Prostate cancer: Early detection saves lives – Vanguard News

By Sola Ogundipe

During an encounter with Dr. Rex Ajayi, Chairman/MD, South Urology Clinics, Albany, Georgia, USA; the discussion centred on prostate enlargement and prostate cancer—both common health issues among middle aged and elderly men all over the world.

Ajayi, who is also Chairman, ROA Specialist Hospital & Surgical Centre, Arepo,  Ogun State, turned 70 last December. A 1974 graduate of the University of Ibadan College of Medicine, he specialises in Urology and Anatomy. With 44 years experience in medical practice, Ajayi is renowned among the top urologists in the USA and is the first Black Urologist in South Georgia.

He gives insight into his prowess in cancer diagnosis and treatment, even as he describes the unique radiation procedure known as Prostate Seed Brachytherapy—a technique that involves implantation of small radioactive pellets, or “seeds,” into the prostate. Read excerpts below:

We all know what the bladder is. Urine comes in to the bladder which you can liken to a balloon. The balloon has a small neck through which you blow air. Now pass that little neck through an apple and the apple wraps around the neck of the bladder.

That is just how it is. So you see that if anything happens and that apple swells up, it would block the urine flow. Most of the time, prostate problems are not cancerous. They are just problems arising from the prostate getting bigger as we age.

If your prostate gets too big, it shuts down your urine. You go to the toilet 3-4 times at night and the urine is slow and eventually it is cut off. Then you are yelling at 2.00AM when trying to urinate. That condition is called Benign Enlargement of the Prostate.

It is just a big prostate. But cancer actually starts from the skin of the prostate. Cancer may start and not give any sign because it is so far from that little tube in the middle where urine goes through and until you compress that tube, you may not even know.

Early detection is cure

So cancer can only be cured through early detection and we are lucky we have the Prostate Specific Antigen (PSA). Before then, even in the US, people were dying like flies. Then we had what was called the Prostatic Acid Phosphatase (PAP) test which was not very accurate.

We also had the Digital Rectal Examination (DRE) that can help in cancer detection and diagnosis. During the exam, a gloved, lubricated finger is inserted in the rectum to detect changes in the prostate that could indicate an abnormal condition, including cancer. But by the time the cancer could be felt, it was usually almost too late.

Now with the PSA, we can detect cancer, sometimes two to five years before it would have become detectable in those days. Now when you have cancer detected, the next thing is to make sure it does not leave the prostate, so the best thing is usually to take it out which is a major surgery. For a benign prostate, you just go through the inner tube and make a hole for urine, you still leave the prostate in place. For prostate cancer you have to cut out.

Impotence and incontinence

The prostate is at the junction of many things. On either side of the gland is a small, very thin line that you can hardly see. It is a nerve and is what causes erection, so while trying to take that big prostate out, removing or cutting that nerve would mean the patient cannot have erection again. Even with robotic surgery, it is 50 percent risk the person cannot have an erection any more. When we were doing it manually, the risk was almost 100 percent. This is one major issue.

Another issue is incontinence. There is a muscle in the neck of the bladder that helps to control urine flow. It is called the voluntary muscle, and is only meant to control the urine. It is a chunk of muscle that is the part of the neck of the bladder. When it is cut, there really isn’t much left to hold the urine, so it results in a condition in which you keep leaking urine (incontinence) like a faucet.

So these two problems— surgery with all the complications—anaesthesia, death, impotence, infection, incontinence, etc., are one reason that for a long time, people have been seeking alternative treatment for prostate enlargement.

Prostate Seed Brachytherapy

Then there is radiation. You shoot x-rays through the prostate, but the problem is that as you are radiating, you are affecting surrounding organs, such as the rectum and bladder. Hence you are limited to the amount of radiation that would not damage these organs. You do not want to cure the cancer and end up with a hole in the rectum and bowel. So because of this, radiation alone was not very adequate. Some people are lucky they were cured while some people had recurrence. So that lead to looking for a more effective method of using additional radiation without damaging the surrounding structures and that’s how radioactive seed implants came in.

The technical name is

brachytherapy. You put the

“seeds” inside the tissues; those seeds look like grains of rice but are smaller. They carry radiation and using ultrasound and fluoroscopic techniques, you line them up in the prostate so that every cell is covered. Because they are always within half a centimetre of radiation that will give about one and a half times the maximum you can get with external radiation.

In some cases, we combine the two. We get some external radiation with seeds, it depends on if you think that the cancer might actually be a little outside the prostate, you can give four weeks of external radiation just to make sure you sterilize the outside and put this one inside so that you end up with almost twice the maximum dose of radiation.

Late presentation fuels recurrence

We have been doing that in my area in the US for 22-23 years and I’ve not seen any recurrence that I cannot account for. All the recurrences I’ve seen, maybe four or five, all came too late. We always knew from the beginning that there might be recurrence if somebody comes with PSA of 55, we just try our best. But for those who come in with PSA less than 10 and they have been given all the proper treatments, I’ve not seen a recurrence. So you get the same result or better with surgery.

Some doctors try to avoid incontinence and shave part of the prostate but that little knob,called the knobbly,develops cancer sometimes. The cancer is a little outside and you can’t see it. You may take the prostate out, but if you’ve left some part of it there and the patient does well for a year or two,  the cancer comes back.

We don’t have that problem with radiation. I used to do one or two radical prostate surgeries for cancer every week but I’ve not done any for over 20 years. Last year I did about 52 seeds, so that’s about 52 surgeries and they are all doing very well.

Enlightenment pays off

Where I am, all the effort in enlightenment has paid off. I talked on radio and TV and wrote a lot in the papers. I even had my own health newspaper. I went from church to church, and community to community including the police department, talking about this prostate issue. The hospital helped. Sometimes they would call all the people once a year and give them incentives and there were times there would be like 500 men they would talk to about the prostate.

No death recorded in 15 years

I do not think we have heard of prostate cancer death in about 15 years over there. The awareness is tremendous. You would not see a man walking around that has not had his PSA done, so it is very effective and I believe in the awareness programme because I was there in 1984 when almost every month I was at the graveyard when one of my patients died of prostate cancer. Now it is almost like ancient history. It’s all about early detection and awareness.

Get tested yearly

In Nigeria we have compound problems. When I got to the US with my friends, we were amazed at how open people were with their health issues. They don’t hide their health issues. We do. Over there, people show up for checks but here, there is a lot of denial.

People are so afraid to be known to have anything. They would not even go for medical check up. I have friends that are called every year to go for check up but they would not attend. The prostate test should be done every year.