1.THE PROSTATE CANCER- 21st Century challenges for Lesotho Leadership by Sejojo Phaaroe M.T ; C.T.(I.A.C) ; M.I.B.M.S; Cert. Assessor President -Lesotho Breast Cancer Network Cancer advocate- Lesotho Palliative Care Country Team APCA Registered Biomedical Scientist # GT 1337 Cytotechnologist of the International Academy of Cytologists # 6467 Registered FP7/HORIZON 2020 EU Health NCP and a Research scientist Institute of Health Systems and Programs- SADC/UNAIDS Cervical cancer Coalition TAC and in- Country focal person Lead Assessor, Technical Assessor and Master Train the Trainers- SADCAS/EU thinktankentr@gmail.co.za +266 63102600

2. There is no need for you to catch the ball if you do not know where the goal is - 3. OUTLINE/ LEARNING OBJECTIVES PROBLEM STATEMENT SWOT and PESTEL LEADERSHIP DEMAND WHAT IS A PROSTATE BPH RISK FACTORS SCREENING FOR PROSTATE CANCER CASES OF PROSTATE CANCER SYMPTOMS TREATMENT MODALITIES PUBLIC HEALTH APPROACH AND INCOLVEMENT OF DISTRICT COUNCILS BEST PRACTICES PREVENTION RECOMMENDATION S 4. PROBLEM STATEMENT-Policies Very few countries in southern Africa have comprehensive policies on cancer. Neither Lesotho has a comprehensive national policy on all cancers to include Prostate cancer. Awareness of Prostate cancer There is a lack of awareness of cancer throughout southern Africa. Awareness is higher in cities and among women living with HIV only . There is a low level of awareness of Prostate cancer or all cancers in rural areas in Lesotho this is an opportunity to increase cancer advocates in Lesotho 5. Strengths knowledgeable staff, research , technology - literacy rate good -funding opportunities -international partnerships -DHMT and decentralisation policies - Patient referral system - Social trends people need services Weeknesses Reputation of resistance- MEN and Health issues -stigma -discrimination, -absenteeism in workshops -Care and support -Social responsibility -Gender inequality --Confidentiality -Attitudes , emotional turmoil -perception, rituals , culture -Quality services low/not there -communication about health issues --poor reporting of cases Opportunities knowledgeable staff, research , =technology - literacy rate good -funding opportunities -international partnerships Threats Cultural believes stigma , attitudes, -vulnerability, -- rituals , Inflexibility, famine- Poor quality of services -poor monitoring and evaluation -Regulation -funeral costs --risk management, ,compensation 6. Stakeholders Needs & expectations Issues to address to exceed stakeholders expectation Health workers( patients),, and Champions as Target Confidentiality, no discrimination, quality service, knowledge, protective clothing Attitude, BCC, Perceptions, quality, KAPBs ,Stigma, discrimination, Clinic and hospital administrators and HR Leadership , and support, services Attitude, BCC, Perceptions, quality Immediate Families Knowledge transfer ,Services, Attitude, BCC, Perceptions, quality Community councilors Knowledge transfer, care and support, leadership The more involved they feel, the more they will give Local community Knowledge transfer, care and support, leadership Knowledge transfer, care and support Traditional leaders Competition, Knowledge transfer, care and support, leadership Attitude, BCC, Perceptions, harmony, Knowledge transfer, care and support, pharmaco-vigilance Religious leaders Knowledge transfer, care and support, leadership Attitude, BCC, Perceptions, Knowledge transfer, care and support Teachers and school principals Knowledge transfer, care and support, leadership Attitude, BCC, Perceptions, Knowledge transfer, care and support Popular business people Leadership, recognition The more involved they feel, the more they will give Community organization leaders Leadership, recognition Quality life, support Shop stewards Leadership, recognition The more involved they feel, the more they will give 7. Sport and cultural stars leadership, recognition Knowledge transfer, Economic Situation, Income, Business Cycles, Employment Community radio DJs and reporters Knowledge transfer, care and support, leadership Awareness raising, The more involved they feel, the more they will give, Printing, Banks and ICT companies Knowledge transfer, Economic Situation Income Business Cycles, Employment The more involved they feel, the more they will give MPs Knowledge transfer, care and support, leadership Knowledge transfer, UN agencies representatives Buy in Knowledge transfer, Embassies Buy in The more involved they feel, the more they will give Internet service providers Economic Situation Income, Business Cycles, Employment The more involved they feel, the more they will give 8. You are Leaders Lead from where they stand Are committed to making a difference Are humble in the face of adversity, but confident in their capacities Walk their talk Believe in the capacity of others and welcome their input and effort Embrace change and create the future You cant believe in the message , if you dont know what the messenger believes.* but If you dont believe in the messenger, you wont believe in the message and be committed to making a difference Ambition, fueled by compassion, wisdom and integrity, is a powerful force for good that will turn the wheels of industry and open the doors of opportunity for you and countless others. 9. Screening for Prostate cancer Screening services are primarily available in major cities but not for Prostate cancer because men are afraid to go to clinics. Prostate Screening services are absent in Lesotho . Different screening methods are less used throughout southern Africa to include Lesotho Its only with your help that we will be able to reach a segment of the population through Pitsos , workshops and community gatherings . 10. Shifts happen Its not what you know, its what you use that makes a difference in the community you lead. You can have everything in life you want, if you will just help enough other people get what they want. Zig Zagler Treatment of Cancer in South Africa cost more than R100 000 per case 11. what is the prostate? The prostate is a small gland about the size of a golf ball. It's found only in men. It sits just below the bladder and surrounds part of the urethra, the tube that takes urine from the bladder to outside the body. The prostate produces some of the fluid that makes up semen. This fluid forms part of the seminal fluid, which nourishes the sperm. Secretions from the prostate increase the pH of the semen and help to neutralize the acidity of the female vagina. The growth of the prostate depends on the male sex hormone, testosterone, which is made by the testes. And the potent one by the adrenal glands It's common for the prostate to get larger as men grow older. This is called benign prostatic hyperplasia (BPH). 12. Symptoms of BPH Symptoms of BPH include poor urinary flow, needing to urinate often at night, and trouble starting to urinate. These are quite common in older men. They usually don't have anything to do with cancer. 13. Risk factors of prostate cancer Factors that may influence risk of developing prostate cancer include: Age Family History of Prostate Cancer Race Dietary Factors Infection with HPV/EBV Infection with Human Papillomavirus and Epstein-Barr Virus A 2012 Australian study examining both cancerous and healthy prostate tissue in the Medical Laboratory found an association between infection with HPV and EBV and an increased risk of prostate cancer. 14. GARDASIL (Quadrivalent Human Papillomavirus [HPV Types 6, 11, 16, 18] Recombinant Vaccine) HPV and Anogenital Warts HPV 6 and 11 responsible for >90% of anogenital warts Infectivity >75% Treatment can be painful and embarrassing.4 Topical and surgical therapies are available for genital warts Recurrence rates vary greatly. 1. Jansen KU, Shaw AR. Annu Rev Med. 2004;55:319331. 2. Soper DE. In: Berek JS, ed. Novaks Gynecology. 13th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2002:453470. 3. Lacey CJN. J Clin Virol. 2005;32(suppl):S82S90. 4. Maw RD, Reitano M, Roy M. Int J STD AIDS. 1998;9:571578. 5. Kodner CM, Nasraty S. Am Fam Physician. 2004;70:23352342. 15. How big is the problem of Prostate cancer ? 16. Response? We need visionary leaders, people with emotional intelligence and spectacles of morality - Paradigm shift and 21 century leadership in programs, systems and projects - And a moral campus - Empathy 17. Response? I see how big it is but there is nothing I can do! WHAT IS IN FOR ME WHERE IS THE LOOPHOLE SO I CAN BENEFIT ALONE ? 18. Response!!!! Millions of men die each year , because of prostate cancer lets mount prevention plans 19. Cancer Situation in Lesotho Cervical 40.9% - (ASIR 66.7:100,000 (LES); (S. Phaaroe e tal MOHSW/WHO 2007) Breast 18% of all cancers Prostrate 13.5%; Skin 12.6%; Lung no estimates ( found on autopsy); Leukemias/lymphomas no estimates; No cancer treatment centre; No cancer registry in Lesotho 20. Medical Laboratory A FACT FACTORY 21. WHAT IS Cancer ? Cancer is a neoplastic proliferation of abnormal cells, invading surrounding tissue and giving distance metastases Cancer of the prostate is the neoplastic proliferation of cells and tissues in the prostate Abnormal proliferation starts with the genetic aberration in a single cell genetic material, which grows and give a clone of abnormal cells A number of factors contribute into the cellular disturbance 22. BPH BENIGN PROSTATIC HYPERPLASIA 23. Screening for prostate cancer The DRE or digital (finger) rectal exam. During this test, the doctor / Nurse inserts a gloved and lubricated finger into your rectum. The doctor /Nurse feels the back portion of the prostate to inspect its size and to detect any peculiar or abnormally hard areas. PSA test or "prostate-specific antigen" test. In this test, a small sample of blood is drawn from your arm. The Medical Laboratory Scientist will inspect the blood to see if the PSA level is normal; prostate cancer can cause large amounts of PSA to end up in your bloodstream. Do regular test of both each year 24. There is reliable evidence that PSA screening can catch early-stage prostate cancer when done with DRE . FNA BIOSPY CYTOLOGY Testing for and treatment of prostate cancer is less likely to be of benefit for older men, especially after the age of 75. The prognosis is good with early treatment,although in some cases there may be no need for treatment if a detected prostate cancer has a slow growth pattern. Your doctor will need to determine your needs depending on an analysis of your particular case; there are no one-size-fits-all treatment options. See your Doctor when you see the above symptoms 25. About Prostate cancer Prostate cancer is a malignant tumour of the prostate. Prostate cancers can be in two main forms: Early prostate cancers (also known as localised prostate cancer) are contained within the prostate. In some cases they may not cause problems for many years and may not need treatment. Advanced prostate cancer implies the cancer has grown faster and spread to the tissues outside the prostate and to other places in the body. Prostate cancer can spread to lymph nodes in the pelvis and through the blood to other parts of the body, such as the bones and lungs. Most types of cancer spread, but treatment can often stop this happening. 26. Prostate cancer Prostate cancer ranks fifth among the causes of death for men over age 45. After lung cancer, prostate cancer is the second leading cause of death among all men signs and symptoms of prostate cancer generally don't show until the cancer is more advanced, and as such, getting early screening checks can be important Generally it is slow growing and early prostate cancer often shows no symptoms 27. Malignancy with mitotic figures 28. CASE REPORT- 29. Biopsy and Gleason score 30. G3 G2 G1 RED MIX BLUE/GREEN 31. RED BLUE 32. Causes of prostate cancer The exact cause/s of prostate cancer are not known but scientists link it to increased levels of testosterone and other hormones . Obesity increases levels of circulating endogenous sex hormones, insulin, and IGF (Neilson et al., 2009:14; Friedenreich, 2001:13) production of proteins in blood (called cytokines causing inflammation) (AICR, 2008:8), adiponectin lowering levels of Sex hormone binding globulin (SHBG) (Friedenreich, 2001:13; Neilson et al., 2009:14; Vona-Davis & Rose, 2009:889), increased peripheral fat conversion of estrogens to progesterone, and increased serum testosterone levels. All these chemicals increased may be associated with an increased risk of Prostate cancer and Breast cancer (Adebamowo et al., 2003:22). However, the chance of getting prostate cancer increases: -as you get older: more than half of all new prostate cancers affect men over the age of 70 -if your father or a brother had prostate cancer, especially at an early age. -Your risk is higher if you have more than one relative affected in this way. 33. Cont PROSTATE Cancer is known as a highly complex multifactorial disease caused by endogenous metabolic or other imbalances associated with age, genetic makeup, variety of exogenous factors including lifestyle, exposure to ionizing radiation, chemicals of natural or synthetic origin (Mandeville, 2001:28), diet, body weight, and reproductive factors 34. Symptoms of prostate cancer Pain or burning during urination. Weak or disrupted flow of urine. The inability to urinate. Frequent urination, particularly at night. Blood in the urine. Ceaseless pain in the lower back, pelvis, or upper thighs. Impotence Note that the symptoms can also apply to other illnesses. The symptoms could also mean lesser illnesses such as an enlarged prostate (BPE or benign prostatic enlargement) or an infection of the prostate (prostatitis 35. Late signs Pain, pain , pain Dyspareuria(pain during intercourse) Urinary symptoms: frequency in urination Dysurea Hematuria Anaemia, Cachexia Vesico-rectal and or recto-urethral fistula Bone pain, due to metastases 36. Treatment of prostate cancer Regular check-ups will tell you and your doctor if treatment is needed. Sometimes the best thing to do is to watch and wait'. Prostate cancer may be treated by surgery, radiotherapy or hormone treatment. Treatment will depend on the size, type, growth and spread of the cancer. It will also depend on your age, general health, symptoms and what you want. If your doctor recommends treatment, make sure that you know what to expect. In most cases you can take time to make your decision. Talk about this with your doctor. 37. What is radiotherapy? Radiotherapy uses radiation, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells and stop them from growing and multiplying. 38. How does radiotherapy work? Radiotherapy damages cancer cells in the area being treated. Although the radiation can also damage normal cells, they can usually repair themselves. Why have radiotherapy? Many people diagnosed with cancer will have radiotherapy as part of their cancer treatment. Research shows that at least one in two people recently diagnosed with cancer would benefit from radiotherapy. 39. Side effects of treatments Side effects of treatments for prostate cancer can involve erectile dysfunction (impotence), urinary incontinence or bowel problems. Try to have a partner or a friend with you when you talk with the doctor. You may also find it helpful to make a list of questions before your visit. 40. System Effects Metabolic alterations are common to all cancers regardless of the specific tissue involved Different types of neoplasm's become more alike as growth proceeds Cancer cachexia (tissue metabolism)- a major symptom common to all types of CA It affects 2/3 of cancer patients Cachexia appears to be tumor mediated I.e cytokines secreted by the hosts immune system in response to tumors seem to induce anorexia and alter metabolism . There is Anorexia and inadequate food intake in the face to increased nutrient needs Tissue wasting 41. Cont--- Impaired organ function and atrophy of organs Apathy and weakness Water and electrolytes imbalances Anemia Grey color Depressed immunity and subsequent decreased resistance to infections Weight loss (>5% per month or > 10% over 6 months Malnutrition Hyper metabolism Decreased resistance to side effects of treatment with increased morbidity and mortality 42. Psychological aspects of palliative care Anxiety and depression are common in Cancer patients Signs include restlessness, insomnia, shortness of breath, numbness These can overshadow the psychological signs in patient with advanced disease A referral to a psychiatrist or other mental health professional when ever depression is suspected. Supportive psychotherapy and good listening is a good palliative practice formal psychotherapy programmes need to be established 43. The patient s wishes It is extremely important to involve individuals with Cancer in the clinical decision making process wherever possible This will give them a sense of control over their own life Many cancer patients decline certain investigations and therapies, but take strength from doing so The wishes of the person with Terminal diseases like prostate Cancer should always be respected as far as is ethically possible 44. Health professionals who care for people having radiotherapy include: Radiation oncologist: a specialist doctor who prescribes and coordinates the course of treatment and advises about side effects Radiation therapist: plans and delivers the radiation treatments Cytologists: screen for cancer , diagnose cancer and look for malignant cancer cells during and after treatment to look for relapse Pathologists: do diagnosis on biopsies where cancer diagnosis is a gold standard Radiation oncology nurses: help you manage emotional and physical problems such as side effects that you may experience during treatment Radiation physicist: ensures that treatment is delivered accurately and safely Dietitian: recommends the best eating plan to follow while you're in treatment and recovery Social worker, psychologist, physiotherapist and occupational therapist: advise you on support services and help you get back to your usual activities Pastoral carer: helps with religious and spiritual concerns Community Councilors ; leaders and councilors, deeds of sales and wills 45. Community Based, multidisciplinary palliative care Physician Initiate care plan Oncology Nurses and other nurses Case MGT, monitor RX Home care Aides Bathing, toilet, meal preparation Social worker Psychosocial issues Rehabilitation therapists Exercises, environmental adaptation Spiritual care , church groups,counselors Spiritual, psychosocial, nutrition Buddies/volunters Provide services according to specific training, transportation, house keeping, companionship etc 46. Possibly protective diet from disease Vit A: carotenes acts as antioxidants Vit C: prevents conversion of nitrates and nitrites to nitrosamine Vit E: is an important antioxidant- part of glutathione peroxidase Lycopene: from tomatoes Folate: for nucleic acid synthesis in repair Selenium: shown that the risk of cancer to be inversely proportional to selenium intake Carotinoids: fruit+ vegetables Indole/phelols: substances found in gruceferous vegetables possibly prevents colerectal, stomach+ respiratory cancers Calcium: Dairy products Omega-3-Fatty acid: dark oily fish( cold waters) Soya products ITS THE ROLE OF COUNCILLORS TO PROVIDE NUTRITIONAL GENERATING COMMUNITY PROJECTS AND FOOD SECURITY 47. Dietary guidelines to try and prevent disease include Control weight and obesity Reduce consumption of total fat