Prostate cancer is leading cause of death for Ugandan men

Wycliffe Twijukye, a 47-year-old secondary school teacher in Mbarara who prefers not to show his face, is about to start his treatment for prostate cancer.
In June 2014, he started having difficulty passing urine especially in cold weather.

A patient’s story
“Initially, the pain when passing urine was bearable and I was reluctant to go for treatment but as time went on, the pain worsened so I thought of seeking medical advice.
I went to Mbarara Diagnostic Centre and the tests showed that my prostate had enlarged. I was then given some drugs on which I survived for some time.
In January this year, my health deteriorated. I became weak and my condition kept worsening every passing day. I developed swollen and painful lymph nodes in June so I asked for sick leave from my place of work.

When I went back to the diagnostic centre, I was referred to Uganda Cancer Institute in Mulago hospital because the doctor suspected there was a cancer because of the swelling.
In August, I came to the cancer institute where a biopsy was taken from the lymph nodes for examination and the tests confirmed I had prostate cancer.
I am waiting to undergo several tests where I will be reviewed to determine my cancer stage and the different types of treatment I am likely to go through. I already feel bad for my family since I have not resumed work since June.

Another cancer patient speaks
Like Twijukye, Seid Mohammed (54), a qualified adult educator and married resident of Kasese suffers prostate cancer. In July this year, Mohammed started having frequent urination.
“I had frequent urination so I thought I had diabetes. When I went for the diabetes check, my blood sugar was normal. I also did a hernia test and I did not have hernia.
I came to Mulago hospital to see a specialist in the department of urology who found out that my prostate was swollen. I went to Kilembe mine hospital where they confirmed the same but the prostate had enlarged so much that I had to undergo operation.

In September, I had the operation and a sample was tested, proving I had prostate cancer. I am in Mulago hospital to see how much the cancer has spread and find out the treatment I have to go through.
After surgery, I use a urinary bag to ease myself and this has disrupted my daily activities because I usually get backaches.
I do not know of anyone with cancer in my family so it could be due to age. I was told it can be cured if it is detected early so I am hoping for the best.

What the experts say
Although the two prostate cancer sufferers were able to experience the warning signs, they are part of only 15 per cent males who are able to experience the signs.
According to Dr Fred Okuku an oncologist and head of research at Uganda Cancer Institute, 85 per cent of the males are unable to experience the signs and symptoms of prostate cancer and may live to die of other causes but not prostate cancer.

“Prostate cancer is the leading cause of cancer deaths among men in Uganda at an increasing rate of 5.2 per cent increase annually but, out of all the men who develop the cancer, only 15 per cent show the signs and symptoms to the cancer,” says Dr Okuku.
He adds that the cancer is slow and may appear a decade before the signs show and that there are no signs in the early stages so this contributes to the very high percentage (90 per cent of patients) that report with the cancer at stage three and four, which are late stages.

“At stage 1 and 2, the cancer is curable but only 10 per cent of the patients come in the early stages, remarks Dr Okuku. Stage 3 and 4 are late stages and most patients come at these stages because the disease does not present with any signs in the early stages.”
The prostate divided into left and right lobes is located in front of the rectum just below the bladder and it surrounds the urethra a tube that carries urine and semen. The growth of cells in the prostate, both healthy and cancerous is stimulated by testosterone found in the testes.

According to Dr Noleb Mugisha, the head of Comprehensive Community Cancer Programme at Uganda Cancer Institute, if any man’s family has multiple members who have had cancers, it makes him more prone to an aggressive type of prostate cancer that may be diagnosed at an earlier age before 40 years.
“The cancer tumour first expands in size leading to an enlarged prostate that blocks the urinary system; eats up blood vessels then spreads into the lymphatic system causing swelling of the lymph nodes,” says Dr Mugisha.
He adds, “In the late stages, the cancer usually first breaks into the capsule, to the pelvic area then eats up the backbone. This is the reason why men with prostate cancer complain of lower back pain. From there, it can spread to the liver and kidneys.”

Prostate cancer tests
Prostate cancer is hard to screen and several tests must be done to confirm the cancer.
Prostate Specific Antigen test (PSA) is a test where a blood sample is taken to measure the level of PSA in the blood.
In a digital rectal exam, a doctor inserts a finger in the rectum to feel the prostate. If it feels like a hard irregular stone, it is likely to be cancer.
A trans-rectal and abdominal ultrasound scan can also be done to confirm prostate cancer.
As in any other type of cancer, a biopsy is done to confirm the cancer. A sample can be taken from the prostate or the swollen lymph nodes for examination.