Prostate cancer is a relatively common cancer afflicting middle aged and elderly black African men. Research conducted by Professor Yeboah and his team at the KorleBu Teaching Hospital shows that seven per cent of 1038 Ghanaian men between the ages of 50-70 who were randomly screened had the disease, making its prevalence in the general population more than 200/100,000.
Yet, until recently, it had not attracted as much attention as other cancers such as breast and cervical had in both the print and electronic media. A number of high profile deaths in the past few years and an increasing life expectancy in men has led to an increasing awareness of the disease which in turn has brought it to the fore in public discourse. This in itself should have been a positive development as knowledge of the disease ultimately translates into early detection and effective treatment.
Unfortunately, in the poorly regulated electronic media terrain that pertain today, it is increasingly becoming difficult to discern facts from myth and falsehood with regards to this disease.
Herbal and alternative medicine
The proliferation of herbal and alternative practice clinics and the stiff competition for clients, is certainly one of the reasons for this phenomenon, as their practice is poorly regulated.
It is becoming common place in my practice to see patients with prostate cancer who for many months or even years were ostensibly being treated for “prostate enlargement“ without any evidential proof of the presence or otherwise of prostate cancer. These men, therefore, miss out on any opportunity for cure if indeed this did exist.
In fact, there is no disease entity known as “prostate enlargement”, however there are two common disease states that can present as enlargement of the prostate, i.e benign(noncancerous) prostatic hyperplasia and cancer. The basis for the treatment of these conditions, if indeed necessary, first lies in distinguishing between these two, because they have different behaviour, course and outcome, hence their management are different.
This distinction can be established in most cases by clinical examination of the prostate and the correct interpretation of appropriate blood tests that are specific for the prostate gland(e.g serum psa). In other cases, however, prostatic tissue must actually be sampled and examined by qualified practitioners (histopathologists).
Benign(noncancerous) enlargement of the prostate occurs with ageing by an interaction of several factors, and only becomes a disease when it is proven that it is the cause of impaired out flow of urine from the bladder. In other words, it is the prostatic obstruction that is the problem and not the enlargement of the prostate per se. It is possible to have a large prostate with little or no obstruction and a relatively small prostate with severe obstruction and bothersome symptoms. The chance of finding an enlarged prostate by an ultrasound scan alone, therefore, should not be the basis for committing a man to life-long treatment. The prostate grows through out the lifetime of a man and a large prostate may actually just reflect the age of the person concerned.
Management and treatment
Mild to moderate benign prostatic obstruction is usually treated with drugs that either shrink the gland or relax the muscles in it, whereas severe obstruction with unbearable symptoms or life-threatening complications should be surgically managed.
Herbal treatment for benign prostatic obstruction is not a novel nor a unique phenomenon. Herbal based products have been documented and used for centuries all over the world. In Ghana today, there are registered, safe, efficacious herbal drugs that are being used in mainstream medical practice. Ultimately, the effectiveness of every treatment is judged on the basis of improved quality of life for the patient.
Management of prostate cancer depends on the stage at which the disease is diagnosed . Early disease usually detected by voluntary screening or early symptoms is curable. Fortunately in Ghana today, all the modalities for cure i.e surgery and radiotherapy are available in referral centres.
Late or advanced cancer, however, is incurable but unfortunately is the commonest stage of presentation in Ghana. The above notwithstanding, even this stage of the disease can be treated with appropriate agents to prolong and improve the quality of life of the affected individual.
One must concede, however, that the emergence and seemingly popularity of some of these unsafe , unethical and unorthodox practices cannot be attributable to their marketing savvy alone, but also the void created by the lack of public education by relevant regulatory bodies, seeming lacunae in our regulatory laws and the sparse and uniform distribution of qualified health practitioners.
Purely traditional herbal practice by its very nature is not diagnosis led or evidence based and, therefore, cannot be held to any strict standard of care. However, with integrated practices which are becoming commonplace in the country where both orthodox and herbal treatment are available and usually complementary, strict standards must be applied and enforced just like in any conventional orthodox practice.
Many of these integrated practices are owned and run by qualified medical practitioner and I daresay, therefore, should be regulated by the medical and dental councils. It is not only irresponsible but even unethical in my view to hold onto patients with probable prostate cancer without the possibility of a definitive diagnosis by a biopsy. We would otherwise continue to lose patients with salvageable prostate cancer all under the guise of treating “prostate enlargement”.
Are there any standards for medical broadcasting in Ghana? It is seemingly too easy once one can pay, to profess in any subject on radio and on TV without any scrutiny of qualification or content.
Prostate diseases might just be the tip of the iceberg as that relates to my practice. There are many more disease conditions that suffer the same fate. The contradictory methodologies in mixed practices create a potential loophole for unaccountability.
The writer is a urologist at the Police Hospital in Accra.
