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Prostate Cancer Screening in Nigeria

What you need to know about prostate cancer screening

Prostate cancer is the most common cancer in Nigerian men, affecting older men predominantly. Men of African descent have the highest global rates of prostate cancer and are diagnosed at younger ages and with more aggressive disease than men of other ethnic backgrounds. Despite this, prostate cancer awareness remains low in Nigeria, and most men present with advanced, metastatic disease. PSA (prostate-specific antigen) blood test screening combined with clinical examination can detect prostate cancer at an early, potentially curable stage.

Signs and Symptoms

✓ Early prostate cancer: usually NO symptoms — cancer is confined to the gland
✓ Urinary symptoms (usually from benign prostatic hyperplasia, not cancer): weak stream, hesitancy, frequency, nocturia, incomplete emptying
✓ Advanced prostate cancer: bone pain (lower back, hips, pelvis — from bone metastases), weight loss, fatigue, blood in urine or semen
✓ Spinal cord compression from metastases: new back pain with leg weakness, numbness, or bladder/bowel dysfunction — neurological emergency

Risk Factors

When to Seek Help

Screening discussion from age 45Nigerian men should discuss PSA screening with a doctor from age 45 (earlier if family history of prostate cancer); understand the benefits and limitations of the test before having it
UrgentAny man with new back, hip, or pelvic bone pain, weight loss, or fatigue — advanced prostate cancer must be excluded with PSA and imaging
EmergencyLeg weakness, numbness, or new bladder/bowel dysfunction with bone pain — possible metastatic cord compression; emergency MRI spine needed

Tests & Diagnosis

🧪 PSA (prostate-specific antigen)
Blood test — PSA >4.0 ng/mL requires further evaluation; PSA 4-10 ng/mL = 'grey zone'; PSA >10 ng/mL = high suspicion for cancer; PSA rises with age, prostatitis, BPH, and after prostate examination — interpret in context
🧪 Digital rectal examination (DRE)
Doctor's finger examination of the prostate through the rectum — detects hard, irregular nodules; combined with PSA improves early detection
🧪 Prostate biopsy
Transrectal ultrasound (TRUS)-guided needle biopsy — definitive diagnosis; Gleason score grades cancer aggressiveness; available at major Nigerian urology departments
🧪 MRI prostate (mpMRI)
Multi-parametric MRI — shows suspicious areas within the prostate; guides targeted biopsy; available at leading Nigerian radiology centres
🧪 Bone scan and CT
Staging — assesses whether cancer has spread to bones (most common site) or lymph nodes

Treatment Options

1
Active surveillance
For low-risk, slow-growing prostate cancer — regular PSA, DRE, and repeat biopsy instead of immediate treatment; avoids side effects of treatment in men whose cancer may never cause problems
2
Radical prostatectomy
Surgical removal of the prostate — for localised cancer in fit men; laparoscopic or open approach; side effects include erectile dysfunction and urinary incontinence; available at teaching hospitals with urology departments
3
Radiotherapy
External beam or brachytherapy (radioactive seed implants) for localised cancer; equivalent outcomes to surgery; available at limited centres in Nigeria
4
Hormone therapy (androgen deprivation)
Luteinising hormone-releasing hormone agonists (LHRH agonists, e.g., leuprolide) or surgical castration (orchidectomy) — dramatically reduces PSA and controls advanced disease; mainstay of treatment in Nigeria where many present late
5
Docetaxel chemotherapy
For castration-resistant prostate cancer (CRPC) — tumour no longer responsive to hormone therapy; available at some Nigerian oncology centres

Frequently Asked Questions

Should all men over 50 have a PSA test?
Screening is not universally recommended because PSA can lead to over-diagnosis and over-treatment of cancers that would never cause harm. However, given the high burden and aggressive disease in Nigerian men, most Nigerian urologists recommend PSA testing from age 45 (40 if family history) with informed discussion of benefits and limitations.
Is a raised PSA always cancer?
No — PSA is elevated by prostatitis, benign prostatic hyperplasia (BPH), urinary tract infection, and even vigorous exercise or recent ejaculation. A raised PSA needs context — rate of rise, pattern, and clinical examination together guide whether biopsy is needed.
Is surgery or radiotherapy better for prostate cancer?
Both are equally effective for localised prostate cancer — the choice depends on patient age, fitness, cancer characteristics, and patient preference regarding side-effect profile. Surgery risks incontinence and erectile dysfunction early; radiotherapy risks bowel problems. Discuss thoroughly with a urologist.
What is hormonal treatment for prostate cancer?
Prostate cancer cells are driven by the male hormone testosterone. Reducing testosterone (with injections of LHRH agonists or surgical removal of the testes — orchidectomy) dramatically shrinks the tumour and reduces PSA. Orchidectomy is cheaper and permanent; LHRH agonists are reversible.
Is prostate cancer treatable in Nigeria?
Yes — localised prostate cancer treated surgically or with radiotherapy has excellent outcomes. Advanced disease can be controlled for years with hormone therapy. The challenge is late presentation — most Nigerian men present with metastatic disease that cannot be cured.

Related Pages

Palliative Care in NigeriaBreast Cancer Screening in NigeriaColorectal Cancer: Warning SignsCancer Treatment Options in Nigeria

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