Prostate screening from age 40 best for Nigerian men — Dr Takure, urologist

With age, men stand a higher chance of developing difficulty urinating. In this interview by SADE OGUNTOLA, a consultant urologist at the University College Hospital, Ibadan, Dr Augustus Takure, says for men, especially those above 40, challenges with passing urine call for immediate medical attention to rule out prostate cancer.

IT is said that black men should start prostate cancer screening at age 45 rather than age 55 that was previously recommended. Why is this important?

The risk of aggressive prostate cancer is higher among blacks, particularly American blacks. Many Afro-Americans do not have insurance coverage; as such, they may not go to the hospital on time. They present at the hospital with very advanced diseases. Now, men with high prostate cancer risk are men above 40 years, whose relatives, particularly the immediate family, had prostate cancer. Such men need to start screening for prostate cancer from age 40.  A lot of things can predispose a man to prostate cancer, but certainly, the environment also has a role to play. Similarly, intake of a westernised diet increases the risk of developing prostate cancer.

 

When should Nigerian men start prostate cancer screening?

For Nigerian men, these are things to consider: if there is no family history of prostate cancer, a man can start to get screened from the age of 55 till the age of 69. But men with a family history of this cancer must start at age 40.

 

Are there signs that can help men determine if prostate cancer runs in their family?

Such complaints may include problem of passing urine or any abnormality of passing urine; maybe they pass urine too frequently; wake up several times in the night to urinate; they cannot even pass urine, or they notice blood in their urine.

 

What is the incidence of prostate cancer in Nigeria, even if it is hospital-based?

For every 10 men that come to the urology clinic and is in the age group of having lower urinary tract symptoms, maybe about three may have prostate cancer. Simple prostate enlargement constitutes the majority; this amounts to between 60 and 70 per cent of them.

 

What are the signs and symptoms of prostate cancer?

The best thing is not to have any symptoms or complaints at all. By the time there are symptoms, the disease has progressed and is now drawing your attention to it. The symptoms are not really specific for prostate cancer; they are symptoms related to prostate irritation and telling you that there is a problem. They include weak urine stream, waking up several times at night to pass urine, urine incontinence, sudden inability to pass urine, prolonged delay in emptying the bladder, and complete inability to hold the urine.

By the time the prostate cancer is advanced, in addition to these symptoms mentioned, the man may have mid-back pain. It is telling you that it has already spread to the bones. Cases like these cannot be cured.

 

What should they expect when they come in for prostate cancer screening?

What are the benefits of prostate screening? The main benefits are if you go for screening, cancer that has not spread can be picked up early and cured.

What are the risks? There are risks at different levels, including at the diagnosis and treatment stages. An infection might occur after a biopsy to confirm a diagnosis of prostate cancer. The infection, if not detected and treated, can kill.

What are the treatments available to cure cancer? One is surgery to remove the whole of the prostate. Two, treatment can be by radiation to use heat to kill the prostate tissue. Both modes of treatments have their side effects, including incontinence of urine, incontinence of faeces and weak erection. For instance, a fifth of those who go for prostate cancer treatment by surgery may have urine incontinence and 50 per cent of those who go for radiation may have a weak erection. About one of every five of those who go for surgery could also end up with a weak erection.  For a man, a weak erection may mean the end of life. Such a man would not be happy, withdrawn and wouldn’t be socially active again.

 

Of what significance is the prostate-specific antigen (PSA) test in determining men that might have prostate cancer?

PSA test is used for prostate cancer screening. The prostate-specific antigen in the blood is measured. Its level in the blood is age-dependent. For a man that is between ages 40 and49, the normal prostate-specific antigen level should be between 0 and 2.5; for men between ages 50 and 59, the normal prostate-specific antigen level is between 0 and 3.5. For those 65 and above, the normal PSA level is between 0 and 6.5. So, if the PSA level is greater than that for a man’s age, then it raises the suspicion that there is a possibility of cancer in the absence of a symptom.

Of course, the second way you can test is to do a rectal examination by inserting the finger in the rectum. Although the Americans do not believe that rectal examination has any added advantage, other parts of the world still consider that rectal examination a part of prostate cancer screening.This is because the ability to pick a prostate cancer actually depends on the skill of the doctor to pick things that may point towards prostate cancer. However, when the cancer is early, rectal examination by inserting the finger in the rectum cannot pick anything.

Nevertheless, the decision to have prostate cancer screening is individualistic after knowing its benefits, risks and the risks associated with the treatment. Screening is compulsory for those who have a family history of prostate cancer. It is advisable that they start screening from age 40, particularly those with first-degree relatives. It is advisable that they go for a prostate-specific antigen test which is a screening test for prostate cancer.

If at the age of 40, the PSA is less than 2.5, then PSA screening needs to be done once in two years. But if  PSA is greater than 2.5, screening should be done every year. Looking at the rate of rising of PSA per year will help determine when to intervene. People over 70 years really don’t need to do screening for prostate cancer.

 

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