New therapy: Add prostate cancer screening to your New Year resolutions

Age remains the most significant risk factor. Dr Komen says prostate cancer is rarely seen in men under 40, with the vast majority of patients diagnosed much later in life.

“We only see prostate cancer in men who are above 40,” he says, adding that in Kenya, the average age at diagnosis is 63.
Genetics plays a role, though in a smaller proportion of cases.

“People who carry certain genetic mutations like BRCA are more susceptible to getting prostate cancer than those who do not,” Dr Komen says.

Emerging treatment options mean these genetic findings can guide therapy.

“There are therapies for patients with BRCA mutations, so testing is not only important for family members but also for the patient’s own care,” he adds.

Race is another factor. Dr Komen says black men face a higher risk than other populations.

Though lifestyle factors such as diet have been studied, they appear to play a secondary role.

“Eating fatty food has been mentioned in some studies, but the strong risks are age and race,” he explains, while cautioning that smoking remains a major factor in cancer and should be avoided.

One of the biggest challenges with prostate cancer is that it often develops without symptoms. That is why screening is emphasised.
“Screening is done for patients who are asymptomatic, meaning they have no symptoms at all. That is the time one gets the disease,” Dr Komen says.

When symptoms occur, they are often subtle and easy to dismiss. They include poor urine stream, difficulty starting urination, frequent night-time urination and a sensation of incomplete bladder emptying.

In advanced cases, the cancer may spread to the bones, leading to back pain or weakness in the lower limbs.

Diagnosis typically begins with a PSA blood test, though Dr Komen says PSA alone does not confirm the presence of the illness.
“PSA is just a warning sign. It tells us that something is happening in the prostate,” he says.

Raised PSA levels may be caused by infection, inflammation or benign prostate enlargement. Further evaluation often includes a prostate MRI, which helps determine whether a biopsy is needed.

“Biopsy is what confirms that this is cancer,” he explains.

In higher-risk cases, advanced imaging may be used to see if the disease has spread beyond the prostate.

Screening guidelines continue to generate debate worldwide. Kenya has opted for early start.

“The Ministry of Health guidelines recommend that men above 45 years start checking their PSA,” Dr Komen says.

While some countries begin screening at 50 or 55, Kenya’s approach reflects higher risk among black men and historical patterns of late diagnosis.

“Many patients used to seek therapy very late. In such a case, treatment is only palliative,” he notes.

A diagnosis does not always mean immediate treatment, however. Dr Komen says prostate cancer is different from patient to patient.

“Not all prostate cancers are aggressive,” he says, adding that doctors use PSA levels, biopsy results and imaging to classify risk.
For men with low-risk cancer, surveillance is recommended.

“Some patients don’t die from prostate cancer; they die with prostate cancer,” he says, stressing that close monitoring can be safer than immediate intervention in selected cases.

Most standard treatment options are available in Kenya.

“For localised prostate cancer, treatment options include surgery or radiotherapy. Both give equivalent cure rates,” Dr Komen says.
Surgical options include open and laparoscopic procedures, while radiotherapy is widely offered across the country.

Robotic surgery is the most advanced option not yet broadly available, though outcomes with existing methods remain comparable.

Radiotherapy has also advanced. Dr Komen says new approaches allow treatment to be delivered more precisely and over a shorter period than before.

“With techniques like stereotactic body radiotherapy, we can deliver treatment in five sessions," he says.

Dr Komen advises men to change their approach health.

“They only come when very sick,” he says.

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