November marks national prostate cancer month. It is a key opportunity to raise awareness about this prevalent and life-threatening terminal disease in men.
The key issue, however, is not so much that men in Kenya are not aware of prostate cancer. It is that they are not getting regularly tested to determine the status of their prostate, and, they should be, especially men in the 45+ age group, as the likelihood of being diagnosed with prostate cancer increases with age.
The findings from the Kenya Demographic and Health Survey 2014 showed that the awareness of the disease for the 45–49 age group was 78.1 per cent, but only 2.6 per cent had had an examination for prostate cancer.
Cancer is the highest cause of morbidity in Kenya (seven per cent of deaths per year), after infectious diseases and cardiovascular diseases, according to the World Health Organisation 2014 NCD country profile.
It is estimated that 37,000 new cases of cancer occur each year in Kenya with more than 28,000 deaths per year. The leading cancers in men are prostate and oesophageal cancers.
The vast majority of cancer cases, about 70 to 80 per cent, are diagnosed in the late stages.
This is due to a lack of awareness, inadequate diagnostic facilities, a lack of treatment facilities, high cost of medication and the high poverty levels. Except for the lack of awareness, all of the other factors are huge barriers in the fight against prostate cancer in Kenya.
Regarding inadequate diagnostic facilities, men who are living in urban areas have greater access to health facilities and diagnostic services than their rural counterparts, where the nearest health facility is a dispensary or health centre.
There are two main tests to ascertain the status of one’s prostate. They are the prostate specific antigen (PSA) test and the digital rectal examination (DRE).
The PSA test can be administered at hospital level, but not at health centres. The test ranges between Sh2,100 and Sh3,600 but few men know that they have this option of being tested, so they do not even make it to the hospital.
The rectal examination is done using a finger to check for growths or enlargement of the prostate gland.
A tumour in the prostate can often be felt as a hard lump. However, not all problems of the prostate can be felt through the rectum.
The DRE can be administered by a trained health worker. However, a major issue is a cultural and gender one, according to Donald Mogoi, Laikipia County health director.
In that, most health workers at dispensaries or village clinics are female nurses. Another major issue is the nature of the DRE itself. It is one of the major reasons why men fear going for prostate cancer screening.
Most men would probably get tested were it not for the awkwardness and the thought that a strange man or woman was intruding in their privacy.
The extremely low levels of men being tested or examined for the risk of prostate cancer is very alarming, considering that prostate cancer is the leading cancer for men in Kenya.
We must take urgent steps to address this major barrier in the fight against prostate cancer. Yes, the battle just starts by knowing that there is a potential risk of having prostate cancer, but at least you are now aware of that and you need to act in dealing with it.
Health policy actions are also critically required, such as ensuring that a male clinical officer is stationed at each health centre, and that he is trained to administer a DRE.
In counties with few male clinical officers, designate one or more in health centres such as referral hospitals who has been trained to do rectal exams.
Add the PSA examination to the standard list of health centre laboratory tests, and ensure that all hospitals are able to offer the test.
Publicise the fact that a PSA test is available at hospital level, and, in the future also at health centres.
Sensitise men, particularly targeting the 45+ age group, that even though the DRE is an awkward examination, it is well worth this uncomfortable moment, as the alternative is the potential progression towards prostate cancer.
If a potential tumour is detected, one should be referred to a hospital or testing clinic for a PSA test. The PSA range for a healthy prostate gland is 0-5.
A higher reading indicates that some abnormality is occurring and that you should be referred to an urologist for further examination.
Unfortunately, there are very few urologists in Kenya with most patients being referred to Kenyatta National Hospital.
After getting the DRE and/or PSA results, and, undertaking the recommended referral path for further examination and treatment, one should also act immediately to try to counter what is happening in the prostate.
These actions involve lifestyle changes in relation to diet and exercise. They should be perceived as complementary to the recommended treatment one would receive if diagnosed with prostate cancer.
My message to fellow men in Kenya, who have had a DRE exam and/or PSA test which is cause for concern, is to act now and start modifying their diet, at least to seriously cut back on meat and diary products.
Douglas Lackey is former Amref deputy director-general, HelpAge International regional advocacy and policy adviser and prostate cancer survivor.