Many women are having mastectomy, a surgery to remove tissues from a breast as a way of treating or preventing breast cancer.
The media was recently awash with the news of a Hollywood actress, Angelina Jolie, who had preventive mastectomies when tests showed that she “has increased risk of breast cancer due to genetic alteration.”
Observers often ask certain questions: Should men also start having prophylactic prostatectomy, the removal of the prostate tissues? Should they worry about the death or their sex life while considering treatment for prostate cancer?
Is prostatectomy the simplest way of lowering the chances of contracting prostate cancer, whether there are signs or not?
For most men, when asked such questions, their answer is usually an emphatic “No”: they would never contemplate having prostatectomy under any circumstance.
The prostate is a gland found only in males; it is located below the urinary bladder and in front of the rectum. Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.
The National Cancer Institute said prostate cancer is found mainly in older men with symptomatic signs, including weak flow of urine or frequent urination and trouble starting the flow of urine.
Other signs include trouble emptying the bladder completely; pain or burning sensation while urinating and blood in the urine or semen.
A medical doctor, Dr Ego, said he would not recommend prostatectomy for anyone. “As an African, your manhood is your pride. So, why would you give room to the risk of impotency and infertility just to limit the risk of contracting prostate cancer? The prostatectomy does not completely eliminate the risk and so, I won’t recommend it.’’
Also, a staff of Wema Bank said he prefers prostate cancer than being impotent. “Instead of to be seen as an impotent person, I rather have prostate cancer because it can be cured if detected early or ‘make the cancer kill me sef.”
An artisan, Anthony Egbule, said his manhood is all he has going for him. “If everything fails, even if I don’t have money, my manhood must never fail me. It is my confidence. Besides, I am an African and I take pride in my manhood, which is necessary to procreate.”
However, Barrister Davis Dike has a different opinion, “If prostatectomy would mean prolonging my life, why not? Besides, I already have children and I want to live to see them succeed.”
In all these, women were asked if they would want their husbands to have a prostatectomy and most of them had the same opinion.
A distributor, Mrs. Vers Aniyo, categorically said she would never endorse it. First, why use a fire extinguisher when there is no fire. Anything can kill him; an accident is more likely than prostate cancer.”
A botany student of Abraka, Miss Franca Edomelu, said “prostatectomy can destroy a man’s ability to perform in bed, thereby eradicating fun from the marriage because sex is an essential part of it, like money and communication. So, in order not to cheat on my husband I won’t allow it. I would not like him to have prostatectomy; we will seek alternative treatment.”
However, a cancer expert, Prof. Aderemi Ajekigbe, said having one’s prostrate removed does not necessarily mean that the cancer has been eliminated completely.
Ajekigbe, who is the Head, Department of Radiotherapy and Oncology, College of Medicine, University of Lagos, said “Prophylactic prostatectomy doesn’t mean you are safe from prostate cancer. Even if we do take the prostate out, there is still a chance that you have already developed the cancer,’’ he added.
He said prostatectomy might cause complications like impotency and erectile dysfunction, adding that while castration was a sure way of not developing prostate cancer, it also means robbing a man of his ability to procreate.
“Although prostate cancer is the most common diagnosed cancer in men, its incidence is not as high as breast cancer. Studies have revealed that cancer of the prostate never occurs in eunuchs. The mere fact that you are a man predisposes you to having prostate cancer. Besides, the management of cancer is multidisciplinary, not only one. If it has spread, it may need chemotherapy, radiotherapy and hormonal therapy,” he added.
Ajekigbe stressed that prostate cancer was a hormonal dependent cancer like breast and ovarian cancer.
He said age was another risk factor, as the disease was common among men who are over 50 years of age and advised that men that are over 40 years of age should have their Prostate Specific Antigens, PSA, done yearly, so as to ensure early detection of the disease.
“The normal value of PSA should be between 0-4 and if a rising value is noticed through screening, it might indicate a problem. Then, further tests can be done and prostate cancer can be detected early. Most cancers, if detected early, are treatable but late presentation can be disastrous. Early detection is very important for successful treatment and also for survival,” he said.
According to the National Cancer Institute, Prostate Specific Antigens is a protein produced by cells of the prostate gland. The PSA test measures its level in a man’s blood.
However, Ajekigbe said there were a lot of things within people’s control that could be done to minimise the risks of developing prostate cancer.
“A healthy diet, physical activity and a healthy weight helps. You should incorporate eating vegetables and fruits into your daily diet and you should consume a little of everything,” he said.
Furthermore, a Professor of Pathology Prof. Maarten Bosland, conceded that prostatectomy could induce several complications, adding that the operation was long and hazardous, unlike that of mastectomy. He said while BRACA Gene 1 or 2 gene mutations increase cancer risks, prophylactic prostatectomy appeared to be the best option for those with genetic alterations.
He, nonetheless, added that he would not recommend prostatectomy.
Bosland of the Department of Pathology, College of Medicine, University of Illinois, in the U.S., was recently in Nigeria for an inaugural lecture organised by the Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, on prostate cancer.
He underscored the need to be mindful of the fact that pre-emptive surgeries might not eliminate the risk of prostate cancer completely, adding, however, that certain lifestyle choices might guard against the development of the disease. “I would never recommend prophylactic prostatectomy, as I have seen many people who had complications after the surgery.
“It is a hazardous operation and different from mastectomy which is less hazardous. It may cause urinary incontinence (not being able to control urination); damage to the urethra and the rectum, urinary flow difficulties and other surgical complications,” he said.
Bosland said prostatectomy could also cause erectile problems.
“Erectile problem is a serious side-effect of prostatectomy, as the nerves that control a man’s ability to have an erection lay next to the prostate gland. The nerves are often damaged or removed during surgery.”
While conceding that there were no known specific causes of prostate cancer, Bosland said certain factors like family history; genetics and high fat diet increase the chances of developing the disease.
“Age, as a determining factor, isn’t specific because the problem is that even in a man that is 25 or 30 years old, there is a 30 percent chance that he has a small cancer in his prostate. “Whether the cancer becomes aggressive early on or not is unknown,” he added.
Bosland noted that the management of prostate cancer in black and white men might not be so different if they have equal access to health care, stressing that early detection and treatment could, therefore, reduce the mortality rate of prostate cancer in black men.
“In the US, there is a notion that prostate cancer in black men is higher and more advanced than in white men; this may be because of the late presentation of the condition at hospitals. However, when black and white men have equal access to health care, they tend to have similar mortality rates. This suggests that, may be, the difference is not so big. “But if access to healthcare is different, it may be three times higher in black men.”
Similarly, the National Coordinator, Committee Encouraging Corporate Philanthropy, CECP, Dr Abia Nzelu, attributed the high mortality rate of prostate cancer to its late presentation at appropriate hospitals.
She said lack of awareness and weak health system also contributes to the high mortality rate.
“We are not doing enough to counter this situation. Most men report the cancer late, particularly when the symptoms have reached an advanced stage; this is largely due to their ignorance and they die unnecessarily. Death from prostate cancer is preventable, but we are not seeing more survivors because of the dearth of facilities like comprehensive cancer centres,” she said.
Nzelu, nonetheless, said the people’s adoption of healthy lifestyles, regular physical exercises and right eating habits could limit the risk of contracting cancer.
She also noted that routine screenings would ensure early detection of the disease and “early detection ensures greater survival chances”.
She, however, conceded that even some affluent Nigerians fail to survive prostate cancer in spite of the fact that they had access to quality treatment abroad, attributing the development to the late presentation of the condition at hospitals.
“Recently, the media was awash with news of several cancer-related deaths, especially of very important and well-known personalities. However, when the late Nelson Mandela had prostate cancer at the age of 83, all aspects of his diagnosis and treatment took place in South Africa,’’ he added.
Nzelu called for the collaborative efforts of corporate bodies and well-meaning Nigerians to bridge the perceptible funding gaps in the establishment and management of comprehensive cancer centres to reduce the mortality rate.
“Many Nigerians have no access to basic cancer screening, much less optimal cancer treatment. We have no single Comprehensive Cancer Centre, CCC, which costs about $63 million to establish and a Mobile Cancer Centre that costs about $600,000 to set up.
“Radiotherapy, which is one of the essential equipment needed to manage cancer cases, is not available in most tertiary hospitals in Nigeria. Many cancer centres in other countries are funded through donations and charity; we can do the same in Nigeria, it is not beyond us,” she said.
Moreso, Prof. Oluyemi Akinloye of the Department of Clinical Chemistry, College of Medicine, University of Lagos, said lack of a national database had affected prostate cancer care in the country.
“Specifically with prostate cancer, even though the same thing applies to most of the other cancers, there is a lot of genetic diversity. Our genetic makeup is completely different from that of the Caucasians. Most of the information we have currently are from the developed world; from the Caucasians. For us to have a complete understanding of the pathogenesis of the problem and be able to address it, we need to look at it globally,” Akinloye said.
In conclusion, the provision of adequate screening and management facilities for prostate cancer and others will not force people to resort to adopting such extreme measures as voluntary castration and prostatectomy


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