Prostate cancer – The silent killer few South African men are prepared to talk about

Prostate cancer – The silent killer few South
African men are prepared to talk about

It all began with what I had expected to be a
routine telephone call from Dr Grant, my medical
doctor, following my annual check-up in
September 2018. He calls me every year after
conducting the extensive medical check-up during
which, among other tests, blood samples are
drawn and taken to the laboratory for analysis.
Over the years, Dr Grant would simply call to
assure me that all was well; but not in 2018.
“Your PSA (Prostate Specific Antigen) is rather
elevated”, he told me in a calm, yet concerned,
voice, “I need you to arrange to see a urologist for
a prostate exam and biopsy, just to be sure that
there is nothing to be worried about”. He gave me
the name of the suggested specialist whose
offices I promptly called to make an appointment.
The two weeks that I had to wait for the
appointment seemed the longest I’d ever had to
wait. When the time came, Dr Moolman turned out
to be a relatively young, affable man who was
reassuring in his manner. To be sure, I had also
done a bit of reading about him and what he does
before I went to see him.
Moolman conducted the dreaded and notorious
“finger test” that many men loath, for its
invasiveness and promptly suggested a biopsy.
Fortunately, the finger test lasted just a few quick
seconds and was done before I realised it. The
biopsy is done under general anaesthetic during
which random samples are taken from the
prostate gland and taken to the laboratory for
testing.
Of the sixteen that were taken from mine, ten
returned with positive indications of the presence
of prostate cancer. The highest Gleason Score –
which indicates the level of aggressiveness of the
cancer – was eight. Ten is the highest score. I
consider myself lucky to have gone for regular
tests and had the cancer diagnosed before it
could spread to other parts of the body.
Some good news
So, the bad news was confirmed; but there was
also what I’ll describe as some good news under
the circumstances. The good news was that all
indications at that time pointed to the cancer
being concentrated in the prostate gland and none
of it having metastasised into the neighbouring
tissue and bone.
Further blood tests, a bone scan and MRI scan,
were done over the next few weeks to ascertain
these facts. Dr Moolman also took the time to
explain available treatment options to me.
Essentially, I could go the traditional
Brachytherapy route, which consists of the
implantation of radioactive seeds into the prostate
gland to attack and kill the cancer. But this
method offers no immediate guarantees, as I’d
have to wait for some nine months to be fully
assured if the cancer has been treated.
And anything could happen in the intervening
period, including the resurgence of the cancer.
Were the latter to happen, the radioactive seeds
could not be injected for the second time, as this
can only be done once. Treatment would mean
possible chemotherapy and a lifelong regular
observation.
The alternative treatment option was to undergo a
Da Vinci X robotics surgery , also called the
“Robotic assisted laparoscopic prostatectomy”. It
is the latest, higher definition, version of the first
generation Da Vinci SI Surgery. “This minimally
invasive procedure”, Moolman explained, “is
performed with the use of a robotic surgical
system that is designed to complete procedures
with an extremely high level of precision. Six tiny
incisions are made to enable the insertion of
small surgical instruments and a drainage pipe
into the abdomen.
The surgical tools, together with a high-definition
camera, are mounted onto the machine’s robotic
arms so that the cameras allow the surgeon to
see the inside of the body in detail. The flexible
instruments can bend and rotate much more than
the human hand can, allowing for complete
accuracy”.
The procedure enables the surgeon to remove the
prostate gland from the urethra, around which it is
normally wrapped. This procedure is
recommended in cases like mine, where there is
cancer inside the prostate gland that hasn’t spread
to the surrounding organs and tissue.
For better cure results, Dr Moolman routinely
removes the seminal vesicles with the prostate
gland. In cases where the MRI scan shows the
cancer to have spread outside the prostate, a
wider resection margin is performed to make sure
that no cancer is left behind after surgery.
If a patient is a good candidate – with very
localised cancer like mine - a bilateral nerve
sparing prostatectomy will be performed to ensure
the return of erectile function after the surgery.
This unexpected personal journey with prostate
cancer - no one in my family, including my father
who died at the age of 92, is known to have had
the cancer - as well as further information from Dr
Moolman - opened my eyes to broader, pertinent,
societal issues in South Africa:
• Most men either do not know they have to be
tested annually (from the age of 40 for African
men and 50 for Caucasian men), they’re too
scared to go for tests, or they simply
underestimate the potential danger of this silent
killer of men;
• Most men are not comfortable discussing
personal medical issues, especially prostate
cancer; possibly because of the stigma associated
with it (potential sexual dysfunction or
incontinence);
• Because of the absence of symptoms in the
earlier stages of the cancer, most men think
they’re fine and do not need to be tested. In
reality, when symptoms begin to show - e.g.
blood in the urine, difficulty passing urine, pain or
a burning sensation when passing urine, or
unusually frequent urination, especially at night –
chances are that the cancer is already in an
advanced stage. This is often the case with those
(mostly) African men who live in rural areas and,
in many cases, either lack the means, e.g.
medical insurance, to get regularly screened for
prostate cancer, or simply lack the awareness for
it;
• It’s important to note that 50-60% of African
men in state hospitals are diagnosed with
metastatic prostate cancer. This means they get
diagnosed too late after the onset of prostate
cancer and can therefore not be cured with
therapy. More awareness is needed to prevent
this;
• Studies have also shown that African men have a
bigger risk of being diagnosed with more
aggressive prostate cancer than Caucasian men;
• Treatment costs are prohibitive. The Da Vinci
Surgery is currently only available in private
hospitals and not in the government sector, which
only offers open surgery or radiation therapy;•
There are currently only six Da Vinci systems in
SA, with each machine costing in excess of
$1000,000;
Since I’m on a Coastal Core Plan with Discovery
Health – also called the Hospital Plan - which
paid for the core surgery and hospital stay, I had
to find another source to complement the many
excess medical costs associated with this
treatment. For this, I accessed additional funds
through my Life Cover with Old Mutual, which also
came to the party when I needed it.
Thanks to Dr Moolman’s expertise, I was
discharged from hospital two days after surgery
and a bilateral nerve sparing prostatectomy to
ensure a return of erectile function. 70% of his
patients leave the hospital after a night following
surgery. None of this is possible with the open
and traditional laparoscopic surgery. Once
discharged from hospital, patient, loving, support
by family and friends makes a huge difference.
Given the vast income disparities in SA, as well
as difficult access to medical insurance for the
majority of our citizens, there is an opportunity for
government and the private sector to form some
kind of Private-Public-Partnership in order to bring
costs for the more modern Da Vinci X Surgery
down and to make it available in the public health
sector.
But until this becomes reality, African men need to
take their health more seriously and get checked
on a regular basis after the age of 40. Only early
diagnosis can improve survival and cure rates.