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Prostate Cancer in Ghana: The role of the Pharmacist
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Prostate cancer is the second most common cancer in men and the fourth commonest cancer. The 2012 GLOBOCAN database contains a report by WHO on cancer incidence and mortality. The report states that there are about 1.1 million new cases of prostate cancer and this accounts for 15% of cancers diagnosed in men [1]. The annual global mortality rate resulting from prostate cancer is estimated to be 307,000, and this represents 6.6% of all cancer related-deaths in men. Although prostate cancer is common among men in the developed world, the mortality rate is high among those of African descent. There has been a global increase in the incidence of prostate cancer; however, the associated number of deaths has been decreasing [2]. The aetiology of prostate cancer is unknown; however, certain risk factors have been shown to predispose some individuals to the development of the disease. These include advanced age, family history, genetic predisposition, race, and geographical location. It is hoped that current advances in healthcare will ultimately result in improved quality of health and life expectancy of patients. However, this will most likely translate into an increase in the incidence of prostate cancer since advanced age is a risk factor.

 

There is limited data on prostate cancer incidence and mortality in Africans; while the incidence is high in the developed world, mortality is high in developing countries. Genome-wide studies have shown that the susceptibility of an African to prostate cancer is attributable to the expression of certain independent genetic loci. These studies have identified chromosomes 8q24 and 17q21 to be associated with a higher risk of prostate cancer development in African men. Chromosome 17q21 variation was found to be 7% higher in Ghanaian men than in men of non-African descent.

 

The incidence of prostate cancer across the African subregion has been observed to be on the increase, as observed globally [3]. Hsing et al. screened 1000 Ghanaian men in Accra and found a high prevalence of screen-detected prostate cancer among them. The incidence was higher in men aged 50-59 years, forming 48% of all the men who were screened [4]. According to a A global cancer database compiled in 2010 , it was estimated that  Ghana records number of 921 new prostate cancer cases every year, which indicates an incidence rate of 200 out of 100,000 men [11]. This depicts a 17.6% increase above the worldwide value of 170 out of 100,000 cases [10]. Out of the 1000 men diagnosed with the disease, a death rate of 80% was recorded [10]. This phenomenon has been attributed to late detection of the cancer, as most of the cases were older men. It is, therefore, anticipated that 20% of Ghanaian men may develop prostate cancer [11]. Statistics from the Komfo Anokye Teaching Hospital also show that prostate cancer is the second most diagnosed cancer in men [5]. A study conducted at the Korle-Bu Teaching Hospital revealed that prostate cancer accounts for 31% of all cancers diagnosed in men [12]. These rates are alarming and hence call for the urgent attention of all, especially healthcare professionals.

 

It is reported that men aged 56-85 years formed 86.6% of men who had their prostate-specific antigen (PSA) levels above the normal value in a screening exercise carried out in Kumasi [6]. In another screening study conducted among 1000 men in Accra, persons in the same age group had higher PSA levels [4].

Patients with prostate cancer are usually asymptomatic during the early stages of the disease. In an environment where people visit the hospital only when the severity of the disease is unbearable, symptoms are likely to be overlooked. Common symptoms associated with prostate cancer include the following [7]:

·      Frequent urination

·      New onset of erectile dysfunction

·      Urge to urinate frequently at night

·      The need to strain to empty bladder

·      Burning sensation during urination (less common)

·      Discomfort while seated

·      Urine incontinence

These symptoms are not peculiar to prostate cancer; hence, it is difficult to address such issues at the initial stages. Moreover, patients may not present with all the symptoms. In the Ghanaian setting where cost is a major determinant in healthcare-seeking patterns, people like to seek first aid to remedy situations rather than visit the hospital for treatment. This is where the pharmacist comes in as the right contact person for such patients.

In the community pharmacy, most pharmacists encounter patients or clients who complain of low libido, pain during urination, or any of the aforementioned symptoms. Mostly, the initial treatment options considered involve management of sexually transmitted diseases or providing a short-term remedy for low libido. Pharmacists may not really be faulted for such treatment choices since our training, to a large extent, does not adequately equip us to go beyond managing diseases of common occurrence.

Prostate cancer is one of the few cancers that can be cured after its early detection. The 5- and 10-year survival rates for men who are diagnosed early are 99 and 95%, respectively, indicating that advocacy for early detection and prompt treatment will go a long way to assist Ghana in reducing mortality associated with prostate cancer.

The question is, “why do countries that report very high incidences of prostate cancer record very low mortality rates?” The answer is straightforward: early detection and prompt treatment. The way forward is to create the awareness for early detection with the pharmacist as a key player. 

So, how does the pharmacist fit into this? The pharmacist is the first port of call in the health-seeking patterns of Ghanaians; therefore, people usually present at the community pharmacy with subtle symptoms such as the ones described above. Firstly, pharmacists ought to be empowered with the requisite knowledge on prostate cancer. Odedina et al. have indicated that 95% of community pharmacists in Florida would appreciate training on prostate cancer for the benefit of their patients, [8] and this is likely to be the same in Ghana. It is imperative that pharmacists build capacity to lead change in the prostate cancer narrative for Ghanaians. Once equipped, pharmacists can adequately educate their community folks appropriately with particular focus on regular screening and early detection. The new guidelines for prostate cancer screening in the USA indicate that men aged 55-69 years should have a PSA screen as part of their routine medical check-up [13]. Given the increasing incidence of prostate cancer in Ghana, it is worth suggesting that men who are at least 50 years old should be encouraged to screen for prostate cancer at least once a year. Pharmacists should also encourage clients who recurrently report at their facilities with some of the symptoms of prostate cancer to get screened, especially if they are above the age of 50. At the individual level, pharmacists can encourage men to develop proactive individualized action plans towards screening for prostate cancer. As part of the agenda to reiterate the role of pharmacists in the healthcare system, risk assessment forms may be provided in a questionnaire format. These will assist community pharmacists carry out risk stratification for clients and also serve as referral notes for further clinical assessment. Moreover, pharmacists in remote areas where healthcare facilities are limited can use the resource as a great tool to reach out to their communities [8].

Hospital pharmacists can also assist patients who have been diagnosed with prostate cancer and are currently receiving treatment by advising them on the side effects associated with hormone therapy and chemotherapy. Through education and constant interaction with patients, pharmacists can identify patient-specific needs, which can be recorded on care-forms for future use [9].

Pharmacists can also use media platforms to educate the public on the importance of screening for prostate cancer and the benefits of early detection.

The clarion call to all pharmacists is that, the next time that old man walks into your facility to request for the usual sexual performance pills, a little probing and chit-chat on prostate cancer screening may go a long way to save a life. Furthermore, an opportunity to speak on prostate cancer may just be an opportunity to save another life. Let us come together as a body to help reduce the mortality associated with prostate cancer in Ghana.

 

REFERENCES

1.         Ferlay, J.S., I.; Dikshit, R.; Eser, S.; Mathers, C.; Rebelo, M.; Parkin,D. M.; Forman, D.; Bray, F.;, Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 2014. 136: p. 359-386.

2.         Wong, M.C.S.G., W. B.; Wang, H. H. X.; Fung, F. D. H.; and C.W. Leung, S. Y. S.; Ng, C. F.; Sung, J. J. Y.; Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries. European Urology, 2016. 70(2016): p. 862-874.

3.         Chu, L.W., et al., Prostate cancer incidence rates in Africa. Prostate Cancer, 2011. 2011: p. 947870.

4.         Hsing, A.W., et al., High prevalence of screen detected prostate cancer in West Africans: implications for racial disparity of prostate cancer. J Urol, 2014. 192(3): p. 730-5.

5.         Laryea, D.O., et al., Cancer incidence in Ghana, 2012: evidence from a population-based cancer registry. BMC Cancer, 2014. 14(362): p. 1-8.

6.         Arthur, F.K.N., et al., Prostate cancer screening in Ghana - a clinical benefit? Journal of Science and Technology (Ghana), 2006. 26(1).

7.         Hamilton, W. and D. Sharp, Symptomatic diagnosis of prostate cancer in primary care: a structured review. British Journal of General practice, 2004: p. 617-21.

8.         Odedina, F.T., et al., Pharmacists as health educators and risk communicators in the early detection of prostate cancer. Res Social Adm Pharm, 2008. 4(1): p. 59-66.

9.         J., H.A. and M. H., The community pharmacist’s role in cancer screening and prevention. Canadian Pharmacist Journal, 2016. 149(5): p. 274-282.

10.  https://www.modernghana.com/lifestyle/5288/prostate-cancer-incidence-rates-in-ghana-the-way-forward.html   (30/5/2018; 3:20 am)

 

11.  http://233livenews.com/2015/02/04/1-in-5-ghanaian-men-will-get-prostate-cancer-in-their-lifetime   (30/5/2018; 3:35 am)

 

12.  http://www.peacefmonline.com/pages/local/health/201404/195626.php  (30/5/2018; 3:47 am)

 

13.  https://www.cnbc.com/2017/04/10/new-guidelines-for-prostate-cancer-screening.html (30/5/2018; 4:10 am)