CHAPTER ONE
1.0 INTRODUCTION
1.1. Background to the study
Prostate cancer (PC) is an adenocarcinoma of the male prostate gland. It is increasingly becoming an important health burden among men in the world (Ferlayet al., 2011; Lozano et al., 2012). An estimated 0.9 million cases and 0.26 million deaths of prostate cancer occur annually in the world (Ferlayet al., 2011). Prostate cancer is the number one cancer in both incidences and mortality in Africa, constituting 40,000 (13%) of all male cancer incidences and 28,000 (11.3%) of all male cancer-associated mortalities (Ferlayet al., 2011). In East Africa, prostate cancer ranks third in both incidence and mortality, and leads to an estimated 9,000 (9% of all male cancers) cases and 7,300 (8.5% of all male cancer) deaths annually (Ferlayet al., 2011). It is important to note that Prostate cancer incidences increased by 64.5% between 1990 and 2010 (Lozano et al., 2012).
Prostate is the tubuloalveolar exocrine gland of the male reproductive system. It is about 3cm long, weighs about 20g and is located in the pelvis, under the urinary bladder and in front of the rectum (Meyers and Robert, 2000). The function of the prostate is to store and secrete a slightly alkaline fluid, milky or white in appearance, that usually constitutes 25-30% of the volume of the semen along with spermatozoa and seminal vesicle fluid (Babain et al., 1999). The prostate gland wraps around the urethra, the tube that carries urine from the bladder out of the tip of the penis.
Prostate enlargement is often a natural part of aging process (Osterling, 1995). An enlarged prostate press on the urethra and causes difficulty with urination (Dennis et al., 2002) and other associated bladder problems that include weak urine stream, difficulty starting urination, leaking urine, and feeling like the bladder has not been completely emptied, frequent need to urinate, especially at night and frequent bladder infections.
Human prostate specific antigen (PSA) is a serine protease, a single chain glycoprotein with a molecular weight of approximately 34,000 Daltons containing 7% carbohydrate by weight. PSA is immunologically specific for prostate tissue; it is functionally and immunologically different from prostatic acid phosphatase (Heller, 1987).
The PSA test measures the level of prostate specific antigen in the blood. Its measurement in the blood can be used to detect disease. It’s sometimes called a biological marker or tumor marker. (Wang et al.,1981) because PSA elevation is not associated with healthy men or is it present in any other tissue obtained from man. Recent studies (Jermal et al., 2005) also indicate that PSA measurements can enhance early prostate cancer detection when combined with ultrasound scanning, digital rectal examination and biopsy.
Elevated PSA has been associated with prostatitis (Dennis et al., 2000) benign prostatic hyperplasia (BPH) (Christensen and Andriole, 2009) Prostate cancer (Kran et al., 1994) and inflammatory conditions of other adjacent genitourinary tissues which have been attributed to age, race, family history (Steinberg, et al., 1990) and hormonal factors (Wigle et al., 2008). Since it is normal for men to have a low level of PSA in their blood, this means that prostate cancer or benign (not cancerous) conditions can increase men PSA levels. As man’s age increases, both benign prostate conditions and prostate cancer become more common.
This proposed study will be undertaken to see the possibility of detecting early the men with elevated PSA and probably prostate cancer.
1.2. Statement of the Problem
Human prostate specific antigen (PSA) is a serine protease, a single chain glycoprotein with a molecular weight of approximately 34,000 Daltons containing 7% carbohydrate by weight. PSA is immunologically specific for prostate tissue; it is functionally and immunologically different from prostatic acid phosphatase (Heller,1987).
The PSA test measures the level of prostate specific antigen in the blood. Its measurement in the blood can be used to detect disease. It’s sometimes called a biological marker or tumormarker(Wang, et al.,1981) because PSA elevation is not associated with healthy men or is it present in any other tissue obtained from man. Recent studies(Jermal et al,2005) also indicate that PSA measurements can enhance early prostate cancer detection when combined with ultrasound scanning, digital rectal examination and biopsy.
In Sub-saharan Africa, prostate cancer reports have been hospital-based and as such very few studies have been hospital-based and as such very few studies, have been conducted on indigenious populations. Not surprising therefore, and not withstanding the increasing incidences and mortality resulting from prostate cancer in Nigeria(Ferlay, et al., 2011), there have been neither specific policies nor effective strategies for controlling the disease. One of the most effective intervention tools for prostate cancer is screening and early diagnosis (Magoha& Ngumi,2000). However, the lack of knowledge on the disease and the low uptake of routine screening among men most at risk of developing prostate cancer compounds the problem. In addition, little is known in Delta , state about the factors predisposing men to increased risk of prostate cancer as well as hindering awareness and uptake of screening and early diagnosis. Moreover, limited studies in Delta in general, have led to over-reliance on research findings from elsewhere in the world, despite the fact that risks and factors influencing the outcomes of the disease are largely different. Thus, there has been an urgent need to identify determinants of prostate cancer initially and hence this study.
1.3. Objectives of the study
General objective
The general objectives of this study was to determine the prostate cancer prevalence, awareness, knowledge, uptake of screening, and their associations with socio-demographic variables among men of 40 years and above in Warri South LGA.
Specific objectives
- i) To assess the prevalence of prostate cancer among men according to age group in Warri South LGA.
- ii) To assess the level of prostate cancer screening among men of 40 years and above in Warri South LGA.
1.4. Research questions
- i) What is the prevalence of prostate cancer according to age group among men in Warri South LGA?
- ii) What is the uptake level of prostate cancer screening among men of 40 years and above in Warri South LGA?
1.5. Hypotheses
H01: There is no association between Awareness and knowledge of Prostate cancer and the uptake of Prostate cancer screening among men according to age group in Warri South LGA.
H02 : Socio-demographic factors (age, education, marital status, religion, and occupation) do not influence Prostate cancer awareness, knowledge, perception on self-vulnerability on Prostrate cancer and uptake of Prostate Cancer screening among men of 40 years and above in Warri South LGA.
1.6. Significance of this study
This is a key study that shows the prevalence of prostate cancer among men in Warri South LGA Delta State. The results of this study calls for urgent health measures aimed at promoting specific knowledge levels on prostate cancer and calls for encouraging behavioural changes towards avoiding risks for the development of prostate cancer in men. The study further calls for the design of novel screening strategies for prostate cancer across the country, as early screening for PC has been shown to contribute significantly to the management of the disease (MPHS & MMS, 2011). It is further hoped that the data and information generated will also be used by local cancer bodies, academicians, scientists and medics for developing policies for control and prevention of prostate cancer in Nigeria. The recommendations of this study on improving uptake of screening and promoting information dissemination on prostate cancer should also go along way in significantly improving the efficient and effective health management of prostate cancer at all stages.
1.7. Scope of the study
This study focuses on the prevalence of prostate cancer in Warri L.G.A. it identifies the low education and poor perception level on self vulnerability to prostate cancer. This lead to low knowledge and awareness level and uptake of screening for prostate cancer Among men Residing in Warri South L.G.A.
About one thousand, three hundred and twenty five men (1,325) of age 40 years and above (median age of 59 years) were assessed for prostate specific antigen (PSA) level with institution approval from hospital, the enzyme linked immunesorbent assay (ELISA) method was used.
1.8. Limitations of this study
Sampling of respondents for this study was not conducted among men residing in the informal settlements and among gated homes that denied access, and income levels were not obtained from the respondents in this study. In order to increase the authenticity of the study, employment and occupation status were used as surrogate for income and residence.
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