Prostate cancer deaths in Nigeria mind-boggling — Consultant urologist

What is laparoscopy?…CONTINUE READING

Laparoscopy is a keyhole surgical technology that will allow you to perform operations in the abdomen or in any cavity of the body with the aid of a telescopic camera that magnifies the operation rather than using the naked eye. With the magnification of laparoscopy, you have over three times the magnification, and these days you have it in high definition, and in the case of a robot, you have it in three dimensions. As a result, you have an unrivalled vision and can go beyond what traditional open surgery allows.
Which areas of disease can laparoscopy help humans with?

Laparoscopic surgery has expanded in recent times. It’s been happening for 40 or 60 years. One of the earliest laparoscopic procedures that were done was prostatectomy, which is the removal of gallstones. That was revolutionary because, before that, gallstones were removed by open surgery in the abdomen. With laparoscopy, it was easy to remove the gallstones.

However, in terms of men’s health, the prostrate is the number one issue, and with the help of laparoscopy, previously difficult surgery can now be performed because of the location of the prostrate deep down into the pelvis.

With a laparoscopic instrument, you’re able to reach and view it in three dimensions. And with such magnification, you can actually perform intricate dissection with more precision than you could have done with open surgery. Laparoscopy can be used in various surgical specialties; you can also use endoscopy for a joint, but when you talk about laparoscopy, you talk of the big cavities, such as the abdomen and thorax.
What’s the difference between laparoscopy and open surgery?

Open surgery is about making a long cut from the abdomen downward. The appendix is a very popular one. When people have it, they open the abdomen and are taken care of for a few days. But I can tell you now that if you have an appendix, it will take you 15 minutes with laparoscopic surgery. And you go home within one or two hours.

The major difference is that laparoscopy reduces blood loss and the length of stay in the hospital. When I was training as a medical student, if you had a prostatectomy, you could finish the whole process within a surgical unit and the patient would still be there. I’m talking about at least one month. And you’re seeing the patient every day in the ward, with a bucketful of blood loss. But I do that same operation laparoscopically in the UK, and you go back in the evening. That is the same operation in that the patient would stay in the hospital for weeks. I first did that in the UK, and I’m hoping that we can expand that to this environment. People should come and have an operation without thinking about death.

But for the prostate, it’s the most important operation in the world. And I said that because it’s the key to a man’s health. There was a study a few years ago that asked men with cancer what they would prefer to cure their cancer with: your cancer with this operation, and you’re alive, you’re safe, but you will lose your erection. On the other hand, would you prefer to have a lesser surgery? You might not be cured, but you will keep your erection.

More than 50 per cent of the patients opted for a lesser surgery. It tells you that for a man, an erection is very important. So, why would a man have an operation and become impotent? They chose to die because they wanted to keep their erection.

But now, with laparoscopy and laboratory techniques, we have unparalleled fissures of the prostate, and we are able to perform the operation and preserve the functions, and that’s important. If you do open surgery, you have to wear a headlamp as the one coal miners wear.
Why did you come to Nigeria since most Nigerians are not financially buoyant to afford a laparoscopic treatment?

This is a very good question. You see, I have achieved everything I could achieve in my career in the UK. I became a professor at a young age. But over the years, I’ve operated on many Nigerians, including very wealthy individuals who came to me for this procedure. And I started thinking about the pandemic—how about those who can’t afford to fly to the UK to have this operation?

They are dying because the mortality rate of prostate cancer is mind-boggling in Nigeria. There is no family or extended family of men aged 50 to 80 that does not have someone who has died from prostate cancer. It was then that I thought of performing this operation for my people. I need to give back to Nigeria while also leaving a legacy that will hopefully encourage other professionals to come to Nigeria.

At the end of the day, it’s important. If I hadn’t come to Nigeria, you wouldn’t be interviewing me. You won’t even have met me. And I’ve met a lot of interesting people who are coming to Nigeria to perform this operation. And I’ve done many of these operations, and nothing gladdens me more than seeing the smile and joy of my patient. I didn’t come to do it for financial reasons because, after all, when you come and have an operation in the UK, you pay a lot of money.

However, I came to do it for the greater good, so that men in this country would not have to die. I’m happy I started to change the narrative to challenge the old concept and make a paradigm shift to a new vision for surgery in Nigeria. And we have started to change things. I also think that the more difficult it would have been a year ago to offer a man in this country an open operation, the more men now know about the keyhole operation.

Now you have a choice, and we have to change the narrative, and that’s what I’ve come to do so that in the future I could train more people who would take over and continue to live the revolution.
Does that mean there is no laparoscopy in Nigeria?

Laparoscopic Radical Prostatectomy is difficult. You do a laparoscopy when you’re looking into the abdomen for a gynaecological problem. They have been doing so, but laparoscopic radical prostatectomy is the ultimate protection because it is extremely difficult to perform and requires a high level of skill. That’s the reason why it’s not available in Nigeria.
Since when did you start coming home?

We performed the first Nigerian case in April 2022, and we’ve done over 25 cases, with countless others planned.

Sadly, a significant number of cases referred to me are beyond surgery. They are already metastatic, which is why we need to spread the news that men should check their prostate so that it can be identified early and cured. There’s no point in postponing it before it spreads. When it spreads, it becomes difficult to treat, and nothing can be done. Also, the life expectancy is less than two years.
What’s your advice for men on regular checks?

We have a simple blood test called the PSA. Although the PSA is specific to the prostate, it’s not cancer-specific. So, your PSA can be high for other reasons than just cancer. But at least with a raised PSA, we can then isolate you and investigate you in more detail. Prostate cancer is three times more common in blacks than whites. A black man is already predisposed to developing prostate cancer.

Secondly, if you have one person in your family who had prostate cancer, you’re two to three steps close to developing prostate cancer. If your father had prostate cancer, you’re three times more likely to develop it as a son. And not only are you likely to develop it, but you’re going to develop it seven years earlier than the normal population. T he peak age for prostate cancer is 60 to 65 years old. But if you have a family history, you’re likely to develop it in your fifties.

A PSA blood test is mandatory for you. If you’re a black man, you should consider checking your PSA at the age of 50. It is the most common male cancer in the United States. The mortality rate is high, but it can be cured when detected early. You would need to see a neurologist and have an MRI scan. That’s the message I have for any man in this country who is over 40.
What is prostate cancer, briefly?

Prostate cancer is a type of cancer that affects the prostate. The prostate gland itself is a small gland that is at the base of the bladder, and it produces part of the semen that nourishes the sperm. To be honest, it has little function and then has problems.

You can have symptoms such as prostate enlargement. But for prostate cancer, you don’t want to have symptoms because when you have symptoms, the cancer is already advanced.
There are reports of nine out of 10 doctors leaving Nigeria. What advice do you have for the medical sector about this brain drain?

The Nigerian government has to urgently address this situation. They need to urgently meet with the Nigerian Medical Association to come up with strategies to overcome the significant brain drain of doctors. I can tell you that in my hospitals in the UK, a lot of Nigerian doctors have been neglected. There are so many of them in my hospital.

So who’s going to look after the population? If you have a heart attack, you’re more likely to die because there’s nobody to treat you. The ones that are left are not the best. The best ones have been chosen by the United Kingdom and the United States of America, and they’ve left.

This is a crisis that needs to be dealt with urgently. And the best way to deal with it is to pay them well.

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Second, they have to have equipment. If you have good equipment and training, you will be equipped to treat people. It’s an issue that’s been troubling me quite significantly.