Prostate Cancer Diagnosis and Treatment: An Explainer for Africans

 

By Oluwasola Samuel, Freelance Writer. With medical review and editorial support by the DLHA Team

 

Elderly African man who is at high risk for prostate cancer

 

 

Highlights
 

• African men, particularly those with a family history of prostate cancer, should be proactive about their health and discuss screening options with their doctor.

• Sub-Saharan Africa (SSA) has a higher mortality and occurrence rate for prostate cancer due to poverty, dietary and genetic differences and late presentation of cancer. 

• Early detection is crucial for successful prostate cancer management. The majority of men diagnosed early with prostate cancer and get treatment end up surviving this condition. 

• Prostate cancer is the second most common malignancy in males and the sixth leading cause of cancer mortality in men with a relatively higher death rate in men of African descent

 

 

Introduction

 

Prostate cancer is a serious health concern for men worldwide, but for those in Africa, it presents troubling and unique challenges.

 

While early detection and treatment can significantly improve outcomes, access to proper diagnosis and effective treatment options can be limited in many African countries.

 

If you or your loved ones are looking to learn about prostate cancer, this article provides you with appropriate and reliable information on diagnosis and treatment options, plus the challenges that African men may face. 

 

 

How is Prostate Cancer Diagnosed?

 

Before carrying out a diagnosis, your urologist or oncologist will consider certain factors, like: 

• Your complaints and detailed history

• Your age and general  health condition

• Your physical examination findings

• The result of any medical tests conducted

After considering these factors, your urologist or oncologist would be in a better position to make a diagnosis of your condition.  

 

 

What Are the Screening Tests for Prostate Cancer?

 

If you are an African man or a man of African descent and you are over 50 years old, you are advised to consult your healthcare professional for prostate cancer screening. (1)

 

If you have a family history of prostate cancer or any type of cancer, you might want to consider going for prostate cancer screening before 50 years.

 

Prostate screening tests aim to catch cancer early when it's likely to be treatable. If you have no symptoms, a screening test is still advised to be conducted.

 

There are two types of screening tests, and they include: 

 

• Prostate-specific antigen (PSA) test

 

Naturally, your prostate gland produces a protein known as prostate-specific antigen (PSA). A small amount of this protein usually leaks into your bloodstream. 

 

To carry out this screening, a urologist or oncologist will take a blood sample from you through your arm. The blood is screened for unusual levels of PSA. While a higher level of PSA (well above 4.0 ng/mL) may indicate prostate cancer or benign prostatic hyperplasia or prostatitis (2), be mindful that you may have a PSA level below 4.0 ng/mL and still be diagnosed with prostate cancer.
 

• Digital rectal exam(DRE)

 

This is a physical examination that requires your urologist to have a feel of your prostate gland. To carry out this examination, your urologist wears a lubricated glove. The lubricated gloved finger is then inserted into your rectum to have a feel for any abnormalities (shape, size, or thickness) in your prostate gland. 

 

A digital rectal exam (DRE) is considered safe and easy, but it cannot spot early cancer. It's usually carried out alongside PSA. Together, they can help catch cancer early before it starts to spread beyond your prostate. 

 

Additional tests for prostate cancer

 

To diagnose prostate cancer, some additional tests may have to be carried out. These tests are used to diagnose cancer and any other prostate problems. If your screening result is abnormal or you begin to exhibit some symptoms, your urologist may recommend further tests to determine if you have cancer. 

 

Some of these tests include: 
 

• Biopsy

 

This type of test requires a urologist (a doctor who specializes in conditions that affect the urinary tract and diseases that affect the reproductive system) to insert a thin needle into your prostate gland to scoop or collect sample tissues. The sample tissues are then taken to the lab where the pathologist (a doctor who studies tissues and classifies diseases) conducts further testing to detect if cancer cells are present. One sure way of diagnosing cancer is through a biopsy test. If the pathologist finds cancerous cells present, he then goes ahead to grade them. 
 

• Magnetic resonance imaging (MRI)

 

This test uses a high-frequency radio wave in an electromagnetic field to create a detailed image of your prostate and other suspected areas where cancer might have spread. This test gives more detailed visual information about your prostate, which helps your urologist determine whether to perform a biopsy or not. 

 

• Transrectal Ultrasound

 

During a Transrectal ultrasound test, a small probe is inserted into your back body (rectum) to provide a detailed image of your prostate and other suspected areas. This test helps to give your urologist or oncologist a clear and real-time visual image of your prostate. This enables your urologist or oncologist to take tissue samples from your prostate gland or affected areas. 

 

 

How is the severity of prostate cancer determined?

 

To determine the severity or aggressiveness of your prostate cancer, the pathologist will Use different tools to grade your prostate cancer, namely: 
 

• The Gleason scoring system

 

This is the most commonly used grading system. It's a tool that grades prostate cancer cells based on how close they look like healthy cells under a microscope.

 

To determine this score, your pathologist first takes two samples from your prostate tissue. The samples are examined under a microscope and then given a Gleason score. The Gleason score is obtained by giving a low score to cells with small and closely packed cells. A higher score is given to cell samples that have spread out. 

 

The Gleason system then provides a score by combining the aggregate scores from the two tissue sampling locations. A score of 6–10 is then used to grade the cancer. A score of 6 is treated as low-risk cancer. A Gleason score of 7 is treated as mid-level cancer. Gleason scores of 8 and above are treated as high-risk cancers. 

 

• Tumour, Node, Metastasis Grading system

 

This assessment method identifies Tumour size, the extent to which cancer has involved neighbouring Lymph Nodes, and spread to neighbouring or distant organs of the body (Metastasis). 

 

The Tumor, Node, Metastasis system (TNM) categories prostate cancer based on the following: 
 

• T (Tumor): This identifies and scores the size and extent of the primary tumor in your prostate gland. Its score is based on the size of the tumor. 

• N (Nodes): This identifies and scores the rate at which cancer has spread to involve nearby lymph nodes. 

• M (Metastasis): This identifies and scores the extent to which the cancer has spread to neighbouring or distant organs in your body. 

 

• The Staging System

 

By combining the comprehensive data obtained from T, N, M, with the Gleason scores and the PSA level, your urologist or oncologist has a handful of information to categorise or stage your cancer as either;

Stage I (slow-growing tumour with normal PSA level and more healthy looking cancer cells),

 

Stage II (a small tumour that is limited to the prostate with a medium level or low PSA, and cancer cells showing increased risk of growing and spread) and

 

Stage III (a tumour that is growing rapidly in the prostate, with high PSA level and cancer cells with a high chance of spreading beyond it). 

 

The staging system helps to guide your doctor in offering you information to make the best treatment decision for your specific situation.

 

 

How to determine whether prostate cancer has spread?

 

If your urologist suspects the cancer in your prostate has spread to other nearby organs in your body, some imaging tests may be recommended to see where it has spread. 

 

Some of the imaging tests include: 
 

• Magnetic resonance imaging(MRI)

• Ultrasound 

• Bone scan

• Blood test

• Positron emission tomography(PET) scan

• Lymph node biopsy (3,4)

 

Your urologist will determine which test best suits you and use the information obtained to determine where it has spread. 

 

 

How is prostate cancer treated? 

 

Before your urologist or oncologist decides with you the best treatment option you will undergo, some factors have to be considered. 

 

These factors include: 
 

• Where cancer has spread to

• Your age

• Results from the diagnostic test  

• How fast is cancer spreading

• Your overall health condition

• Your preference about potential side effects or long-term effects of treatment. 

 

Your urologist or oncologist considers all these to achieve the best treatment outcome and minimize complications during or after treatment.

 

Available treatment options for prostate cancer

 

There are different treatment options available. Your urologist or oncologist will provide you with information on the different options so that you can make an informed decision as to which option is best for you.

 

Some of the available treatment options include: 
 

1. Active surveillance

 

Not all cancers need treatment immediately. Some may require active surveillance (i.e. watch) due to the stage of the cancer. Active surveillance may be an option for you if cancer isn't exhibiting symptoms and it's still within your prostate. 
 

2. Watchful waiting

 

Watchful waiting is similar to active surveillance, but it's commonly used for people who have early-stage prostate cancer, are old, and are likely to die of other causes. It's for men with other health conditions that make the surgical option too risky, ill-advised, or unnecessary. 
 

3. Surgery

 

Surgical treatment involves the complete removal of your prostate gland, seminal vesicles, and nearby tissues. When cancer has spread beyond your prostate, this procedure may be considered. Before removing your prostate gland, the surgeon could choose from any of the following removal methods: 
 

• Open radical prostatectomy

 

The surgeon makes an incision from your belly button down to your pelvic bone. After this, the surgeon removes your prostate gland with the seminal vesicles and reconstructs your urinary bladder and urethra. 
 

• Robotic radical prostatectomy

 

The surgeon operates and performs surgery on you using a robot. The robot is carefully guided to make very small cuts in your lower abdomen. This enables the surgeon to remove your prostate gland with ease. This procedure is one of the most common prostate cancer surgeries carried out, but the skills and tools for carrying out the surgery are not readily available in most African countries. 
 

• Perineal open radical prostatectomy

 

This removal method is less common than open radical prostatectomy and robotic radical prostatectomy. The surgeon makes an incision between your scrotum and anus to get to your prostate gland and other surrounding tissues, which are removed. 

 

Surgery comes with its risks, such as infections, pain, urinary incontinence, seminal vesicle injury, and bleeding. Furthermore, surgery to treat prostate cancer may cause impotence (erectile dysfunction). Some men later recover their erection and control their urine flow. 

Please note that not all men will experience these side effects after surgical treatment.

 

4. Radiation therapy

 

Radiation therapy is the use of high-powered energy rays to kill off cancerous cells in the prostate. These rays are so powerful that they instantly heat cancerous cells and damage their DNA (genetic footprint). This procedure kills the cancerous cells and stops them from growing again or replicating themselves. 

 

Furthermore, radiation therapy is recommended for men whose cancer is at an advanced stage or when cancer has spread beyond their prostate to areas like the bones. It can also be deployed if surgery does not remove cancerous cells completely. 

 

There are two ways radiation can be used to treat prostate cancer, and they include: 
 

• External beam radiation therapy(EBRT)

 

This therapy is like using several giant torches to spotlight the corner of your room from all angles just so you can kill a dangerous insect. EBRT works the same way. Before this procedure is carried out, your oncologist asks you to lie down on a table. 

 

As you lie down, a big machine begins to move around your body. The machine then directs high-powered rays to where cancerous cells are developing in your prostate. While this is going on, the rays begin to kill off cancerous cells, while normal and healthy tissues are left out. This treatment is usually given daily or for several weeks. 
 

• Brachytherapy

 

This therapy is like when a king of a kingdom plants his elite fighters as spies right inside his enemy's camp. Once on the ground, they begin to work hand in hand to kill their enemies from the inside out. 

 

Brachytherapy involves planting radioactive seeds directly into your prostate gland. These seeds release radiation that kills cancerous cells from the inside out while leaving healthy tissues. These seeds can be left temporarily or permanently, depending on medical advice.

Your healthcare provider will advise you on the best treatment option to go for, depending on your health condition. 

 

Some of the adverse effects of radiation therapy are: 
 

• Urinary problem (frequent burning sensation when peeing, urinary urgency)

• Bowel problems

• Impotence (erectile dysfunction)

 

Please note that not all men will experience these symptoms after having radiation therapy. 

 

5. Focal Therapy

 

This is a new treatment option available to you. This treatment aims to get rid of dangerous cells completely while leaving out healthy tissues. There are different methods under focal therapy, and they include: 
 

• Cryotherapy or Cryoablation

 

This involves the use of cold gas to freeze your prostate gland to kill off cancerous cells. 
 

• High-intensity focused ultrasound (HIFU)

 

This treatment involves the use of a high-powered soundwaves to generate heat to target and destroy cancerous cells in your prostate gland. 

 

Focal therapy may be considered for men with early-stage prostate cancer and also when surgery isn't an option. The focal therapy is still under study and requires further research. 

 

Some of the side effects of focal therapy include urinary problems and impotence (erectile dysfunction). 

 

Please note that not all men will experience these symptoms. 

 

6. Hormone Therapy or Androgen deprivation therapy(ADT)

 

A man’s prostate needs testosterone to grow. (5) This means that cancer cells can feed on this and begin to develop and multiply as well. Hormone therapy, also known as androgen deprivation therapy, is the use of drugs or surgical procedures to suppress or block testosterone and other male hormones from reaching the prostate, thereby starving your cancer cells. 

There are different treatment types for this treatment, namely: 

 

• Surgery to remove testicles (orchiectomy)

 

To starve your prostate of testosterone, your testicles and other glands that produce testosterone are surgically removed. This procedure is permanent and cannot be reversed. 
 

• Medication

 

This procedure involves the use of drugs to suppress the ability of your testicles to produce testosterone. Your healthcare provider gives you specially modified drugs to block testosterone production. As a result, cancer cells starve for testosterone. 

 

It's important to note that hormone therapy, or androgen deprivation therapy doesn't cure prostate cancer; it aims to checkmate or control the growth and spread of cancer cells. Furthermore, this treatment comes with some side effects, like:
 

• Impotence (erectile dysfunction)

• Fatigue

• Mood swings

• Depression

• Bone loss (osteoporosis), etc. 

 

Not all men will experience these side effects from hormone therapy or androgen deprivation therapy. 

 

7. Chemotherapy

 

Chemotherapy is a powerful treatment option you can consider. It uses strong medication to kill off cancerous cells in your body. This treatment is often administered through the veins or as pills. Chemotherapy aims at fast-growing cancerous and noncancerous cells.

 

Furthermore, chemotherapy is often combined with hormone therapy to achieve an improved treatment outcome. Chemotherapy is considered when cancer has grown and moved past your prostate gland to nearby organs or tissues.

 

Chemotherapy can cause several side effects, like:
 

• Nausea

• Hair loss

• Vomiting 

• Fatigue 

 

Please note that not all men will experience these symptoms if they decide to undergo chemotherapy. 

 

 

Challenges of treatment of prostate cancer in Africa

 

Africa faces a big health problem in the diagnosis and treatment of cancer generally.

 

Diagnosing and treating prostate cancer is like having a plumbing problem at home. It's easy to fix it when you have the right tools to remedy the situation. Without the necessary plumbing tools and skills, the problem could become bigger and more uncontrollable. 

 

Here are some of the challenges of treating prostate cancer in Africa.

 

1. Poor Awareness and Late Presentation

 

Diagnosing prostate cancer in sub-Saharan Africa is challenging due to a lack of awareness among people and a lack of access to diagnostic tools. This leads to many African men being diagnosed at an advanced stage. When cancer is at an advanced stage, it’s trickier to treat. Early detection is the key to the successful treatment of cancer generally. 

 

2. Inadequate Healthcare Infrastructure and Resources

 

Even if a man is diagnosed early, access to healthcare resources and advanced treatment options is another issue on its own. Many African men living in rural areas do not have access to these treatment options because of their location, compared to African men in urban areas or high-income countries.

 

3. Limited Skilled Providers

 

Thirdly, there are a limited number of qualified healthcare specialists dedicated to diagnosing and treating prostate cancer and other forms of cancer. (6) While some health facilities might have the required diagnosing and treatment resources, most of these resources are locked away because there are a limited number of qualified specialists who can use them efficiently.

 

4. Cost

 

Another challenge is the high cost of diagnosis and treatment of prostate cancer in most African countries. (7) Diagnosis and treatment can be very expensive for an average African man. According to the World Bank, 85% of Africans live on less than $5.50 per day. (8) Many Africans live in extreme poverty, and the cost of treatment can be a huge burden on them. 

 

5. Cultural and Religious Beliefs

 

Cultural and religious beliefs are also challenges hindering the treatment of prostate cancer in Africa. Many people believe cancer is inflicted by their enemies or a Supreme Being or deity for their sins.

 

Despite all these challenges, there are many African researchers, in collaboration with government bodies, who have invested their time and resources in achieving a better cancer outcome in Africa. There is a need for the even distribution of healthcare resources, more efforts to raise awareness, and improved access to screening and treatment.

 

 

Frequently Asked Questions  About Prostate Cancer (FAQ)

 

• What's the survival rate of prostate cancer? 

 

African men are at higher risk of developing prostate cancer compared to white men. 

 

Here are some facts regarding survival rates in prostate cancer: (9)

• Black men are unfortunately about twice as likely to die from prostate cancer compared to white men. This is based on recent data (reported in 2022).

• For both black and white men, if prostate cancer is found early (localized stage), the survival rate is very high—around 96% for black men and 98% for white men over 5 years. This shows early detection is crucial for a positive outcome.

• When prostate cancer has spread beyond the prostate (metastatic stage), the survival rate drops significantly for both races.

• Looking at the bigger picture, a black man has a higher chance (1 in 26) of dying from prostate cancer in his lifetime compared to a white man (1 in 44).

• Black men tend to develop prostate cancer at a younger age than white men. Additionally, by the time it's diagnosed, the cancer is more likely to be at an advanced stage in black men. This could be due to various factors and highlights the importance of earlier screening for black men.

 

Early detection is essential for good outcomes in prostate cancer. 

 

• Is prostate cancer curable? 

 

If you catch prostate cancer early, treatments like surgery or radiation can kill it off while potentially curing it completely.

 

Sometimes prostate cancer grows slowly. In cases like this, your doctors will recommend "active surveillance," just to monitor it without rushing into treatment.

 

Once the cancer begins to spread beyond your prostate, a cure becomes less likely. But that doesn't mean there aren't good treatment options. Treatments can still be effective at slowing the cancer down, managing any symptoms you might have, and helping you live a longer life.

 

The good news is that many men diagnosed with prostate cancer, especially those with early detection, go on to live long and healthy lives after treatment.

 

• Can prostate cancer reoccur after treatment?

 

Yes, cancer can come back after treatment. This is called recurrence or relapsed prostate cancer. (10) It happens when tiny cancer cells stay hidden and undetected. Regular check-ups with your doctor are crucial for the early detection of any recurrence.

 

• When should I talk to my doctor about prostate cancer?

 

You should visit your doctor immediately if you experience any potential signs or symptoms of prostate cancer. You should visit your healthcare provider if you experience any of the following: 
 

• Blood in urine or semen

• Difficulty urinating

• Trouble starting and continuing the urine stream

• Pain in the lower back, hip, and thigh. 

Even if you don't experience any of these symptoms, regular checkups are important, especially for men over 50 or those with a family history of prostate cancer or other types of cancer.

 

• What questions should I ask my doctor if I have prostate cancer concerns?

 

Depending on your situation and regardless of if you have undergone prostate cancer screening before or not, you can ask questions like: 

• What is my risk of developing prostate cancer? (Mention your family history and health history.)

• At what age should I start getting screened for prostate cancer?

• What are the different screening tests that are available to me?

• What stage is my prostate cancer at?

• How aggressive is my cancer?

• What are the treatment options available to me, and what are their potential side effects?

• What are the benefits and risks of each treatment option peculiar to my cancer stage?

• What is the recovery process like for each treatment option?

 

You have the right to be fully informed about your options. Ask thoughtful questions, and ensure you work with your doctor to create a treatment plan that best suits your condition.

 

Please note: If your doctor says something and you are unclear, request for a simpler explanation.

 

 

Conclusion

 

Prostate cancer is a significant health problem in Africa. Limited access to diagnostic tools, specialists, and effective treatments poses a great challenge for African men. However, there is hope. Increased awareness, investment in healthcare infrastructure, and the development of more affordable diagnostic and treatment options are paving the way for a brighter future.

 

Early detection is the key to overcoming prostate cancer. African men, especially those with a family history of prostate cancer or any other cancer, should be more cautious. Talk to your healthcare provider about your risk factors and the possibility of prostate cancer screening. Early detection significantly improves treatment outcomes and offers you a better chance of successful treatment and management. 

 

References
 

1. Graham LS, Lin JK, Lage DE, Kessler ER, Parikh RB, Morgans AK. Management of prostate cancer in older adults. American Society of Clinical Oncology Educational Book [Internet, 2023 May] [Cited 2024 Apr 6]; (43):e390396. Available from: https://ascopubs.org/doi/10.1200/EDBK_390396.

2. Mayo Clinic. Prostatitis - Symptoms and causes [Internet. 2020 Feb. 19]. [Cited 2024 Apr 6]. Available from: https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766.

3. Unterrainer M, Eze C, Ilhan H, Marschner S, Roengvoraphoj O, Schmidt-Hegemann NS, et al. Recent advances of PET imaging in clinical radiation oncology. Radiat Oncol. 2020 Dec;15; 88 (2020). Available from: https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01519-1

4. Lymph node biopsy [Internet. Last reviewed 2020 Sept. 25]. [Cited 2024 Apr 6]. Available from: https://www.cancerresearchuk.org/about-cancer/hodgkin-lymphoma/getting-diagnosed/tests-diagnose/lymph-node-biopsy.

5. Nassar GN, Leslie SW. Physiology, testosterone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Apr 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK526128/

6. Green, MA. Africa’s healthworker brain drain | Wilson center [Internet. 2023 May 23]. [Cited 2024 Apr 6]. Available from: https://www.wilsoncenter.org/blog-post/africas-healthworker-brain-drain.

7. Nigerian cancer patients fret over medical costs [Internet. 2020 April 02]. [Cited 2024 Apr 6]. Available from: https://www.aa.com.tr/en/africa/nigerian-cancer-patients-fret-over-medical-costs/1723509.

8. World Bank Blogs.85% of Africans live on less than $5.50 per day [Internet. 2019 Oct. 3]. [Cited 2024 Apr 6]. Available from: https://blogs.worldbank.org/en/opendata/85-africans-live-less-550-day.

9. Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal A, Siegel RL. Cancer statistics for african american/black people 2022. CA A Cancer J Clinicians [Internet]. 2022 May [cited 2024 Apr 6];72(3):202–29. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21718.

10. Cancer Research, UK. Treatment if your prostate cancer comes back [Internet. Last reviewed 2023 Feb, 15]. [cited 2024 Apr 6]. Available from: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/if-your-prostate-cancer-comes-back

 

 

Related:

Prostate Cancer in African Men: Symptoms, Causes and Risk Factors

 

 

Published: April 13, 2024

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