Two years ago, Raphael Mwangi’s older brother and business associate was diagnosed with prostate cancer. He had been complaining of having trouble urinating, and burning sensations from time to time over a couple of years. Raphael’s brother thought it was a case of bacterial infections and would often pop over-the-counter pills, but the problem persisted.
“One pharmacist asked him to consider taking a prostate cancer test but he rubbished the idea saying that there was no way he was suffering from problems associated with sexual drought,” says Raphael. By the time he decided to take the test two years ago, his prostate cancer had gone too far. He was oozing pus and blood during urination and erections had become a thing of the past. “It was the erectile problems that made him take the test. He was told that the tumour had invaded the seminal vesicles, and he would be put on a combination of radiation and hormonal therapy treatment,” says Raphael, who is now 54.
This prompted Raphael to go to a prostate testing clinic in Nakuru in November last year. “I was reluctant at first, but I decided to know my state rather than live to handle the consequences like my brother,” he says.
When he got there, the young-looking doctor nearly scared him off. “I’d heard that doctors insert fingers in the rectum to check the prostate, and I wasn’t sure I could drop my trousers in front of a man young enough to be my son,” says Raphael. True to what he’d heard, the doctor opted to check his prostate through a digital rectal examination (DRE) test.
“He asked me to pull down my trousers and underwear, and lie down on my left side in the knee-to-chest position. Then, after putting on some gloves, he inserted a finger into my rectum and firmly pinched what he said was the prostate gland. I urinated. It was very embarrassing. I felt robbed of my dignity.”
I ask him if he’d be willing to take another test. Raphael shakes his head vigorously. “No. I don’t think I am ready to have another man inserting fingers in my rectum in the name of testing,” he says.
Boniface Mbuki, a director at the Cancer Awareness Centre of Kenya, says that this 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 was intruding in their privacy,” he says.
Unfortunately, there are currently only two ways of testing for prostate cancer. “Men can undergo a digital rectal examination (DRE) or a prostate-specific antigen (PSA) test,” Mbuki says. The PSA test is a blood test, but while that is easier than a rectal exam, not many men know that they have this option so they do not even make it to a testing clinic to hear that they have that choice.
Daniel Wambua, 47, has attended several prostate clinics over the past five years. He took his first test in 2011. Although he has never been asked to take a DRE, he wouldn’t mind because it is all for his wellbeing. “The first time, the doctor drew my blood after watching me urinate. I was informed that if my case was severe, I would have to get an x-ray ,” he says. In 2014, he went for his second exam. In both cases, nothing abnormal was found. Wambua adds that unlike Mwangi who underwent a rectal examination test, the doctors in all his cases have only used blood samples and urination examinations in conducting the PSA test.
According to the Prostate Cancer Foundation (PCF) journal, having a higher or lower PSA does not always mean you have prostate cancer. It could be a sign of other ailments. “Although prostate cancer is a common cause of elevated PSA levels, some men with the disease can still present lower PSA levels,” says the medical journal. “PSA is produced by the prostate in response to other problems that could be affecting the prostate gland such as infection or engorgement.”
The most common signs of prostate cancer include increased urination, a burning sensation during urination, poor or unsteady urine flow, and urine accompanied by blood or pus. Other key signs include pain on ejaculation, difficulty in getting an erection, and a distended bladder.
A random survey of men for this story revealed that most men were not planning to go for prostate cancer screening. Besides the mistaken belief that a rectal exam is the only option, there are a number of myths that surround it. Gideon Kiptanui, a 40-year-old who owns an electronics business in Nakuru, has no plans of getting screened despite entering into what doctors consider as the high-risk age bracket. “Why should I go? I am sexually potent and I have a wife who can provide me with sex,” he says.
According to the National Guidelines for Prevention and Management of Cervical, Breast and Prostate Cancers (compiled by the Ministry of Health), prostate cancer affects mainly men aged 40 and over. The cancer risk grows rapidly after the age of 50, and by age 65, the risk has risen to two out of every three men. “By the age of 70, at least 80 per cent of men are at risk of developing prostate cancer,” says the report.
Gideon is not the only man at risk of cancer who is apathetic towards testing. His sentiments are echoed in the Kenya Demographic and Health Survey of 2014. According to the report, 96 per cent of men in Nairobi have not been tested for prostate cancer. Ironically, 66 per cent of men in all age groups have heard about prostate cancer. Mbuki adds that while prostate cancer testing remains low, awareness of the disease is currently highest in the central Kenya region.
Evidently, this lack of interest towards testing has contributed to the late diagnosis and the subsequent difficulties in treatment. During its worst stage, prostate cancer will require a combination of surgery, chemotherapy, hormonal therapy, and radiation. In Kenya, according to the Kenya Cancer Registry, at least four out of five cancer cases are diagnosed in the late stages of the disease. Additionally, according to World Health Organisation, the late diagnosis of prostate cancer is the second most likely after the late diagnosis of lung cancer. Nonetheless, regular testing has shown that prostate cancer can be nipped in the bud if found early.
Prostate cancer and sex
Testosterone: According to the cancer guidelines report, the onset of prostate cancer could be related to high testosterone levels. However, according to Prostate Cancer Foundation (PCF), ejaculation in itself has not been scientifically linked to prostate cancer.
Vasectomy: According to the Prostate Cancer Foundation journal, men who have had a vasectomy do not have a higher risk of developing prostate cancer. On the contrary, their choice of contraception means that they are more likely to be examined for prostate cancer and any abnormal development of the prostate gland detected early.
Erectile dysfunction: Not all men will suffer erectile complications or urinary incontinence. However, the two are likely to be possibilities if a patient has undergone radiation or surgery.
Surgery: If your entire prostate gland and seminal vesicles are removed during surgery, you will only have dry orgasms during intercourse.
Prostate cancer risk factors
According to the National Guidelines for Prevention and Management of Cervical, Breast and Prostate Cancers, men are likely to be at risk of developing prostate cancer if:
They are 40 years and above, with those above 50 years being the most vulnerable. “Age is the strongest risk factor for prostate cancer,” states the guidelines.
They have a family history of prostate cancer.
They take a poor diet, especially meals with inadequate intake of micronutrients such as vitamin E, zinc and selenium.
They have chronic prostate infections or recurrent sexually transmitted diseases.
What does a prostate exam cost?
Prostate examinations should only be done at level E and F specialised laboratories which are certified by the Kenya Medical Laboratory Technologists and Technicians Board. According to the Medical Practitioners and Dentists Board fee guidelines, prostate cancer tests average between Sh2,100 and Sh3,600.
Additionally, according to Boniface Mbuki, the cost of screening will range between Sh2,000 and Sh5,000 depending on the hospital a person chooses.
“However, during cancer awareness months, screening is subsidised. For instance, on November 19, we will be hosting prostate cancer screening centres along Thika Road which will charge about Sh800,” he says.