risk level. They also take into account your personal circumstances and will allow you to make treatment choices based on your health benefits and preferences.
Prostate cancer treatments involve several options. The first includes “watchful waiting” – or as the oncologists say, active surveillance. Early forms of prostate cancer may not need surgery or radiation. Your specialist will check you frequently using PSA results and a digital rectal exam (DRE) to monitor the progress of the cancer.
If the prostate cancer is more advanced, your specialist may recommend a prostatectomy. This is where the affected part of the prostate gland is removed, and in the case of a radical prostatectomy, the entire prostate as well as some of the tissue around it is removed.
There are other treatments, including hormone therapy, cryotherapy and chemotherapy. Radiation therapy is also an option. It uses high-energy rays or particles to kill cancer cells. Cure rates are similar to those for radical prostatectomy. Radiotherapy is also useful for cancers that have grown outside the prostate gland and into nearby tissues where surgery is ineffective, or for cancer that recurs after a prostatectomy.
In our private cancer center here in Accra, we perform image-guided radiotherapy (IGRT) that is the same as is done in developed countries, with external beam radiation. This year, we’re expanding into brachytherapy, which is an internal radiation technique. Treatment duration is 38 working days, and it is done on an out-patient basis – making it easier for business executives to have scheduled appointments so they can come and go without affecting their work routines.
Speaking of our centre, let’s go back to the washroom again and my epiphany. How do you know if you have prostate cancer symptoms? The easiest way for any man to keep his hand on the matter (so to speak) is to constantly monitor his urination patterns. This is where you will see some of the first signs.
For example, when you use the washroom, you may experience a slight burning or discomfort while you’re peeing. Perhaps you notice that your urine stream isn’t flowing as fast or strongly as it used to. Or you are having to get up during the night to use the washroom more often than you have in the past. It’s interesting that some theories why African men have higher mortality rates from prostate cancer say it is because African men don’t like seeing doctors, and they have higher thresholds for pain and discomfort. Please, if you have difficulty urinating, or have trouble starting or stopping, then you should seek medical advice!
Finally, there’s a very good reason why you should watch where you are peeing – and that’s not only because I want you to miss the toilet seat and keep it in the bowl. One of the key indicators of urinary or prostate problems is blood in the urine. That means your urine will be slightly darker in colour than it is normally, perhaps more concentrated.
Is there anything you can do to prevent prostate cancer? Well, based on the results reported by Harvard of a recent long term study that involved almost 30,000 men; sexually active men who have frequent ejaculations (more than 21 per month) had a lower risk of prostate cancer.
Right now, prostate cancer is one of the leading causes of death in men in Ghana and Nigeria. You can change that. If you are African and over the age of 45, then it is time to start a frequent screening process and have a PSA test done. And as with prevention for all types of cancer, make sure you watch your diet, limit your drinking and smoking vices, and get plenty of exercise.
But, please, if you’re a man reading this, the next time you use the washroom, remember that when it comes to the Big ‘P’, you’re holding one of the best diagnostic measures right there in your hand. And aim for the bowl!
Janine de Nysschen is the General Manager of Sweden Ghana Medical Centre (SGMC). She believes that business is the key to Africa’s future, and that healthy business leaders will help fuel the continent’s growth.