Opinion

Talking Cancer: Misconceptions of Medical Castration

On Thursday April 7, 2016 I featured on Radio Hot FM’s live phone-in programme the Hot Seat together with Dr. Maurice Mwale a consultant oncologist at the Cancer Diseases Hospital (CDH). I was on the programme hosted by Zachariah Chavula as Founder and Chief Executive Officer of the Prostate Cancer Foundation of Zambia (PCFZ).

It was during this programme that I mentioned the fact that as a prostate cancer patient I am actually castrated. During the same programme I also gave out my mobile phone number to a listener who called in wanting to know what telephone number I could be reached on. I readily and willing gave out my number. As a result of this, I have received a lot of calls from people that listened in wanting to know what this castration entails and I must admit a lot of them are very scared. There is no cause to be scared of this if it will help in improving your quality of life as a prostate cancer patient. I am actually inclined to believe that it is mainly because of this aspect of castration that a lot of men with symptoms of prostate cancer tend to shun going a step further, to get screened.

What men and everyone else should know is that castration is not performed on all prostate cancer patients except for those with it in an advanced stage like the case was with me. The main reason for castration, which is performed surgically or medically, is to starve the prostate gland of testosterone -the male hormone – which is the main nourishment of the cancer cells. Almost always, medical staff will give the prostate cancer patient the two options – surgical or medical castration. Surgical castration simply means the testicles are removed but I have also come to learn that to spare the testicles like it is with medical castration, only the tube that carries the testosterone is cut. By the time I started treatment in July 2015 after being diagnosed two months earlier I had done a lot of reading on prostate cancer and was well informed so I chose the medical way which involved taking one small tablet, whose name I have forgotten, for 15 days. Medical castration leaves the testicles intact but effectively cuts off the supply of the male hormone even though at some point the testicles may shrink.

There being no more testosterone being produced automatically implies that reproduction is a thing of the past. I shall never have children ever again even though I am able to have sex as normally as I used to before the medical castration. Now, I imagine someone’s eyes bulging out and the other person stopping to read but this is the reality and at least I am writing from the point of view of a prostate cancer patient who is medically castrated but is able to have an erection and have sex. I wish I could get hold of a fellow patient who has undergone surgical castration to find out if he is able to have an erection and sex. At the end of the day it is the prostate cancer patient’s choice to be castrated or not. May the truth be told, I do not know of any sperm bank here in Zambia where sperms may be stored for castrated prostate cancer patients that still want to have children. Thanks be to God, I have three daughters, two sons and a very understanding wife. But one very important aspect to also have in mind is that almost all cancer treatment has an effect on reproduction in both men and women.

From what I have observed a lot of men start prostate cancer treatment when the disease is in its advanced stage. I have also rightly observed that a lot of men are diagnosed with prostate cancer in their fifties, mid-fifties and so on but for reasons only known to themselves never want to face the reality in the process delaying treatment to when they are in their late sixties or early seventies all along surviving on pain killers and the grace of God. It is for this reason that here in Zambia a lot of people think that prostate cancer affects only men of that age group, late sixties and early seventies. This is a terrible misconception.

A few months ago I was greeted by an elderly woman who had escorted her husband for treatment at the CDH who when I told her what I was at the hospital for prostate cancer treatment thought that the disease got me while I am still very young believing that I am way below forty years. When I told her that I am more than fifty and men at risk of having the disease are those fifty years and above she simply went mute. It turned out to be that her husband in his early seventies actually has prostate cancer. So I am more than convinced that this kind of thinking may be contributing to men of my age not wanting to come out if they have any symptoms of the disease. The truth is also that prostate cancer in Zambia does not only affect men in their late sixties early seventies. There may actually be a lot of men in their fifties with clear symptoms of prostate cancer but because of it bordering on reproduction there is untold fear of the unknown, they would rather be ‘MEN’ and die than face up to it.

Whatever the case, I shall continue encouraging all Zambian men especially those 50 years and above to go for prostate cancer screening as at yesterday and do it regularly if they are found negative. For those that are 45 also make sure you go for screening every year. Take note that early detection as a result of regular prostate cancer screening will work to your advantage and make treatment decisions easy for the medical staff. I also hope and pray that PCFZ may succeed in lobbying government that prostate cancer screening is performed at no cost in all government hospitals and clinics as soon as possible.

As for medical castration, do not worry there are still a lot of bedroom gymnastics after that.

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