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Awareness is critical in the fight against prostate cancer

Tens of thousands of South African families impacted by the disease

Monday, 31 October 2016 While prostate cancer does not receive the kind of public attention that some other forms of cancer do, it nevertheless impacts tens of thousands of South African families every year.

“Large numbers of South Africans know someone who is or has been struggling with this disease, which is the second most common form of cancer experienced by men, after lung cancer,” points out Dr Johan Venter, a urologist who practises at the Netcare Pretoria East Hospital. “It has impacted the lives of such prominent public figures as Desmond Tutu.”

“More than 900 000 men worldwide are diagnosed with prostate cancer each year and one in 23 South African men will develop the disease at some point in their lives. It is an important men’s health issue both locally and internationally and it is of critical importance that we continue to improve awareness of this disease,” he adds.

According to the National Health Laboratory Services (NHLS) and National Cancer Registry and Research, more than 4 300 men are newly diagnosed with prostate cancer and 2 000 men die from the disease each year in South Africa.

A treatable condition

“More widespread and regular screening, early detection and new technologies resulting in improved treatment make it possible for more and more men to survive prostate cancer. If the cancer is diagnosed early, while it is localised to the prostate gland itself, the five-year survival rate is close to 100%.”

The prostate is a walnut-sized gland that is part of the male reproductive system, producing fluid that forms part of male semen and energises the sperm to fertilise the egg. Prostate cancer occurs when abnormal cells grow out of control in the prostate gland.

Prostate cancer is usually a slow-growing cancer, however there are more aggressive types. If left untreated, aggressive forms of this cancer may metastasise, or spread to other organs in the body, and become life threatening.

Prostate cancer usually develops in men over the age of fifty, and most commonly in men in their sixties, seventies and beyond but younger men can also develop prostate cancer.

What are the symptoms?

Dr Venter says it is important to note that patients with prostate cancer often experience no symptoms whatsoever.

If symptoms do occur they may include some of the following:

· Blood in urine

· Trouble urinating

· Sudden or urgent need to urinate

· Waking frequently at night to urinate

· Difficulty starting or stopping urine flow

· Weak or interrupted urine flow

· Pain during urination

· Difficulty having an erection and/or painful ejaculations

· Frequent pain or stiffness in the lower back

· Unexplained weight loss

Who is at risk?

Dr Anesh Naidoo, who practises at Netcare Blaauwberg Hospital in Cape Town, says there are a number of risk factors for prostate cancer. In most cases there are usually no clear causes of the disease, however, and it is important to note that men of all ages and races may be at risk.

“Advancing age is an important risk factor, with older individuals having a much greater chance of developing the disease. Prostate cancer also appears to run in certain families, which would suggest that in some cases a predisposition to the disease might be inherited. Nevertheless, the majority of men who develop the condition have no history of it in their families whatsoever.”

How is it diagnosed?

Prostate cancer can be detected using screening tests such as a digital rectal exam (DRE), a prostate specific antigen (PSA) test and a biopsy. During DRE, the doctor uses a gloved finger to feel for hard lumpy areas on the prostate gland. PSA is a simple blood test for signs of prostate cancer.

If a man’s PSA level is high or has increased since his previous test, and irregularities in the prostate are detected, the doctor may call for a biopsy. During a biopsy the doctor will use a thin needle to extract small tissue samples from the prostate, which will then be tested in a pathology laboratory for signs of cancer.

To detect signs of potential disease as early as possible, it is recommended that men over the age of 45 should have regular check-ups with their doctor, at least once a year, and earlier if they are at high risk.

Range of treatment options

There have been significant advances in the treatment of prostate cancer over the past number of years. According to Dr Naidoo, there is a wide range of treatment options available today. Treatment will depend on the type of cancer involved and whether or not the disease is localised to the prostate itself or has spread beyond it.

Treatment options for prostate cancer include radical prostatectomy — which is the complete surgical removal of the prostate — radiation, cryotherapy, brachytherapy, watchful waiting and hormone therapy.

Dr Naidoo explains that radiation acts by radiating the cancerous cells, and cryotherapy works by burning or freezing them. Brachytherapy involves the insertion of tiny pieces of radioactive material, known as ‘seeds’, into the prostate, where they act to destroy the DNA of the cancerous cells.

With watchful waiting (also known as active surveillance), the cancer is not treated but monitored through regular tests and check-ups. Doctors sometimes adopt this approach in the case of older men with a slower developing form of cancer.

Highest success rate

According to Dr Naidoo, for those cases in which the cancer is still localised to the prostate itself, radical prostatectomy in which the prostate is surgically removed, has the highest success rate of all the treatment options.

“Studies have shown prostatectomy success rates of between 76 to 98% for low risk disease; 60 to 76% for moderate risk disease; and 30 to 76% for high risk disease,” he explains.

How are prostatectomies performed?

There are various ways prostatectomy can be performed today, including by traditional open surgery, by laparoscopic surgery or by robotic-assisted surgery, the latter two being minimally invasive procedures. Robotic-assisted surgery is regarded internationally as a significant step forward over open surgery and as the gold standard for the treatment of localised prostate cancer.

Some 80% of all radical prostatectomies in the United States are now done using robotic technology. Since its introduction into South Africa a few years ago, robotic-assisted surgery has also made significant inroads in becoming the treatment of choice in our country.

“The robotic technology provides urologists with a cutting edge tool in the fight against prostate cancer. The robotic system incorporates magnified three-dimensional high-definition technology, and the instruments used in the surgery rotate with much greater dexterity than can be achieved with the human wrist alone.

“These features enable the surgeon to operate with enhanced vision, precision and control. In addition, da Vinci robotic-assisted prostatectomy patients usually experience a speedier recovery and shorter hospital stay. They are often able to start walking on the same day as the surgery because the tiny incisions result in minimal blood loss during the surgery and less post-operative pain. The lesser blood loss also means that the need for a blood transfusion is reduced,” notes Dr Naidoo.

An important benefit of robotic-assisted surgery technology is that it enables surgeons to perform more accurate nerve-sparing prostatectomies, ensuring that the nerves controlling erectile function and continence are better preserved. This increases the chance of restoring patients’ normal erectile function and for this to happen faster. Studies have also shown that patients have improved early outcomes with regard to urinary continence.

“In short, in the hands of a well trained, experienced surgical team using da Vinci robotic technology, prostate cancer patients can experience effective cancer control with significantly fewer complications,” concludes Dr Naidoo.

Netcare introduced da Vinci Si robotic technology at Netcare Waterfall City Hospital in Midrand and Netcare Christiaan Barnard Memorial Hospital in Cape Town in mid-2014, and in April 2016 the system was introduced at Netcare uMhlanga Hospital in KwaZulu-Natal.