Silent killer having a field day in Botswana

01 Jul 2019

BY MPHO KUHLMANN

First the good news: It is that happy time of the year when men let down their hair, huddle around television sets over cans of lager to watch the AFCON football tournament. Then the bad news, for every half a dozen men who will be cheering their teams on, one is likely to be suffering from prostate cancer and most likely unaware.

The second-most-common cancer among men, behind skin cancer, and the second leading cause of cancer deaths among men, Prostate cancer is dubbed the silent killer, it strikes without warning. A man in his 50s or 60s can have it for many years without suffering from any physical symptoms whatsoever, widely recognised as a slow-growing tumor, prostate cancer usually only becomes a terminal illness when it has spread beyond the prostate gland into the bone causing fractures, paralysis and excruciating bone pain. Late detection has been linked to higher mortality.

Botswana however has not been able to create as much knowledge about prostate cancer as it has about cervical cancer because most men choose to suffer in silence.

Dr Orapeleng Phuswane, a Public Health Psychican under the Ministry Of Health says “From a research perspective, we are not at a level where we can rank it. For now we only know of cervical cancer as the leading cancer in the country. Prostate cancer isn’t exactly hard to diagnose it is just that men don’t frequently go to the doctor as much as women do. Also it is somehow still treated like a taboo because men don’t exactly feel comfortable talking about it, with other men and with their spouses. The kind of test that used to be done to check for it also put a lot of men off (Digital Rectal Exam); men just felt that they didn’t want someone poking their behind all in the name of checking for cancer. However these days a blood test is used to check for it but men are still reluctant to have routine medical checkups.  It used to be known as an older man’s disease but we are seeing a lot younger men being diagnosed with it which is why men are advised to keep going for routine medical checkups and detect and treat it early.”

Kadimo Galeboe, the executive assistant at Cancer Association of Botswana “The Cancer Association of Botswana’s main mandate is to increase awareness about cancer in Botswana through education; presentations in schools, offices, malls or Kgotla gatherings and also through handing out information booklets. During the month of November, the Cancer Association of Botswana will take part in a worldwide movement (MOVEMEBER) and uses the month to raise awareness on men’s health issues primarily Prostate Cancer awareness. A light blue ribbon will be used during the month to bring awareness to Prostate Cancer. Prostate Cancer is a cancer that occurs in the prostate. This is a small walnut-shaped gland in men that produces seminal fluid that nourishes, protects and transports sperm from the testicles during ejaculation. The prostate gland is a male reproductive organ therefore this is cancer is gender specific and only men can get it.”

Ms Kadimo says Prostate Cancer is the third common cancer affecting men in Botswana. “Problems in the prostate gland are linked to urinary incontinence (being unable to control urine) and erectile dysfunction (impotence, problems getting or keeping erections. Some of the signs and symptoms that may indicate problems with the prostate gland are frequent urination, weak or uninterrupted urine flow or the need to strain to empty the bladder, the urge to urinate frequently at night, blood in the urine, blood in the seminal fluid, new onset of erectile dysfunction and pain or burning during urination. Men are advised to note that these symptoms may come and go without warning. It is your responsibility to take action when you notice irregularities and visit the nearest health facility for assistance. Screening for prostate cancer includes; Digital rectal exam (DRE). During DRE, the doctor inserts a gloved lubricated finger into the rectum to examine the prostate, which is adjacent to the rectum. If the doctor finds any abnormalities in the texture, shape or size of the gland then further tests are to be done. Blood tests; these tests for prostate specific antigen (PSA) levels in a man’s blood. “She further urges men to at least do one of the tests to screen for abnormalities in the prostate gland as part of their annual medical examinations because early detection saves lives.

The threat of prostate cancer for men is far greater than is commonly thought. Even more alarming is that Prostate Cancer is being diagnosed more and more in younger men. The number of younger men diagnosed with prostate cancer has increased nearly 6-fold in the last 20 years, and the disease is more likely to be aggressive in these younger men. Typically, prostate cancer occurs more frequently as men age into their 70s or 80s. However, when prostate cancer strikes at a younger age, it's likely because the tumor is growing quickly.

When prostate cancer manifests, early symptoms include changes in urination, such as increased urgency and frequency of urination, blood in the urine or semen, interrupted or changed flow of urine stream, painful urination, erectile dysfunction, and pain in the pelvis, hips, thighs or lower back. Prostate cancer is often referred to as “couple’s cancer” because it affects not only the man but also their partner. Family dynamics and role changes may occur. A conversation about prostate cancer is not one in which many men want to have with their doctors or the women in their lives. Urine leaks, a penis that won’t get hard, or body changes like hot flashes, body hair loss, and weight gain can cause a crisis in how a man feels about himself. And, these may occur with prostate cancer treatment. Some men say they feel less manly and or less independent. Some say they don’t even want to talk with women because they don’t feel like “whole” men. They feel different. To complicate matters, honest and open conversations with the doctor aren’t always available largely because of fear, pride and the low possibility to seek care. These combined with cultural taboos and qualities of care are to blame for the lack of participation in detecting prostate cancer early on. A summary on the Cancer statistics in Botswana in the year 2018 show that cancer has become increasingly common. Most common are cervical cancer, breast cancer, and Kaposi's sarcoma in women, and Kaposi's sarcoma, head and neck cancer, and prostate cancer in men. Many patients present with advanced disease, and cancer mortality is almost 75%.