Chief Okafor had mild urinary symptoms he had attributed to age. His son insisted on a PSA test. It came back at 11.4 ng/mL — nearly three times the upper limit of normal for his age. Biopsy found localised prostate cancer at a grade and stage where curative treatment was possible. He is now in remission.
Retired civil servant, Gbagada. Presented at the insistence of his son for a prostate check — had no urinary symptoms severe enough to prompt attendance. PSA: 11.4 ng/mL (significantly elevated for age; age-adjusted normal: < 4.0 ng/mL for men 60–69). Prostate scan: 42 g prostate, no gross suspicious lesions on ultrasound. Referred to urology. Biopsy: Gleason 3+4 (Grade Group 2) prostate cancer confirmed.
PSA Test (Prostate-Specific Antigen)Chief Okafor had been resisting his son's suggestion of a "prostate check" for two years. He was 68, he had some slowing of his urine stream and one or two trips to the toilet at night — but so did every man he knew at his age. He was not ill. He did not want to know.
His son, a pharmacist in Lagos, drove him to Mascot Healthcare on a Saturday morning and sat with him while the blood was drawn. Chief Okafor agreed to the PSA test on the condition that "if it's normal, you never mention the prostate again." The result came back the next morning: 11.4 ng/mL.
"That number means there is a significant possibility of prostate cancer," the doctor told him. "The PSA alone does not tell us — we need a scan and then likely a biopsy. But we need to act quickly." The prostate ultrasound showed a 42 g prostate — moderately enlarged — with no obvious lesion on imaging (early prostate cancer is often invisible on standard ultrasound). The urology referral was urgent.
PSA (prostate-specific antigen) is a protein produced by prostate cells — both benign and cancerous. Elevated PSA prompts further investigation but is not a direct cancer test. It is the best available blood marker for prostate cancer risk and is the cornerstone of prostate cancer early detection.
Age-adjusted normals: < 2.5 ng/mL (40s), < 3.5 (50s), < 4.0 (60s), < 5.5 (70s). Chief Okafor's: 11.4 at age 68 — significantly elevated.
PSA divided by prostate volume. High density (> 0.15 ng/mL/cc) increases cancer suspicion even with moderately elevated PSA.
Rate of PSA rise over time — rapid rise (> 0.75 ng/mL/year) is a cancer signal even if absolute level is modest.
Low ratio (< 25%) increases cancer probability; BPH tends to produce a higher free PSA fraction.
PSA prompts biopsy — 12 core transrectal/perineal biopsy under anaesthetic gives histological diagnosis and grading.
Prostate cancer found at a localised stage (confined to the gland) is curable — with radical prostatectomy or radiotherapy achieving 95%+ 10-year survival. Prostate cancer found after it has spread to bone or lymph nodes is treatable but rarely curable.
Chief Okafor had mild urinary symptoms he had attributed to BPH — which is what it was, in part. But behind the BPH, a Gleason 3+4 cancer had been growing. Without the PSA test, the cancer would likely have been detected at a more advanced stage — when the urinary symptoms became severe or bone pain developed.
Transrectal ultrasound-guided biopsy: 12 cores taken. Histology: Gleason 3+4 (Grade Group 2) — intermediate risk. 4 of 12 cores positive; maximum core involvement 60%. No extracapsular extension on MRI (ordered by the urologist). Clinical stage: T2b — localised to the prostate.
Treatment options discussed at MDT: radical prostatectomy vs. external beam radiotherapy + androgen deprivation. Chief Okafor chose robotic-assisted radical prostatectomy at a specialist centre in Lagos. Surgery performed 6 weeks after diagnosis.
Histology of the prostatectomy specimen: pT2c — organ-confined, clear surgical margins. All lymph nodes clear. Post-operative PSA at 6 weeks: 0.04 ng/mL — near-undetectable. Biochemical remission confirmed.
PSA 11.4; biopsy: Gleason 3+4 (Grade Group 2), 4/12 cores, T2b. Radical prostatectomy: pT2c, clear margins, nodes clear. Post-op PSA 0.04.
Urgent urology referral; MRI prostate; biopsy; MDT discussion; robotic prostatectomy; post-operative PSA monitoring 3-monthly.
PSA at 6 weeks: 0.04. PSA at 3 months: 0.03. PSA at 12 months: 0.03 — sustained biochemical remission. Continence fully recovered at 6 months.
Chief Okafor is in biochemical remission at 12 months. Gleason 3+4 localised prostate cancer — found by a PSA test his son insisted on — was cured by surgery. He now advocates PSA testing to every man he knows over 50.
Prostate cancer in the early, curable stage causes no symptoms different from BPH. Weak stream and nocturia are not cancer symptoms — they are the symptoms of the BPH that may be present alongside an early cancer. PSA is the test that finds what the symptoms cannot.
The 5 minutes it took to draw blood for a PSA test — and the test Chief Okafor almost refused — was the intervention that enabled a curative operation and a normal life expectancy. His father, who died of prostate cancer at 72, had never had a PSA test.
Prostate cancer feels like normal ageing until it's advanced. A PSA blood test every year from age 50 is the test that finds it while it's still curable.
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