By ANYANG\’ NYONG\’O
In July 2010 I was diagnosed with prostate cancer in Nairobi. I have been taking my annual physical health examinations for several years and in July such an examination revealed a rather high level of PSA (Prostate Specific Antigen).
The PSA is a protein produced by cells of the prostate gland that every male human being has. The PSA test measures the level of PSA in the blood. The doctor takes a blood sample and the amount of PSA is measured in a laboratory. Because PSA is produced by the body and can be used to detect disease, it is sometimes called a biological-marker or a tumour marker.
Under normal circumstances, men should have a PSA that ranges between 1 and 4 when measured scientifically in a laboratory. But when the PSA measure goes above 4 and begins to rise even further it will point to the fact that there could be something wrong with the prostate gland.
Most men over the age of 50, particularly African and African-American men, have a high risk of developing prostate cancer the older they become. At age 50, 50pc of the men are likely to have the cancer; at age 65, 65pc are also likely do so. When you reach 100, the risk is almost 100pc. Here we are talking about probabilities, not direct correlation between age and getting prostate cancer.
Generally the PSA rises when the prostate gland begins to enlarge for one reason or the other as one grows older. The enlargement may be non-cancerous (or benign) or it may be cancerous (or malignant). But the rise in the PSA may also be as a result of some infection in the urethra or urinary system which doctors can treat with antibiotics.
The most frequent benign prostate conditions are prostatis ("inflammation" of the prostate) and benign prostatic hyperplasia (BPH), or enlargement of the prostate, both of which do not cause cancer. It is, however, possible for a man to have one or both conditions and to develop prostate cancer as well.
Thus a man\’s PSA level alone does not give doctors enough information to distinguish between prostate conditions and cancer. But once the PSA is on the rise, the most urgent step the doctor and patient should take is to do a biopsy of the prostate of the patient to establish exactly what is going on in the prostate gland.
Usually when doctors suspect something wrong with the prostate they will do a physical examination of the gland through the rectum to establish the nature of the malady. This, however, cannot establish beyond any reasonable doubt whether or not cancer is present. A biopsy is the surest way to rule out cancer or establish its presence.
What, then, is a biopsy?
Since the prostate gland can be reached through the rectum – or the anus to speak the language of the ordinary human being – a doctor will insert a long needle and remove tissues from all sides of the gland so as to examine them later under a microscope. The doctor may also use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to tell if cancer is present.
In my case after the biopsy was done at the MP Shah Hospital, the examination of the tissues revealed that I had a Gleason Score of 7. The Gleason Grading System is used to help evaluate the prognosis of men with prostate cancer.
The pathologist assigns a grade to the most common tumour patterns, and a second grade to the next common tumour pattern. The two grades are added together to get a Gleason score. Each of the two ranges from 1 to 5; in my case the range was 3 plus 4, making a total of 7. This essentially meant that the cancer was aggressive, and needed urgent attention before it started invading the surrounding tissues or spreading to the rest of the body.
When prostate cancer is detected in its early stage it can be cured through radiation or surgery by modern science and technology. But if left for long so that it spreads beyond the gland, the story is rather different: it becomes more life threatening. It is therefore important that men know about their condition by having regular and proper physical examinations so as to live longer and healthier lives.
I am currently undergoing Intensity Modulated Radiation Therapy (IMRT) at the University of California San Francisco, Mount Zion Medical Centre. I will refer to this as the UCSF Medical Centre. My wife and I arrived here in December 2010. Fortunately it is one of the best Prostate Cancer centres in the world, with two very well known prostate specialists, a surgeon and a radiologist. This will be followed finally by Brachytherapy. What does all this mean?
In IMRT, the radiation is focused on the prostate gland from a source outside the body, very much like an X-Ray works. In this case, a computer-driven machine moves around my body delivering very precise beams that are focused on burning the cancer cells in the prostate with minimal effect on surrounding tissues. This is done on an outpatient basis from Monday to Friday for 20 minutes every day for 5 to 8 weeks.
I discussed this process in details with the doctor in charge and the medical personnel before it started and I am fully informed about what is being done to me. This is what proper medical practice is: both patient and doctor are involved in the process of treatment and have full confidence in each other.
When this is over, brachytherapy, or internal radiation therapy, will follow. Small radioactive pellets -or "seeds" -will be placed right inside my prostate gland so that they will continue to kill any cancerous cells remaining, or frustrate any that may turn rogue when the external radiation is over.
We do not have such facilities in Kenya at the moment. My ambition as the Minister for Medical Services is that we do our best to have them so that ordinary Kenyans can have access to proper health care and live longer.
We need to do two things: first improve our diagnostic services so that both doctors and patients can know what ailments are on their way or are already affecting a patient. Two, once diagnosis is done, we need proper facilities with trained personnel who can treat patients scientifically and effectively.
We have done rather poorly in the area of cancer prevention, diagnosis and treatment. In fact the situation in our country is simply deplorable; and my heart bleeds for our people when I accept this.
Next week I will discuss what we need to do at the individual level, in government and in society in general to deal with the rising cases of cancer in Kenya.
Prof Nyong\’o is the Medical Services Minister. This article was first published in the Standard on Sunday.