Doctor recomends regular sex to prevent prostate cancer

It’s a new dawn for cancer patients in Kenya.

In what is expected to revolutionise the treatment of the disease in the country, doctors at the Mediheal Group of Hospitals in Nairobi will for the first time perform a key-hole camera prostate cancer surgery on two patients on Monday.

Dr Naveenchandara Acharya, who will be leading the team performing the procedure scientifically known as laparoscopic radical prostatectomy (LRP), says it will take about an hour, unlike the open radical prostatectomy (ORP) that takes three hours.

“The LRP has a range of benefits, including enhancing the quality of life of the patient, in this case, addressing his sexual life, which naturally means happiness,” says Dr Acharya, who landed in Kenya from India less than a month ago.

The procedure involves a cut, less than 1.5 centimetres on the patient’s skin, and directing the key-hole camera through small holes — often three or four — to remove the prostate gland. A patient is expected to recover fully within a week.

With this advanced model, Dr Acharya says patients concerned about erectile dysfunction after ORP now have hope of a fulfilled sexual life. This is due to the fact that open surgeries often result in the severing of nerves in the prostrate region and damaging of the sphincters, leading to erectile dysfunction and lack of urine control.

Read: How cancer management is changing in Kenya

Why laparoscopy is better

“In open surgery, you cannot see the nerves. They are very small, so laparoscopy is better. It offers less chances of going to the ICU; less chances of harming the sphincter muscles. Imagine a 50-year old who’s operated to remove his prostate gland in open surgery losing his sexual life. Imagine this person wearing diapers for the rest of his life because he cannot control his urine,” he says.

The key-hole camera has the ability to magnify the body organs, thus assisting the surgeons to separate the internal organs better.

“In laparascopy, everything is magnified inside. We can separate the nerves from the prostate. So when the nerves are intact, the most common quality of life indicator is the sexual life. If the sexual life dies, the quality of life dies. With laparoscopy, you can preserve the sphincter and the nerves, we can control the urine and preserve the erectile function so one can have a normal sexual life,” says Dr Acharya.

“Currently, there is no LRP in Kenya apart from the open surgery where specialists make a big incision in the abdomen. What I am trying to start here is a procedure that will remove the prostate gland with the patients recovering fast.”

Prostate is among the common malignant cancers in Africa. On top of the list is lung cancer. Though its main cause is yet to be established, many scientists across the world attribute the malignancy to either genetics or hormonal imbalance that results in higher testosterone levels in the body.

Early detection

Whereas the illness is treatable, it is important to detect it early for it to be cured. The laparoscopic procedure is safer, faster and has minimal loss of blood compared to open prostate surgeries.

“The surgery is also safe in terms of blood loss. Reduced blood loss remains one of the crucial advantages of LRP compared to open radical prostatectomy. Mean blood loss in LRP is about 250ml compared to approximately 600ml in open surgery,” says Dr Acharya.

Lack of awareness and cultural impediments — since many African societies do not encourage discussions on sexual health — have seen many prostate cancer patients being diagnosed when it is too late.

“In my years of experience spanning 16 years, at least 80 per cent of patients come to the doctor when the disease is at an advanced stage and we cannot do much for them. We can only give hormonal treatment or chemotherapy or radiotherapy to ease pain,” he says.

It is imperative for men over 50 years to undergo annual PSA (prostate specific antigen) tests. However, if one comes from a family with a history of prostate cancer, the annual PSA tests should begin at 40.

“When the disease is diagnosed early, treatment often results in a complete cure,” says Dr Acharya.

Low level prostate cancer

A survey conducted by the African Journal of Urology in Kenya showed that at least 57.3 per cent of the respondents had a low level of prostate cancer.

“The prevalence of prostate cancer was 5 per cent. Willingness to undergo screening in the future was 81 per cent among the participants. The most frequently cited (56.9 per cent) reason for lack of willingness to screen was the participants’ belief that they were well,” stated the survey, published in January, 2021.

Dr Acharya urges the public to take part in early screenings and check-ups to improve their quality of life.

“Most of these patients are just asymptomatic. They walk in, but after doing the PSA test, we find that it’s very high. When we conduct a biopsy, we are able to see prostate cancer. However, when you see symptoms like blood in the urine; pain while passing urine, or kidney failure, you will realise that it's already too late to cure it,” he warns.

Deaths

With about Sh2,500, one can undergo a PSA test. The doctor encourages more screenings, awareness and a shift in cultural beliefs to beat cancer. Prostate cancer is the eighth leading cause of deaths in the country. In 2018, the World Health Organisation ranked Kenya 26th in prostate cancer globally.

“Prostate cancer deaths in Kenya reached 2,202 or 0.86 per cent of total deaths, with the age adjusted death rate of around 33.06 per 100,000 of population, placing Kenya number 26 in the world,” states the WHO.

According to the World Cancer Research Fund (WCRF), prostate is the second most commonly occurring cancer in men and the fourth overall. In 2018, there were 1.3 million cases globally.

“Age adjusted incidence rates of prostate cancer have increased dramatically and this is largely because of the increased availability of screening for Prostate Specific Antigen (PSA) in men without symptoms of the disease. This test leads to detection of many prostate cancers that are small and would otherwise remain unrecognized, and which may develop further into higher stage disease,” states the WCRF report conducted in 2018.

In 2013, the Institute for Health Metrics and Evaluation (IHME) estimated that the disability adjusted life years (DALYs) from prostate cancer increased from 100,200 in 1990 to 219,700 in 2010 and deaths also increased from 5,600 to 12,300 over the same period.

The key-hole camera procedure will cost Sh800,000 at the Mediheal Group of Hospitals whereas the open surgery goes for Sh700,000.

Dr Acharya has conducted two public meetings in Narok and Nakuru to raise awareness on prostate cancer and is expected to visit Mombasa, Eldoret and Kisumu in the coming weeks.

“I have moved to Kenya permanently and I intend to work with other doctors and share skills. Kenya is a fast-developing nation and soon, this procedure will be available in other hospitals. This will stop Kenyans from flying abroad for treatment,” he says.

Eating tomatoes

The doctor recommendations regular consumption of tomatoes, since they contain lycopene, one of the cancer preventive drugs.

“Probably because of the tomato intake, prostate cancer incidence is very low in the Seventh Day Adventist church. Lycopene is a cancer preventive drug. It’s used to bring the PSA down,” says Dr Acharya.

He also urges men to have regular sex and ejaculate more for better prostate health. This rids the body of the seminal fluid, which has to be expelled regularly, failure to which, it risks getting infected, resulting in pain in the male gonads, which could affect the prostate glands.

“Ejaculation will definitely get rid of the sperm in the body. Sperm clearance helps in bringing the infection down. Prostatitis is less in people who enjoy regular sex. I always tell young people with chronic prostate infection to have sex regularly; ejaculate regularly. The sperm will get clear and you will get a continuous flow. Semen and sexual fluid should not be there in the body, let it come out; have sex,” he added.

There are also professional prostate massages, which help those who cannot have sex regularly to expel semen from their bodies. This procedure is done weekly, he offers.