In marking prostate cancer awareness month [November], the Uganda Cancer Institute (UCI) last Friday held a live Facebook/Twitter session to sensitize the public. DR FRED OKUKU, an oncologist at UCI, was online to discuss prostate cancer. Yudaya Nangonzi brings you excerpts from some of the questions and answers:
Briefly tell us about our work...
Cancer is a very challenging disease. It is difficult to treat and requires a lot of expertise and resources. At UCI, we receive close to 5,500 new patients annually. We have facilities to treat cancers like the chemotherapy unit, radiation unit, surgical and the palliative care team.
We also have counsellors that keep talking to people with or without cancer.
At what age should one start worrying about prostate cancer?
We start worrying at age 40 because there are very few people who get prostate cancer below that age. But, you should also worry or check more when you have a family history of the cancer because we take you to be at high risk. We need to even screen you as early as 35 years if you have a family member with prostate.
Why do men fear to be diagnosed with prostate cancer?
Just like any other cancers, it is fatal and kills. Just make sure you go for checkups because that is the reason we all worry about this disease. It is the commonest cancer among men in Uganda.
Some drops of urine remain and come out late, leaving my pants wet. Could it have bearing with prostate cancer?
What you could be having is terminal dysuria, a urinary tract infection that comes with painful urination. Usually, you don't empty the bladder; there is often some residue.
As you grow older and your prostate becomes bigger, the volume of urine that stays is a little higher. Sometimes, it is just an issue of contraction to allow urine to leave. This should not really worry you if you are young and it's just a little drop. If it continues, it should worry you.
Is cancer curable?
True. Cancer is a curable disease if diagnosed early. Cancer is in four stages with stage one being early and four considered late.
If one of our relatives succumbs to prostate cancer, is there a possibility that more relatives have it?
It's true that prostate cancer can be hereditary and we worry if one has died. We regard you as a high risk individual because your chances of developing prostate cancer can be about 25 per cent. If you come from the same family, your chances are as high as 50 per cent. The more family members, the more risk. We usually request that you come for screening early.
How is prostate cancer diagnosed?
It is diagnosed by taking a tissue or biopsy from your prostate. Normally, we also look at symptoms but some men do not have them and it makes prostate cancer a very difficult disease.
There are men without symptoms but have advanced stages of prostate cancer. So, every man needs to have a check especially if you have urinary problems but others may not have any symptoms.
There are few things we ask for like symptoms; we also put a finger in your rectum to feel how big the prostate is, in addition to ultra sound check and blood test known as [prostate-specific antigen]. Those three results are done by a doctor and if we find the results abnormal, we can do further tests including a biopsy.
What are the signs and symptoms of prostate cancer?
Initially, signs are associated with the urinary tract. Your prostate is just below the bladder. When you have the cancer, your prostate becomes bigger and the signs are usually associated with your inability to pass urine, infections or blood in urine.
For some men, you may have erectile dysfunction, wake up many times to pass urine, hesitant to pass urine because of blockage or your urine flow is small or dripping instead of passing like a tap.
Late signs include bone pains, in the back, yellow anaemia and other complicated issues associated with cancers.
Is there screening [of prostate cancer]?
Yes. Every week, Monday to Friday, we have a doctor who sits in our shade at UCI. You can go there and register and be screened free of charge.
What are the risk factors that cause prostate cancer?
If you have a strong family history of prostate cancer and age. However, in Uganda, don't expect to see men in 20s having it but it has a peak age between 60 and 70.
Other risk factors are not eating right foods, not exercising, eating too much fast food and inability to cut and be in the normal Body Mass Index (BMI). Foods that can reduce on the risk of prostate cancer include cherries, tomatoes and watermelons [which] are high in lycopene, berries, and all vegetables.
There is also research that red wine can cut down on some toxins but this does not mean you should take all the red wine in the city. However, there's some evidence that it can cut on your risk of prostate cancer and cancer of the heart.
Is there vaccination against prostate cancer?
Prostate cancer is not caused by viruses and vaccination is only done for diseases caused by an infection. So, vaccination for prostate cancer is currently not possible but researchers are developing vaccines that can boost your immunity to generally fight cancer.
One of the things that cancer does when in your body is that it puts down your immunity to fight infections. That is one of the ways in which cancers have managed to invade the body.
You need to eat well, exercise regularly, and be active in any way to boost your immunity?
Can prostate cancer affect one's fertility rate.
Yes. One of the things I mentioned earlier that one of the late signs of prostate cancer is erectile dysfunction which means a man's inability to have an erection.
How often should one screen for prostate cancer?
Usually, every year a man needs to go and have a test.
Does sexual displacement put you at risk of prostate cancer?
Yes, it puts you at risk and one of the treatments especially for late prostate cancer is to put down your testosterone. We do this by surgery and remove your testicles or give you drugs in what we call hormonal treatment.
How common is prostate cancer?
It is the commonest cancer among men in Uganda and in many countries neighbouring us; it is the number one cancer.
Can other types of cancers be tested for one to know the early stage?
Not all cancers can be tested or screened. Screening is a process where you are attempting to catch cancer in its early stage in people who don't have cancer. If you have cancer and come to us, that is called diagnosis.
There are a few cancers that we screen like cancer of the cervix, colon cancer, breast cancer, cancer of the lung mainly recommended for people who smoke to see if they are developing anything in their lungs and prostate cancer.
All these places have areas where it is easy for the doctor to touch and feel. But it is difficult for the others to screen like blood cancer and leukaemia. But should one have any symptoms, we of course act immediately.
I have swollen glands in the groin and neck... .
Those swollen glands are called lymph nodes which is one of the ways through which cancer spreads. There are three main ways in which cancer moves; blood circulation, lymph nodes and local extension in the neighbouring area where the cancer has begun. For instance, in the breast, it spreads in the neighbouring breast tissue and then to the chest and invades other parts of the body.
So, if you have [swollen] lymph nodes, you need to have a check to ensure this is not something dangerous.
Are there any cases of prostate cancer below the age of 45?
Yes. This is especially with people who have one or two or three members of their family who have prostate cancer. Such people start cancer at an early age.
Any prevention tips...
Generally speaking, there are many diseases that you can fight. As a key rule, there are certain things that you shouldn't do. One, alcohol has been proven to increase your risk of cancer. Two, smoking is a risk factor for many cancers including leukaemia and cancers in different organs.
Three, HIV and other viral infections; please avoid any sorts of viruses. The reason why HIV patients develop cancer is that the HIV hits the immune surveillance system that fights cancer. So, this puts HIV patients at risk.
The other thing is to mind your diet; vegetables and fruits have anti-toxicants that help get rid of toxins. The foods we eat have a lot of toxins. For example, when you eat burnt parts of roasted meat, it puts you at a very high [risk of cancer]. You need to eat less of red meat including pork that many confuse for white meat yet it's purely red meat.
Please settle for less processed meat and more white meat like fish and chicken to cut on your risk of cancer. Ugandans, we need to be knowledgeable about these things because knowledge is power. If your body mass index (BMI) is above 30, then you need to start worrying because high BMI predisposes you to many diseases like diabetes, hypertension and cancer.