Prostate cancer cases on the rise, say researchers

“These changes were due to changes in risk factors and population growth,” the researchers noted. Top among the risk factors for prostate cancer, Dr Fred Okuku, a consultant at the Uganda Cancer Institute (UCI), said, include being aged 45 years and above, family history of cancers, being African, lack of physical exercise, taking alcohol and unhealthy diet.

Statistics from the International Agency for Research on Cancer indicate that prostate cancer in Uganda killed 1,329 in 2020 and a total of 2,375 people developed the disease that year.

This made it the second leading cancer among men, just behind Kaposi sarcoma, a cancer that affects the blood pathways under the skin and lining of the intestines and stomach. For all types of cancers in Uganda, around 35 in number, prostate cancer falls as the seventh leading cause of death.  

Rev Canon Garshom Twinamatsiko, 73, a resident of Rukungiri, is currently undergoing treatment for prostate cancer at the UCI. 

He told this newspaper he has been prescribed 28 sessions of radiotherapy and has to show up daily for the treatment. 

“I was operated on in Mengo Hospital on October 28 last year,” Rev Canon Twinamatsiko said, adding “They removed the prostate because it was enlarged. That is the same time they discovered it [enlarged prostate] was cancerous.” 

This discovery came about 10 years after he first experienced symptoms suggestive of prostate cancer.  

“I started experiencing difficulties in passing out urine in 2013. I would feel a lot of pain when urinating. I went to Kisiizi Hospital (a facility affiliated with the Church of Uganda) and was given treatment for shrinking the enlarged prostate,” Rev Canon Twinamatsiko revealed. 

But this didn’t cure him. Midway, as he was struggling with the prostate problem, in 2016, he had a motorcycle accident which left him unconscious for seven days.  

“During 2019, I again went back to the Kisiizi Hospital and they repeated the procedure but from then, I never went back because it was not helping me,” he narrated. 

After this, Rev Canon Twinamatsiko decided to head to Kampala, about 382 kilometres, away from his home in Rukungiri District, in search of a cure. 

“It was from Kampala that a doctor advised me to go to Mengo Hospital (a facility which is also affiliated with the Church of Uganda) where I was operated and from there, they found I had prostate cancer and I was referred to UCI,” he said.  

“It is a long way [to know the actual disease]. But by God’s grace, I am still alive. I am now getting radiotherapy (treatment of cancer using radiation). I have completed 16 days. I was given 28 days. I have also completed two rounds of chemotherapy [treatment of cancer using drugs),” he added.   

Rev Canon Twinamatsiko is part of more than 1,000 new prostate cancer patients who Dr Okuku said they see at the UCI annually.  

He said about 90 percent of the patients they get come late with advanced cancer that may not be cured. As a result, UCI is struggling with a cancer survival rate of around 20 percent, meaning the majority of patients die.   

“The patients are not only delayed in lower health facilities but also by herbalists. We engage the hospital directors and we are planning to engage lower carders including doctors and nurses and clinical officers to give them knowledge and training on how to identify simple symptoms that help to identify patients of cancer,” he said.

Symptoms

According to information from the UCI, common symptoms of prostate cancer include increased frequency of urination, higher urge to urinate, pain while passing out urine and erectile dysfunction. 

“If you are in your 40s and you are waking up to go for urination more than once in the night, then there is a problem. If it is more than three times, then that is high. Some elderly have a bucket by the bedside and that shows there is a problem,” Dr Okuku said.

“Apart from the frequency, we also have other symptoms like urgency (do you run very quickly to go and urinate?), hesitancy (urine delays to come out) and pain. There can also be blood in the urine. We can also have obstructive symptoms where only little or no urine comes out when you have the urge to urinate. 

“We also have effects on sex libido. Some men have erectile dysfunction. So some men go to hospital after experiencing those symptoms and the doctor finds out they have advanced prostate cancer,” the consultant explained. 

According to a 2023 study report authored by Innocent Atuhe of King Caesar University in Kampala and Dr Jackson Orem, the executive director of UCI, prostate cancer (PCa) is increasing at a rate of 5.2 percent per annum in Uganda and yet “as few as five percent of men have ever been screened for PCa in Uganda.”

However, another study in Lira City showed that besides limited knowledge about PCa, difficulty in accessing screening and diagnosis services are also the main barriers to PCa fight.

“Of the 400 participants, only 18.5 percent (74/400) had ever been screened for prostate cancer. However, 70.7 percent (283/400) were willing to screen/rescreen if provided with the opportunity,” the 2023 report authored by Mr Richard Ekwan of Makerere University reads. 

According to information from UCI, currently, the known and available PCa screening tests in Uganda are prostate-specific antigen (PSA) and digital rectal exam (DRE). PSA is a protein produced by cells of the prostate gland and the test measures the level of PSA in the blood. 

During the DRE procedure, the doctor feels the surface of the prostate gland for bumps, hard spots, and any other abnormalities, according to the report by Mr Atuhe.

Dr Okuku also revealed that some symptoms of prostate cancer may be similar to those of non-cancerous prostate enlargement. The prostate is a small, rubbery gland about the size of a ping-pong ball (a light hollow ball used in playing table tennis). The prostate is located deep inside the groin, between the base of the male organ (penis) and the rectum.

“Prostate has many functions. It also controls urination as well as serves as the exit for semen –sexual function. So those two are affected when it gets sick, becomes enlarged, as is the case when it is affected,” Dr Okuku explained.

“But this can be benign –non-cancerous enlargement. Most men just have an enlarged prostate but it is not cancerous. Most men start experiencing prostate enlargement from age 20 and you start experiencing symptoms like passing urine more frequently.

“Enlarged prostate may not necessarily become cancerous. Many men just have enlarged prostate and there is no cancer in there. However, when you have an enlarged prostate, you will have similar symptoms and our work [as doctors] is to ensure there is no cancer there,” he added.

However, Dr Okuku said if one is suspicious, they should come to the hospital for the right diagnosis. 

“After assessment, the treatment is started depending on the stage of the cancer. You will be on chemotherapy or radiotherapy, we also have hormonal treatment which makes your libido go completely,” he said.

There are four stages of prostate cancer. “At stage 1, cancer is within one lobe of the prostate, stage 2 the cancer has grown to two lobes, stage 3 is when it is very close to the covering of the prostate and stage 4 is when it has broken through the covering of the organ,” Dr Okuku explained. 

Prevention

Dr Gerald Mutungi, the assistant commissioner for non-communicable disease (NCDs) prevention and control, said prostate cancer is a silent killer that should be fought.  

“Risk factors like sex may not be modified but other risk factors that can be modified include diet. An unhealthy diet is a risk factor for most of the non-communicable diseases like diabetes, hypertension and cancer,” Dr Mutungi said.

“Unhealthy diets include red meat such as pork and sausages. Sugary drinks like soda also expose you to NCDS including cancer. Reduce salt, this business of adding salt before you even taste food is also dangerous. Reduce alcohol consumption. Also, reduce the amount of food you consume –such as when you go to parties. Increase consumption of fruits and vegetables,” he added.

Dr Fred Okuku, a consultant at the Uganda Cancer Institute (UCI), also said a recent study shows that in China, men in that country rarely develop prostate cancer with one of the reasons being what they eat. 

“But if a Chinese migrates to USA, they are likely to develop prostate cancer. Diet and the way you live are very important in cancer prevention. There are certain foods that we know will help prevent or even reduce the size of your prostate…one of the ingredients of these foods is lycopene,” Dr Okuku said.

“These reduce the risk of prostate cancer and even the size. (Lycopene-rich foods help in reducing the risk of cancer or shrinking enlarged prostate,” he added.

According to food scientists, this substance is found in red, pink, and orange fruits and vegetables such as tomatoes, apricots, melons, papayas, grapes, peaches, watermelons, and cranberries.  

“Epidemiology doesn’t seem to point to masturbation increasing the risk of prostate cancer. There are those who think if you don’t have sex on a daily will increase your risk. There is no research evidence supporting such,” he added.