PROSTRATE CANCER - early detection saves lives

Dr. Rex Ajayi
During an encounter with Dr. Rex Ajayi, Chairman/MD, South Urology Clinics, Albany, Georgia, USA; the discussion centred on prostate enlargement and prostate cancer—both common health issues among middle aged and elderly men all over the world.



Ajayi, who is also Chairman, ROA Specialist Hospital & Surgical Centre, Arepo,  Ogun State, turned 70 last December. A 1974 graduate of the University of Ibadan College of Medicine, he specialises in Urology and Anatomy. With 44 years experience in medical practice, Ajayi is renowned among the top urologists in the USA and is the first Black Urologist in South Georgia.


He gives insight into his prowess in cancer diagnosis and treatment, even as he describes the unique radiation procedure known as Prostate Seed Brachytherapy—a technique that involves implantation of small radioactive pellets, or “seeds,” into the prostate. Read excerpts below:

We all know what the bladder is. Urine comes in to the bladder which you can liken to a balloon. The balloon has a small neck through which you blow air. Now pass that little neck through an apple and the apple wraps around the neck of the bladder.

That is just how it is. So you see that if anything happens and that apple swells up, it would block the urine flow. Most of the time, prostate problems are not cancerous. They are just problems arising from the prostate getting bigger as we age.

If your prostate gets too big, it shuts down your urine. You go to the toilet 3-4 times at night and the urine is slow and eventually it is cut off. Then you are yelling at 2.00AM when trying to urinate. That condition is called Benign Enlargement of the Prostate.

It is just a big prostate. But cancer actually starts from the skin of the prostate. Cancer may start and not give any sign because it is so far from that little tube in the middle where urine goes through and until you compress that tube, you may not even know.

Early detection is cure

So cancer can only be cured through early detection and we are lucky we have the Prostate Specific Antigen (PSA). Before then, even in the US, people were dying like flies. Then we had what was called the Prostatic Acid Phosphatase (PAP) test which was not very accurate.

We also had the Digital Rectal Examination (DRE) that can help in cancer detection and diagnosis. During the exam, a gloved, lubricated finger is inserted in the rectum to detect changes in the prostate that could indicate an abnormal condition, including cancer. But by the time the cancer could be felt, it was usually almost too late.

Now with the PSA, we can detect cancer, sometimes two to five years before it would have become detectable in those days. Now when you have cancer detected, the next thing is to make sure it does not leave the prostate, so the best thing is usually to take it out which is a major surgery. For a benign prostate, you just go through the inner tube and make a hole for urine, you still leave the prostate in place. For prostate cancer you have to cut out.

Impotence and incontinence

The prostate is at the junction of many things. On either side of the gland is a small, very thin line that you can hardly see. It is a nerve and is what causes erection, so while trying to take that big prostate out, removing or cutting that nerve would mean the patient cannot have erection again. Even with robotic surgery, it is 50 percent risk the person cannot have an erection any more. When we were doing it manually, the risk was almost 100 percent. This is one major issue.

Another issue is incontinence. There is a muscle in the neck of the bladder that helps to control urine flow. It is called the voluntary muscle, and is only meant to control the urine. It is a chunk of muscle that is the part of the neck of the bladder. When it is cut, there really isn’t much left to hold the urine, so it results in a condition in which you keep leaking urine (incontinence) like a faucet.

So these two problems— surgery with all

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