Like a traffic marshal, one gland on a man’s nether parts, opens and closes channels for movements to happen. That gland is the prostate.
Thanks to the prostate, a man’s semen cannot come out simultaneously with urine, even though they use the same exit.
It is also the prostate that assumes the role of a pump and it helps a man’s reproductive fluids mix into a substance, that offers the best conditions to carry sperm out of the body. Then it provides the pressure that pushes out the mixed fluids (semen) at a high speed. Think of it like a gun’s firing mechanism.
Testosterone, the hormone that dictates the sex drive and informs many body functions, is also activated at the prostate after being made by the testes. Thus, the tiny gland that weighs about 20 grams is a core part of the masculinity engine.
However, the gland becomes susceptible to problems as a man ages. It often enlarges as a man accumulates his birthdays.
And sometimes it can develop cancer. Because it is situated right under the body’s urine bag, and given the fact that it is never too far from the rectum, a swollen prostate announces itself and is tested in various ways — some that make men fret about having it inspected.
To shed light on that organ and to sift through the truths and half-truths regarding testing, we posed numerous questions to Dr Abeid Athman, the head of the Oncology Department at the Kenyatta University Teaching, Referral and Research Hospital.
Dr Abeid Athman: Ten facts to keep your prostate in perfect check
Dr Athman says that among the people with cancer in Kenya, prostate cancer lies third, in terms of the number of patients. The first two positions are held by breast cancer and cervical cancer respectively. From his insights, here are the 10 things you should know about your prostate and the cancer that may attack it.
1. Not all swellings mean cancer
Dr Athman explains that as a man ages, prostate activity reduces in intensity: “Because of this, sometimes it can have a compensatory mechanism. It wants to work the way it used to be when young. In this process, it starts enlarging,” he says.
This enlarging affects the urine system, and Dr Athman says it is the reason the short calls by older men do not come out with the force they had in their younger years.
Age-related prostate enlargement is common. According to the United Kingdom’s health agency, the National Health Service, the swelling that is medically described as benign prostate enlargement “is common in men aged over 50”.
“It’s not a cancer and it’s not usually a serious threat to health,” it says.
However, as the enlarging happens, an error can happen in the genes that dictate growth and create rogue cells. Whereas the body has its own mechanism of killing cells that go rogue, sometimes the renegade cells can bypass the checks and tinker with the balance.
“When this balance is lost, then it means it is leading to cancer because the growth is not regulated,” says Dr Athman, adding that such growth has the potential to leave the prostate gland and spread to other parts of the body. The prostate can sometimes get diseases like prostatitis, a bacterial infection, that can also cause swelling of the gland.
2. Fingers for testing? Modern medicine may not need that
One of the most dreaded realities about prostate cancer is that a man faces the possibility of having a medic insert fingers inside his rectum to detect an enlarged prostate.
Dr Athman says the medical term for the procedure is digital rectal examination (where “digital” refers to digits, that is the fingers).
“Once they go inside there, they are trying to see how the prostate is. In prostate cancer, the prostate is very firm and rough and coarse. Nowadays, we don’t routinely do it,” he says.
He notes that once a person’s blood sample has been tested and the levels of the prostate-specific antigen (PSA) have been flagged as too high, other testing methods can be deployed.
Once a man’s PSA levels are found to be abnormal, other tests like magnetic resonance imaging (MRI) may follow, to pinpoint the exact area where there is a problem.
Dr Athman says an MRI scan is preferred to an ultrasound. Afterwards, a sample is taken from the suspected cancerous area to be examined for cancer. This is called a biopsy, and the status of the cells will determine if there is cancer and what stage it is.
3. Aching bones and link to prostate cancer
“Prostate cancer has the potential of going to the bone very fast,” says Dr Athman.
As such, he says, a patient might live on painkillers, thinking he is grappling with the pains that come with age, while the cancer is developing.
“We should never ignore bone pain in males who are aged over 45. We need to investigate why it is happening and we need to do a PSA test,” he says.
The more the cancer invades the bones, he says, the worse the effects. It can go as far as blocking the spinal canal, rendering the patient unable to walk.
“This patient was OK and then suddenly wakes up saying he cannot walk. Or suddenly, a patient wakes up and cannot control the urine coming out, or the stool.,” says Dr Athman. “All these are already late signs.”
4. Why you may lose your testes after prostate cancer
Once the tests confirm it is cancer and the stage has been established, prostate cancer treatment starts. At this stage, Dr Athman says, the production of testosterone in a man’s body has to be stopped.
He notes there are two ways of doing this. One is castration, where the testes are removed surgically. The other involves an injection that introduces a chemical to the body that stops the production of the hormone.
“That is what we call chemical castration. It is the most acceptable with most men, because no man would like to lose his testes,” he says.
The chemical castration, he notes, is reversible. Once the injections stop, a man’s body resumes the production of testosterone. It is after blocking the testosterone production that the various treatment procedures are conducted.
Because of the shutting of the manly hormone, side effects arise.
“Generally, it reduces the libido, but it is manageable,” says Dr Athman, who admits that in some cases, men can develop breasts, though that can be reversed.
5. By age 45, you need to start getting tested
Dr Athman is concerned that prostate cancer is being detected in younger men: “Usually, prostate cancer is considered a disease of elderly men. But in Kenya, there’s a significant number of young males being diagnosed with prostate cancer."
“Overall, prostate contributes to 21 per cent of all cancers... It is the leading cancer in males in Kenya, after lung cancer,” he adds.
“The average age of most prostate cancer patients in the world would be at the age of 70 or 65 and above. But in Kenya, we are seeing the average age coming down all the way to 55-60. Then we have a significant number of male cancer patients coming at the age of 45,” Dr Athman further says.
“According to the National Cancer Control Programme, at the age of 45, we can start doing our PSA screening.
6. Prostate cancer can’t be transmitted to another person
Because it targets a component of a man’s reproductive system, a cancerous prostate might spark fears of infection to the man’s partner. “Cancer cannot be passed from one person to another through actions like eating food and sexual intercourse,” says the medic.
7. The cyberknife and emerging technologies to fast-track prostate cancer treatment
Researchers keep coming up with quicker ways of treating prostate cancer, which in medical circles is the easiest f cancer to treat —alongside breast cancer.
Once the extent of growth of the rogue cells has been established, various methods of killing the cells are applied. Dr Athman says the method depends on the patient’s age, his preferred treatment processes and how bad the situation is.
Surgery can be all that is needed, he says, if the affected area is small. Other than surgery, brachytherapy (use of radiation) can be used. Smaller cancers can also be treated by a cyberknife, which delivers a large dose of radiation with very high precision.
“It reduced [chances of] the unwanted dose going to other organs,” he says. “It reduces the period of time you’re going to use.”
From the standard 6.5 weeks, Dr Athman says, such technologies reduce the treatment duration to 1.5 weeks. There is also the prostate-specific membrane antigen, which Dr Athman says the medical community is embracing. It entails adding a substance to a patient’s blood that kills all cancerous cells in the body.
8. Sometimes, medics can opt to let the cancer be
One peculiarity about prostate cancer is that it tends to progress slowly. So, once medics establish how healthy the person’s body is – and how long he is likely to live – sometimes they can leave the cancer alone.
“One of the treatment options is not to treat the patient. I think this may surprise many people,” says Dr Athman adding it can take 10 to 20 years for the cancer to become pronounced in some cases.
9. The risk factors
Having a history of prostate cancer in one’s family, Dr Athman says, is a major risk factor. Being black is also a risk on its own, as the cancer is more likely to attack people of African origins. But, there are avoidable risk factors.
“We advise men to quit smoking, and those taking a lot of alcohol to reduce and even stop, because we know it contributes to causing cancers. Away from that, obesity is a very big problem not only for prostate cancer, but it can also lead to any type of cancer."
10. Prostate cancer is not a death sentence
One message Dr Athman wants to spread is that prostate cancer is never a death sentence: “Patients who are treated live an extremely long life."
“Even if it comes very late, it’s manageable. We have had patients coming here when they cannot even walk because the disease has spread all over the bone,” he adds, noting that modern treatments can reverse a lot of the damage caused by cancer.
