Why men should screen for prostate cancer early

In this interview with PREMIUM TIMES, Motolani Ogunsanya, an Assistant Professor in Clinical and Administrative Sciences in the Department of Pharmacy at the University of Oklahoma Health Sciences Centre, shared findings from her research on “the experiences of black men who have survived prostate cancer.” She also made recommendations for improving the management and treatment of the disease in Nigeria.

PT: Prostate cancer is known to occur in men, kindly tell us what the research study is about and what makes it unique.

Ms Ogunsanya: The research study focuses on prostate cancer, specifically in black men. I have a vested interest in improving quality of life outcomes for ethnically diverse individuals. Our research laboratory goes beyond viewing blackness as a monolithic concept and considers factors such as country of origin, culture, and social determinants of health.

By examining the experiences of black men from various backgrounds, including those from Africa, the Caribbean, and the US, we aim to understand how these factors, along with healthcare interactions, norms, cultural acculturation levels, and other intrinsic and extrinsic influences, can impact overall survival and outcomes related to prostate cancer.

Our approach recognises the importance of individual differences within the black male population and seeks to identify predictors that may affect survivorship in this group.

PT: What are the major findings from the research and your recommendations for the Nigerian group?

Ms Ogunsanya: The major findings from our research highlight the importance of early detection of prostate cancer, particularly for the Nigerian group. However, the healthcare system in Nigeria operates on an out-of-pocket basis, placing a significant financial burden on individuals.

Alongside early detection, it is crucial for the government to provide affordable treatment options and reduce the financial burden on patients. Cancer treatments can be prohibitively expensive, exceeding the minimum wage in Nigeria, making it difficult for individuals to access necessary care.

For individuals with a family history of prostate cancer, it is recommended to begin screening at the age of 40 using the Prostate-Specific Antigen (PSA) blood test and the Digital Rectal Examination (DRE). Regular health check-ups are also essential for monitoring overall health.

Monitoring vitamin D levels is also important, as lower levels have been associated with more aggressive forms of prostate cancer. Therefore, my recommendations for the Nigerian group will include prioritising early detection, ensuring affordable treatment options, and maintaining regular health check-ups to improve prostate cancer outcomes.

PT: What were the treatment options adopted by the men in the study?

Ms Ogunsanya: Regarding treatment options adopted by the men in the study, various approaches were utilised. The average age of the participants was around 65 years, with the African group being diagnosed approximately 10 years earlier. Radiotherapy was the most common form of therapy, with approximately 20 per cent of men receiving combination therapy, such as radiotherapy, followed by surgery. Active surveillance, which involves closely monitoring less aggressive cancers, was also an option.

Recurrence of cancer is a concern, and previous cancer diagnosis is a risk factor. In our study, we explored the impact of diet on cancer recurrence. Many patients made dietary changes by incorporating fibre-rich foods, nutrients from vegetables, and vitamin D, which are known for their antioxidant properties. Spouses and loved ones played a crucial role in supporting individuals during their cancer journey through open communication and understanding of individual needs.

PT: What are the symptoms men should look out for based on the experiences of the men in the study?

Ms Ogunsanya: So, unfortunately, when it comes to signs of prostate cancer, it’s not quite direct and I will highlight some examples. There is blood in urine, another is urinary pain, you can also have pain in your back and the last one would be erectile dysfunction.

However, it’s important to note that not all men may experience these signs, and some may have one or none, or even all of them. Therefore, when the signs do appear, it’s often not a positive indication. This is why again, primary prevention is better than cure, especially in this part of the world where the healthcare system isn’t well equipped to handle the burden of cancer as we are seeing especially in the younger demographic.

Taking charge of our health should be a priority. Allocating funds for regular yearly check-ups is crucial. In Nigeria, prostate cancer is largely undiagnosed due to various factors. One major challenge is the limited number of pathologists available.

As far as my recollection goes, there are approximately 106 pathologists for a population of over 200 million people. This number is significantly low, and it’s even possible that some pathologists may have left the country at the time of this interview, further reducing the available (human) resources. As a result, many people may have died without these deaths being attributed to prostate cancer.

Another significant challenge we face is the lack of real-time reporting for cancer incidence, especially new cases. In countries like the United States, they have regional databases that actively collect and record diagnosed cases of prostate cancer in a central repository. Unfortunately, Nigeria does not have such centralised data, and our reliance on information primarily occurs after individuals have passed away.

Furthermore, Nigeria’s budgetary allocation for healthcare is alarmingly low. The Abuja Declaration of 2001, which involved African governments, committed to allocating approximately 15 per cent of their GDP to healthcare. However, the current GDP expenditure on healthcare in Nigeria is a mere 3.4 per cent, falling significantly short of the World Health Organisation‘s recommended minimum of 10 per cent.

This inadequate funding has led to a shortage of healthcare providers, like pathologists for cancer diagnosis and an ill-prepared healthcare system to cope with the increasing number of cancer cases, particularly among younger individuals, including men with prostate cancer. Additionally, we are still grappling with other diseases such as HIV and malaria, which already put incredible strain on our fragile system.

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To address these challenges, we must strengthen our healthcare systems by improving real-time reporting mechanisms for cancer incidence. It is crucial to allocate a more substantial portion of the GDP to healthcare and invest in training more healthcare workers, including ancillary ones like community health workers. Creating conducive conditions, including competitive wages, will encourage healthcare professionals to stay in the country, reducing the brain drain phenomenon.

By making our healthcare systems more robust, ensuring an adequate number of skilled professionals, and prioritising healthcare expenditure, we can effectively tackle the growing burden of cancer and other health challenges we face in Nigeria.

PT: Nigeria is currently experiencing a prevalence of cancer cases, how would you review the country’s preparedness and response to the various forms of cancer? And what are your recommendations for Nigerians?

Ms Ogunsanya: Well, cancer has become a significant burden in Nigeria, and unfortunately, we lack a nationwide registry to accurately track the prevalence and incidence rates. We rely on statistics from external sources like GLOBOCAN via IARC, which can be reasonably reliable, but having our in-house data is crucial for a more comprehensive understanding of the situation.

In recent years, we have observed a concerning increase in breast cancer rates among younger women in Nigeria, often presenting as aggressive forms of the disease. Multiple factors contribute to this trend, including environmental pollutants and the absence of adequate zoning laws and regulations for pesticides. These issues highlight the importance of being proactive about our health in a country where the healthcare system still requires substantial improvement. The responsibility then falls on individuals to be vigilant and assertive in safeguarding their own well-being.

Being mindful of what we consume is essential. Reading labels, making informed choices, and being aware of the potential health impacts are crucial steps. Additionally, we are also witnessing an increase in kidney cancers, which may be linked to the use of alternative medicine. While I acknowledge the potential benefits of natural herbs as a pharmacist, it is essential to exercise caution and ask questions about the medications we take. Some alternative remedies may contain high levels of alcohol, posing risks to the kidneys and liver.

It’s important to prioritise regular physical activity as part of our overall health strategy. Engaging in exercise, such as brisk walks or recreational activities, not only helps maintain a healthy weight but also reduces the risk of various cancers and improves overall well-being. By combining healthy eating, cautious medication use, and regular physical activity, we can take significant steps toward protecting our health and reducing the burden of most cancers in Nigeria.

Finally, taking charge of our health should be a top priority. This entails understanding our health values and numbers, sharing our family history, actively seeking information, and advocating for our well-being. In a healthcare system that still has much progress to make, again, we must be proactive in protecting our health and well-being.