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“THE IMPACT OF ALTERNATIVE MEDICINE IN
GHANAIAN MEN OF AFRICAN DESCENT DIAGNOSED
WITH PROSTATE CANCER”
SYNOPSIS
SUBMITTED TO THE
INDIAN BOARD OF ALTERNATIVE MEDICINES ACADEMY, KOLKATA, INDIA
FOR THE DEGREE
OF
DOCTOR OF PHILOSOPHY
IN
ALTERNATIVE MEDICINE
BY
RAPHAEL NYARKOTEY OBU
REGISTRATION NO: FFF/13/23
UNDER THE GUIDANCE OF
SHREETAMA KANJILAL
INDIAN BOARD OF ALTERNATIVE MEDICINES,
KOLKATA, INDIA
March, 2015
“THE IMPACT OF ALTERNATIVE MEDICINE IN GHANAIAN MEN OF AFRICAN
DESCENT DIAGNOSED WITH PROSTATE CANCER”
ABSTRACT
About 50% of all men by 50years will have prostate cancer cells at the dormant stage in their
prostate gland so the question now is why are there great geographical prostate cancer
variations? It is also believed men of Africa descent have high androgen level than white men
and is the fuel for prostate cancer. According to a publication by the Ghana news Agency, Ghana
has exceeded the global prostate limits as the country records 200 cases out of every 100,000
men as against 170 world-wide, a survey by the Korle -Bu Teaching Hospital revealed(GNA -
August, 07, 2007). This study aims to look at the impact of alternative medicine on Ghanaian
men of African descent diagnosed with prostate cancer. This research study is in two forms,
firstly an observational study will be used to assess Ghanaian men diagnosed with Prostate
cancer and the use of traditional medicinal plant call croton membranaceus to ascertain its anti
cancer efficacy. Croton membranaceus root extract marketed as URO 500 at Center For Plant
Medicine Research in Ghana (Mampong , Akuapem) 10mg per capsule will be given to about 30
patient diagnosed with Prostate Cancer at the experimental site , De Men’s Clinic & Prostate
Research Lab in Dodowa, Akoto House for an observational study to be conducted and cohort
for this important research will report after three month of treatment after which their PSA will
be assess again as the PSA is the best marker in terms of the diseases monitoring or progressing.
Secondly, an extensive research using online search engines to conduct a literature review,
summarizing the body of evidence on impact of alternative medicine and prostate cancer use in
men of African descent to date will be use for this important second phase of the study.
Results will be analyzed using the PSA at the stage at diagnosis and after treatment with the
croton membranous. The International Prostate Symptoms score (IPSS) and the international
Index of Erectile Function (IIEF) questionnaire will also be assessing before and after.
Abdominopelvic Scan using Sonoscape A6 with full bladder to enable acoustic widow to assess
prostate Volume before and after will also be access.
INTRODUCTION:
BACKGROUND
Do the prostate cancer disparities seen in Black men around the world follow the path of the
Transatlantic Slave Trade? (Odedina et al 2009). Although prostate cancer incidence and
mortality rates have been declining in both African American and White men since 1991,
possibly due to improved diagnostic techniques, better screening and improved surgical and
radiologic treatments, the rates remain comparably higher among African American men. Why
does this disparity continue to exist among African American men in spite of the significant
research to eliminate this disparity? ( Odedina et al 2009).
Thus the variability in risk and mortality across these populations of West African descent
suggests a potential and important influence of environmental/lifestyle factors acting on prostate
cancer risk in these already susceptible populations. Can this my PhD research work data hold
the key to my better understanding of the etiology of lopsided burden of this disease in men of
African descent such as Ghanaian men? There are more questions than answers at this time:
Does the similar genetic characteristic of Black men of West African ancestry put them at higher
risk for prostate cancer compared with other groups? Are there common environmental
conditions/lifestyle factors among these men that may be responsible for the prostate cancer
burden experienced by this group? What is the relative contribution of genetic, lifestyle and
environmental factors in prostate cancer incidence and mortality among this group? (Odedina et
al 2009).
In Ghana, It is also opined that men with numerous or promiscuous men get this dreaded cancer.
However numerous researches also prove the benefit of frequent sex and prostate health. So does
frequent sex causes prostate cancer in men of African descent as most of the research black men
are not involve and even if they are they are only made of a few percentage. Prostate cancer
comes with lots of disparities from screening and treatments. It is also know that black men have
about 60% chances of getting prostate cancer than white men and according to the Prostate
Cancer UK(Prostate Cancer UK 2014) 1 in 4 black men will get prostate cancer in their life time
which involve men of west African continent.
Men of African descent have been label as endangered species and black ancestry have been
implicated as an established risk factor for the high rates of prostate cancers in the black
communities. However race and genetic specific evidence is still missing. Also according to the
American cancer society genetic prostate cancer accounts for only 5-10% of prostate cancers so
the question now lies is the high rates of prostate cancers in the black communities linked to
genetic or lifestyle or what I call De Jure or De Facto judging from the fact that cancer cells lies
dormant in all of us. There are also great geographical variations in prostate cancer incidence
between western societies and eastern societies. If cancer is a disease that starts in our cells and
our bodies are made of up of trillions of cells, group together to form tissues or organs such as
muscles and bones, the lungs, or the liver and genes inside each cell order it to grow, work,
reproduce and die and normally our cells obey these orders and we remain healthy then is
lifestyle or De Facto the major factor. If sometimes a cell’s instructions get mixed up and behave
abnormally and after a while, groups of abnormal cells can circulate in the blood or immune
system, or they can form a lumps or tumor then the health of Ghanaian men of African descent
cells is crucial if they want to live a long, healthy and vibrant life.
Why? Because cells provide the power for everything these men do–from thinking to growing.
Simply put, these men cannot be healthy unless their cells are healthy. So I have been wondering
if Ghanaian men of African descent lifestyle or de facto influence or promote prostate cancers or
even put the prostate cancer cells in their dormant stage in the management of the disease? Yes
because the body is jus t like a computer and it does exactly you tell it to do and not often how
you want it to do and it’s adapt to changes this is what is call compensatory adaptation at work.
For instance in the northern region in Ghana it has been observe that crops in the region cannot
yield high without using chemicals because the soil is used to the chemicals the farmers use to
grow their crops. This is one reason why the Okinawa’s and Humzas and it pertains to men in the
Asian enclaves who live to 145years stay freely from chronic degenerating diseases like cancers
and live happily healthy lives partly because of their way of life and the most important lifestyle
factor is the dietary habit. Men of African descent have buy into the ideal of modern devitalized
cheap foods and the result is the modern day civilization disease like cancers. In Ghana prostate,
breast cancers and now sky rocketing kidney diseases are on the increased the result poor health
and early death. This cheap food results in low enzymes levels in Ghanaian men depriving the
cells of good cellular nutrition resulting in sky rocketing prostate diseases because the prostate is
a deep inside organ just like the breast and uterus in women. The prostate sits between two
organs of elimination, the urinary bladder and rectum so the more toxic your urine and feces the
more the prostate is vulnerable in absorbing the toxic and toxic build up is one of the reasons
there is high sky rocketing prostatic diseases in Ghana and black communities. Every single
process is controlled and regulated by an enzyme produced by the body specifically for that
process. According to medical dictionaries, “life “is the regulated interaction of all the processes
performed by enzymes in the body it follows that disease is the disruption of this harmonious
interaction between enzymes.
The body’s enzymes work together. If a single cell becomes active, a whole cascade of enzymes
is immediately prepared for action. The enzyme matrix is genetically differentiated. In other
words, Europeans have and need different enzymes than Asian. Statistics show that a person’s
life expectancy and quality of life is directly proportional to the efficiency of the body’s enzyme.
At birth and during breast feeding, every infant receives a large supply of enzymes for his or her
future life. The infant’s future vitality and health depends on this supply of enzymes being
properly maintained. This is guaranteed by unprocessed foods that ensure the supply of enzymes
components so low enzymes levels cause of today’s civilization or lifestyle diseases that have
being implicated that black men have 60% chances of getting prostate cancers than their white
counterparts. According to world wide studies, over 80 of the population suffer a lack of vital
nutrients or low enzyme levels.
As early as 1991, the “declaration of Santa fee”, leading nutritional scientist stated that poor
nutrition and the severe exposure of our food to pesticides, processing and conservations are the
main reasons for serious illnesses. Hence the reason for the low enzymes in Ghanaian men of
African descent would the early of fast foods stuffs, long storage periods and additional
processing in today’s food factories using methods such as irradiation , heating , sterilizations
and conservation have a massive and negative impact on essential enzymes and other vital
substances. Fast food crazes in Ghana for example has a nutritional value dangerously close to
zero and serves virtually no other purpose than to make individuals feel satiated. It has also been
revealed that black men have low level of Vitamin D level and the darker the skin the lower the
vitamin D level in black men
STATEMENT OF PROBLEM
Very often you find elderly male patients in Ghana above 40years complaining of a feeble urinay
stream, hesitancy, dribbling, having to urinate frequently and urgently, feeling that they can’t
empty their bladder completely and loss of libido. These observations are usually on the increase
whilst little or no effort is made to raise awareness for early detection and treatment (Obu 2014).
In Ghana and most African countries, prostate cancer is the most common cancer in males after
hepatocellular carcinoma. Whereas in the advanced countries, screening for prostate specific
antigen (PSA) has led to early detection and management of the disease, screening has been very
low in Ghana, thus leading to low detection rate, poor management and increased mortality(
Arthur et al 2006)
A survey conducted on the prevalence of the disease as reported at five major hospitals in the
country. It was observed that 83.6% of the subjects had their PSA levels above the upper limit of
the reference range (4 ng/ml), with their ages ranging between 56 to 85 years. Coincidentally, the
survey also revealed that 96.5% of those who had the disease within the period of study were
above 50 years (Arthur et al 2006). Most research in prostate cancer is based on how the disease
behaves in white men and not black men yet it is black men who are hit hard with this disease.
The quality of treatment men received and the health related quality of life of prostate cancer
patients will differ according to race and access to health care, even after accounting for patient
and disease characteristics, type of primary treatment and other factors (Obu 2014).
Not all men diagnosed with prostate cancer will need treatment and men needs different
treatments option in Ghana to make their inform decision on treatment options. Conventional
treatment only target the symptoms or kill both normal and healthy cells and about 30-45% of
men diagnosed with prostate cancer will have recurrence. There is the need for a holistic
treatment to target cancer dormancy to prevent recurrence. 76% of all men diagnosed with
prostate cancer will suffer either permanent or temporal erectile dysfunction and could go on to
about 95% after radical prostatectomy and the quality of treatment for prostate cancer men
received and survival rates also depends upon where men leave.
According to the men’s charity in Ghana, Men’s Health Foundation, 1 in 5 Ghanaian men will
get prostate cancer in their life time. The charity work out the Ghanaian men life time risk factor
and was published during the world cancer day , February 04, 2015 with their supporting
statistics, 95% of Ghanaian men are not aware of prostate cancer
Closed to 1000 men are diagnosed with prostate cancer yearly in Ghana
1 in 5 men will get prostate cancer in Ghana
7 out of 9 men diagnosed with prostate cancer will die in Ghana
3 of 4 men will get enlarged prostate
Unspecified number of Ghanaian men are living with and after prostate cancer in Ghana
almost 10 out of 10 adults (100) in Ghana don’t know what the prostate gland does
95% of Ghanaian men didn't know the Prostate sits underneath the bladder.
5% correctly thought it was the size of a golf ball.
95% of Ghanaian men don’t know that closed to 1000 men diagnosed with Prostate
Cancer yearly in Ghana and closed to 800 men died of the disease.
100% of Ghanaian men said that not enough is being done in Ghana about it to raise
awareness on the disease.
Not enough Ghanaian men know about their risk of prostate cancer.
98% are not even aware that being black is a key risk factor.
100% said it was time for Ghana to consider a specific policy on prostate cancer in Ghana
and men must screen for free under the National Health Insurance Scheme (NHIS)
Statistics areas we used: churches, corporate institutions and communities
Total of 100 Men answered the Men united V Prostate Cancer Questionnaire form
The screening involved ultrasound and PSA simultaneous
Highest PSA level =3756ng/ml
Age group=45-75years
12 referred Men who came after biopsy
5 confirmed with prostate cancer
99.99% of Ghanaian men were not happy with their sex life
The clergy and fire service had excellent prostate health at Dodowa
Highest Prostate Volume -=274g
Lowest prostate volume=8.75g
90% of Ghanaian men prefer herbal medicine because of media advertisement and bogus
treatment claims
5% had family history of the disease , Some also don’t know
90% also don’t know that the PSA test is not a test for prostate cancer but it is a test to
know your risk of prostate cancer simply it is a prostate cancer risk test and normal result
doesn’t mean that you are cancer free!
90% men also don’t receive the right treatment information regarding prostate cancer
treatment.
92% also don’t know that there is no evidence of using traditional herbal medicine to
cure prostate cancer and they are only move by media advertisement of false cancer cure!
90% also don’t know the benefits of using complementary medicine in the management
of prostate cancer and it right use
95% are not aware of the PSA test for prostate cancer screening
90% also don’t know the work of the prostate gland also thought that it is a taboo for a
man to have prostate because of the education they received.
Almost, 100% of Ghanaian men don’t know that not all men diagnosed with prostate
cancer will need treatment and also don’t know that watchful waiting and active
surveillance is part of the management process of prostate cancer
Almost 100% of women also thought that promiscuous men or womanizers get prostate
cancer
90% of men also thought that frequent sex, multiple sexual partners get this dreaded
disease
90% of Ghanaian men don’t know the difference between enlarged prostate, prostate
cancer and prostatitis!
98% of herbal practitioners in Ghana don’t have much knowledge in the disease and it
management and would also not refer patients to see urologist or prostate cancer medical
expert hence there is the need for collaboration between this practitioners and the
Traditional and alternative heath practice council must organized programs in cancer
management to members who want to specialize in the field.
98% of men also don’t know that the quality of treatment received, rate of survival and
support also depends upon where men live
Almost 100% of men also don’t know when using the natural approach for prostate
cancer management it may takes time and hence they must not expect immediate result
(Men’s Health Foundation Ghana, 2015)
The research proposal implies the impact of alternative medicine in Ghanaian men of African
descent diagnosed with prostate cancer. It is also estimated that by 2030, prostate cancer will be
the most commonly diagnosed cancer. In Ghana among males, the mean age at diagnosis for
cancers was 48.4 compared with 53.0 years for females and Prostate accounts for 13.2 %(Laryea
et al 2014). Another study that estimate the prostate cancer burden in West African men the
study authors performed a population based screening study with biopsy confirmation in Ghana.
They randomly selected 1,037 healthy men 50 to 74 years old from Accra, Ghana for prostate
cancer screening with prostate specific antigen testing and digital rectal examination. Men with a
positive screen result (positive digital rectal examination or prostate specific antigen greater than
2.5 ng/ml) underwent transrectal ultrasound guided biopsies.
In their results of the 1,037 men 154 (14.9%) had a positive digital rectal examination and 272
(26.2%) had prostate specific antigen greater than 2.5 ng/ml, including 166 with prostate specific
antigen greater than 4.0 ng/ml. A total of 352 men (33.9%) had a positive screen by prostate
specific antigen or digital rectal examination and 307 (87%) underwent biopsy. Of these men 73
were confirmed to have prostate cancer, yielding a 7.0% screen detected prostate cancer
prevalence (65 patients), including 5.8% with prostate specific antigen greater than 4.0 ng/ml.
the study authors concluded that in this relatively unscreened population in Africa the screen
detected prostate cancer prevalence is high, suggesting a possible role of genetics in prostate
cancer etiology and the disparity in prostate cancer risk between black and white American men.
According to the authors further studies are needed to confirm the high prostate cancer burden in
African men and the role of genetics in prostate cancer etiology.
The editorial of Today Newspaper, the Daily Democrat and the New statesman on 4 February
2015 called on the Ghanaian government to wake up on Prostate cancer. The same editorial on 1
September in the Today Newspaper also called for a prostate cancer policy for men in Ghana.
There is lot of conflict of interest exciting between traditional, alternative medicine practitioners
and conventional practitioners in Ghana in the management of prostate cancer (Obu 2014). There
is a long standing issues whether there is current evidence in using traditional or indigenous
herbal medicine to cure prostate cancer as most indigenous practitioners in Ghana make lot of
claims using the media to advertise their ability to cure prostate cancer using local herbs as there
is no pragmatic measures from the traditional medicine council to regulate the practitioners in the
field in the case of medical advertisement.
Some conventional practitioners called on the Ghanaian government to institute a policy to
punish herbal practitioners who advertise their treatment for prostate cancer because they
believed that these practitioners are rather amassing wealth and killing Ghanaian men. In the
chronicle paper Jan 21, 2015, according to the story, Dr. James Edward Mensah, head of the
Urology department at the Korle-Bu Teaching Hospital has called on government to institute
measures to prosecute practitioners in the herbal sector who claim they have treatment for
prostate cancer.
According to him, these self-acclaimed herbal doctors do not have scientific knowledge about
the disease; rather they are amassing wealth out of the ignorance of people who visit their
facilities for treatment. Dr. Mensah explained that these herbal doctors are just misinforming and
killing people in the country, as a result of their activities.
PURPOSE OF THE STUDY
In Scientific research the purpose of statement indicates ‘why you want to do the study and what
you intend to accomplish’ (Locke, Spirduso, and Silverman, 2000). According to this; the
purpose of this research study is to first explore the impact of alternative medicine in Ghanaian
men of African descent diagnosed with prostate cancer as most prostate cancers are slow
growing and men diagnosed with prostate cancer die of other cause and not from the disease.
It has also been revealed that prostate cancer can be very aggressive in black men who are on
active surveillance or watchful waiting as a form of prostate cancer management because of
tumor biology and therefore present with more complications before surgery(Ha et al 2013 ) so
this study intends to reveal whether Ghanaian men of African descent diagnosed with prostate
cancer can benefit from alternative medicine as a form of prostate cancer management if they for
go conventional treatments and also solve the long standing controversy in the health sector
between the conventional practitioners, traditional and alternative medical practitioners claim in
the media of finding cure for prostate cancer using the herb plant call croton membranaceus in
Ghana. It will also assess the anti cancer efficacy of croton membranaceus and prostate cancer.
This research will also prove whether Ghanaian men relying solely on alternative therapies alone
are gambling with their cancers. The research study will finally also show the benefits of
integrative approach in the management of prostate cancer in Ghana to reduce the prostate cancer
related mortality rates in the country.
HYPOTHESES OF THE STUDY
1. Impact of alternative medicine in Ghanaian men of African descent diagnosed with
prostate cancer.
2. The barrier face by Ghanaian men diagnosed with Prostate cancer who are considering
relying on alternative medicine in Ghana
3. Conventional doctors knowledge, perception and attitudes towards Ghanaian men
diagnosed with Prostate cancer
4. Conventional doctors relationship with alternative practitioners in the patients’ cancer
journey.
5. No conventional treatment is superior and about 30-45% of all conventional cancer
treatment recurred.
6. Conventional cancer treatment cannot target prostate cancer at its dormant stage whether
at the cellular level or tumor stage
7. There is significant benefits in using the Integrative approach in the management of
Ghanaian men prostate cancer patients diagnosed with Prostate cancer as integrative
approach can put the cancer at its dormant stage and prevent recurrence
8. Relying on Traditional or folk medicine and neglecting conventional treatment could also
be a calculated gamble for Ghanaian men diagnosed with prostate cancer.
9. Treating Prostate Cancer starts from the cellular or tumor dormant level and conventional
therapies have a long way to go to find cure for prostate cancer.
10. Low enzymes level breed prostate diseases in Ghanaian men
RESEARCH METHODOLOGY
1. Croton membranaceus root extract marketed as URO 500 at Center For Plant Medicine
Research in Ghana (Mampong , Akuapem) 10mg per capsule will be given to patient
diagnosed with Prostate Cancer at the experimental site , De Men’s Clinic & Prostate
Research Lab in Dodowa, Akoto House for an observational study to be conducted
2. Prostate cancer patients will be made to sign a form and this will form the cohort to take
part in the study and will be under medical supervision. The stage of diagnosis and age
will be reported. Patients will also be made to report any adverse effects and report them
using a help line to be provided. Any Conventional treatment in case the patient has
started will also be presented for this important research. Patients will be sought from
various hospitals in Ghana for this important research.
The Four main research instruments for this observational study will include:
3. The International Prostate Symptoms Score(IPSS)
4. The international Index of Erectile Function (IIEF) questionnaire
5. Blood sample for PSA and special biochemical tests before and after
6. Abdominopelvic Scan using Sonoscape A6 and patients will have a full bladder to enable
acoustic widow to assess prostate Volume before and after.
The cohort for this research will report after three month of treatment
7. Case study for this research will involved Ghanaian men diagnosed with organ confined
prostate cancer who started hormone treatment that were supported with complementary
therapies at the De Men’s Clinic & Prostate Research Lab in Dodowa, Akoto House
8. Finally, extensive research using online search engines to conduct a literature review,
summarizing the body of evidence on impact of alternative medicine and prostate cancer. The
aim is to merely examine the available proof in an effort to better understand the impact
alternative medicine used and prostate cancer among men of African descent. A systematic
search of the computerized database, MEDLINE, will be conducted for each alternative
treatments type from the originating date of MEDLINE to date using the following keywords:
alternative medicine, prostate cancer, race, prostate cancer incidence; and the inclusion criteria
will be:
 Original studies and review articles;
 Publication in English;
 Relevance to prostate cancer impact, incidence, prevalence or mortality; and
 Sufficient quality and quantity of evidence based on study design and validity on
men of African descent with good evidence to support study conclusion.
11. Limitations of the study
The study is restricted with limited sample and variables straightly to Ghanaian men of West
African descent as black men are more prone to and there is research also on tumor biology as
black also have more aggressive to prostate cancer than their white counterparts.
The Attitude Scale doesn’t include all the dimensions as the quality of treatment and rate of
survival also depends upon where men live
The Barriers Inventory doesn’t include all the barriers as most Traditional practitioners in Ghana
lacks the scientific knowledge in the management of the disease and about 70-8% of Ghanaians
depends upon Traditional herbal medicines.
FINDINGS OF THE STUDY
1. Alternative medicine has great impact on Ghanaian men diagnosed with Prostate
Cancer as most prostate cancers are slow growing
2. Relying slowing on Traditional Medicine and forsaking Conventional Treatment can
be a calculated gamble to Ghanaian men diagnosed with prostate cancer and the
cancer can latter be very aggressive.
3. Integrative approach in Prostate Cancer Management in Ghana is the best way to
tackle prostate cancer in Ghana to prevent the high mortality rates in the county
4. Conflict of interest in the Ghana Health Sector between the Traditional and allopathic
practitioners show be solve in transforming the future of prostate cancer in Ghana to
support patient quality of life and rate of survival.
5. Most of the Conventional practitioners have little or no knowledge in the alternative
approach use in the management of prostate cancer in Ghana.
6. There must regulations in advertisement in medical treatment information by the
Traditional and Alternative Practice Council to regulate practitioner’s advertising
their treatment in Ghana.
7. Conventional Practitioners have bad attitude towards patients who claim to use some
of alternative medicine for prostate cancer in Ghana.
8. More studies on Croton membranacues is needed to ascertain it anticancer properties
and also combining it with other plants to have it synergistic effects.
9. Alternative Practitioners should not promise patients cure for prostate cancer as good
physician do not promise cure.
10. The Traditional and Alternative Practice Council in Ghana should organize workshop
and educational programs in prostate cancer management in both conventional and
alternative to its practitioners to know the scientific knowledge in the disease.
11. Future Prostate cancer centers in Ghana should target the integrative approach to the
management of the disease as patients have more confidence in that approach.
12. De Facto or lifestyle has great impact on Prostate Cancer cells to become abnormal
13. De Facto or lifestyle has the tendency to prevent prostate cancer recurrence after
treatment.
14. The high rates of prostate cancer incidence in men of Africa descent can be reduce if
men of Africa descent become more proactive about their health, early screening and
practice good dietary habits.
15. The enzyme matrix is genetically differentiated by race?
16. Person’s s life expectancy and quality of life is directly proportional to the efficiency
of the body’s enzyme system and we see this in Asians because of their diets.
17. Safe sex is good for prostate health as toxic get out of the prostate which is good for
prostate health and a form of exercise for the prostate.
18. Too much of sitting position also not good for the prostate as it puts pressure on the
prostate.
19. we all have cancer cells in our bodies
20. About 50% of all men by 50years will have prostate cancer cells at the dormant stage
in their prostate gland so the question now is why are there great geographical
prostate cancer variations?
21. The recipe for good health lies in our food and water
22. Testosterone is not the cause of prostate cancer in men of African descent but rather
the accumulation of synthetic estrogen the body accumulate as men ages from the
food and plastic containers
23. The enzyme 5 alpha reductase inhibitor that converts testosterone into the potent form
Dihydrotestosterone DHT ground prostate disease.
24. Hormone therapy does not cure prostate cancer
FORMAT
I intend to structure my thesis as a series of chapters modified from journal articles that have
or will result from this thesis.
ABSTRACT
INTRODUCTION
REVIEW OF LITERATURE
CHAPTER 1: Aetiology and Physiology of the Prostate Gland
Chapter 1will be based on a literature review and I will aim to explain the aetiology and
Physiology of the Prostate Gland
CHAPTER 2: Role of Endocrinal Regulatory of Prostate Gland.
Here, I will discuss the role of endocrinal regulatory of prostate gland
CHAPTER 3: Aetiology of Prostatic cancer
In this chapter I will focus on causes and established risk factors of prostate cancer in men of
African descent as they are more prone to prostate cancer. This chapter will also discuss whether
men of African descent cancer risk are as a result of De Facto or De Jure. It will also looks at the
influence of low enzyme levels in men of African descent as a possible cancer cause. It will look
at whether androgen level plays a significant factor in prostate cancer in black men.
CHAPTER 4: Topographical Impact of Prostatic Cancer
This chapter includes a summation of the topographical impact of prostate cancer and also
discuses why prostate cancer is not universal occurrence as there is great geographical variation
in prostate cancer in western men and eastern men. It will also focus on the men in Okinawa and
Humzas communities and how they stay off prostate cancer and why aging is not a, major
problem in prostate cancer as the centenarian are able to stay free of prostate cancer. It will also
look at the disease on the Africa continent in general and lifestyle factors that contribute to
Ghanaian men chances of getting prostate cancer in Africa.
CHAPTER 5: Pathology of Prostate cancer
I will present the modern special pathology of prostate cancer.
CHAPTER 6: Clinical Features of Prostate Cancer
Here I will discuss my overall findings and understanding of clinical features before and after
diagnosis in Africa as even in areas where screening is available, many prostate cancers are
diagnosed after the symptoms begin. However, the risk posed by particular symptoms is largely
unknown, especially in unselected populations such as primary care.
CHAPTER 7: Diagnosis of Prostatic cancer in Africa in Holistic Concept
In this chapter it will reveal prostate cancer diagnosis, screening in African men and also agues
for separate screening programs for men of African descent. It will show how the cancer is stage
CHAPTER 8 Isolation of Alternative Therapies to treat prostate cancer
This chapter will concentrate on management of prostate cancer by alternative therapies and will
isolate each evidence based alternative approach to treat prostate cancer
CHAPTER 9 Justification of Treatment by Alternative Therapies
This chapter will present evidence based research that support using alternative remedies to treat
prostate cancer. It will also involve using the integrative approach to manage prostate cancer and
some notable organization that have supported the use of alternative therapies to manage prostate
cancer.
CHAPTER 10 Indication of Selection of Alternative Therapies to treat prostate cancer
In this I will focus on patients selection in choosing alternative treatment for prostate cancer as
also relying on these therapies alone and forsaking conventional treatment could be a calculated
gamble for the patient and various side effects from alternative therapies for prostate cancer
management.
CHAPTER 11 Modus Operandi of Alternative Therapies
This chapter will focus on each evidence based alternative therapies for prostate cancer and how
they work to manage men diagnosed with prostate cancer and the cost involved.
CHAPTER 12 Prostate Cancer Prognoses
This chapter will focus on prostate cancer life expectancy rate as it also not universe because the
quality of treatment men received also depends upon where men life as Ghanaian men belongs to
men of African descent and leaving in West Africa with lack of health care access and mostly
relying on Traditional remedies Taking that into consideration, the relative survival rates for
most kinds of prostate cancer are actually pretty good in advance countries but most not counting
men with prostate cancer who die of other causes: 99% of men with the most common types of
prostate cancer overall will survive more than five years after diagnosis that are not evidence
based. In Ghana most of the cancers are diagnosed at the late stage that makes survival rates to
be much lower in Ghana.
CHAPTER 13 Role of Holistic medicines for treatment of Prostate Cancer
In this chapter I will focus on how the integrative program benefits men diagnosed with prostate
cancer. Dietary changes and lifestyle modifications for Ghanaian men that can prevent prostate
cancer recurrence and especially how some Ghanaian dietary habits can help prevent or allow the
cancer to recur.
CHAPTER 14. Why This Topic-“Impact of Alternative Medicine in Ghanaian Men of African
descent diagnosed with Prostate cancer”.
In my years of experience in medical ultrasound diagnosing men with prostate diseases in the
Herbal Hospitals in Ghana and who work previously with a medical doctor who specialized in
using Traditional medicine to solve Ghanaian men Prostate issues I then developed the interest in
prostate issues and after my masters program in Prostate Cancer –Sheffield Hallam University,
UK when I was therefore introduced to the real world of prostate cancer controversies and
realizing conventional therapies have a long way in finding cure for prostate cancer and the
treatment only suppress symptoms I therefore chose this topic to look at the alternative remedies
and impact of Ghanaian men diagnosed with Prostate cancer. In Ghana some herbal
practitioners also makes lots of claims of finding cure for prostate cancer using traditional
medicine and displaying lots of awards on their bill boards that I try to find their work in any
scientific journey that I was unable to find which means their claims are only speculative in the
media in Ghana. This chapter will focus on why this topic is relevant to solve the controversy in
using alternative therapy to treat prostate cancer to give the conventional practitioners the
overview in management of the disease using the alternative means and also solve the long
standing issues in Ghana on whether there is evidence in using traditional medicine to treat
prostate cancer as conventional practitioners in Ghana believe that Traditional or Herbal
Practitioners lack the scientific knowledge in the management of the disease. Finally to see if
Ghanaian men of African descent that rely on traditional or alternative medicine are gambling
with their prostate cancer or not.
CHAPTER 15 Three Cases Treated in Ghana at the De Men’s Clinic & Prostate Research Lab in
Dodowa, Akoto House.
I will discuss the benefit of my prostate cancer program using the integrative approach to treat
patients successfully and its impact on prostate cancer dormancy
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
APPENDICE
References
1. FKN Arthur, FA Yeboah, M Adu-Frimpong, EE Sedudzi, KA Boateng(2006) Prostate
cancer screening in Ghana - a clinical benefit? Journal of Science and Technology
(Ghana)
2. “1 in 5 Ghanaian Men Will Get Prostate Cancer In Their
...https://233livenews.wordpress.com/.../1-in-5-ghanaian-men-will-get-pros...
Last accessed dated Feb 4, 2015
3. Dennis O Laryea, Baffour Awuah, Yaw A Amoako, E Osei-Bonsu, Joslin Dogbe, Rita
Larsen-Reindorf, Daniel Ansong, Kwasi Yeboah-Awudzi, Joseph K Oppong, Thomas O
Konney, Kwame O Boadu, Samuel B Nguah, Nicholas A Titiloye, Nicholas O Frimpong,
Fred K Awittor and Iman K Martin(2014) Cancer incidence in Ghana, 2012: evidence
from a population-based cancer registry. BMC Cancer 2014, 14:362 doi:10.1186/1471-
2407-14-362
4. Hsing AW, Yeboah E, Biritwum R, Tettey Y, De Marzo AM, Adjei A, Netto GJ, Yu K4,
Li Y, Chokkalingam AP, Chu LW, Chia D, Partin A, Thompson IM, Quraishi SM, Niwa
S, Tarone R, Hoover RN(2014) High prevalence of screen detected prostate cancer in
West Africans: implications for racial disparity of prostate cancer. J Urol. 2014
Sep;192(3):730-5. doi: 10.1016/j.juro.2014.04.017. Epub 2014 Apr 18.
5. World Cancer Awareness Day: Why Ghana must wake up ...
www.todaygh.com › Editor's Choice last accessed Feb 4, 2015 –
6. The Need for Prostate cancer policy for men .www.todaygh.com › Editor's Choice
Last accessed Sep 1, 2014
7. Prosecute Herbal Doctors Who Advertise Prostate Cancer ...
Last accessed the chronicle.com.gh › News January 21, 2015
8. Dr. Karl-Heinz Blank, Ekkehard Arnd Wittich Scheller, Johannes Aaron Seidler,
Dr.med.vet. Lothar Knopf .Dr. Axel Kohler handbook on Diagnosis: “Healthy at Last!”
Spectacular healing success with cascade-fermented enzymes. April 2012
9. Canadian Cancer Society handbook on Radiation Therapy, A guide For People with
Cancer
10. Folakemi T Odedina, Titilola O Akinremi, Frank Chinegwundoh, Robin Roberts, Daohai
Yu, R Renee Reams, Matthew L Freedman, Brian Rivers, B Lee Green and Nagi
Kumar(2009) Prostate cancer disparities in Black men of African descent: a comparative
literature review of prostate cancer burden among Black men in the United States,
Caribbean, United Kingdom, and West Africa. Infectious Agents and Cancer 2009,
4(Suppl 1):S2 doi:10.1186/1750-9378-4-S1-S2
11. 1 in 4 stat explained Prostate Cancer UK
Last accessed prostatecanceruk.org/about-us/how...make.../black.../1-in-4-stat- explained...
12. Yun-Sok Ha, Amirali Salmasi, Michael Karellas, Eric A. Singer, Jeong Hyun
Kim, Misop Han, Alan W. Partin, Wun-Jae Kim, Dong Hyeon Lee, and Isaac Yi Kim(2013)
Increased Incidence of Pathologically Nonorgan Confined Prostate Cancer in African-
American Men Eligible for Active Surveillance. Urology. 2013 Apr; 81(4): 831–835.
13. Locke, L., Spirduso, W. W., & Silverman, S. (2000). Research proposals that work. 4th
Edition. New York: Sage Publishing Co., issued August 1999. 3rd Edition, 1993; 2nd
Edition, 1987; 1st Edition, 1976 New York: Teachers College Press
14. Ghana exceeds global prostate cancer records | Health ...
www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID... Last accessed Aug
7, 2007
15. Obu Raphael (2014). An evaluation of the factors that might influence the prostate cancer
mortality rate and QOL of Ghanaian men; including the impact of a healthy relationship
and cultural issues. Global Research Journal Of Health and Epidemiology: ISSN-2360-
7920, Vol.1(2)pp012-017
16. Deborah Mitchell(2012)Black men and prostate cancer last accessed
www.prostate.net/2012/.../why-black-men-higher-risk-prostate-cancer/

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“THE IMPACT OF ALTERNATIVE MEDICINE IN GHANAIAN MEN OF AFRICAN DESCENT DIAGNOSED WITH PROSTATE CANCER”

  • 1. “THE IMPACT OF ALTERNATIVE MEDICINE IN GHANAIAN MEN OF AFRICAN DESCENT DIAGNOSED WITH PROSTATE CANCER” SYNOPSIS SUBMITTED TO THE INDIAN BOARD OF ALTERNATIVE MEDICINES ACADEMY, KOLKATA, INDIA FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN ALTERNATIVE MEDICINE BY RAPHAEL NYARKOTEY OBU REGISTRATION NO: FFF/13/23 UNDER THE GUIDANCE OF SHREETAMA KANJILAL INDIAN BOARD OF ALTERNATIVE MEDICINES, KOLKATA, INDIA March, 2015
  • 2. “THE IMPACT OF ALTERNATIVE MEDICINE IN GHANAIAN MEN OF AFRICAN DESCENT DIAGNOSED WITH PROSTATE CANCER” ABSTRACT About 50% of all men by 50years will have prostate cancer cells at the dormant stage in their prostate gland so the question now is why are there great geographical prostate cancer variations? It is also believed men of Africa descent have high androgen level than white men and is the fuel for prostate cancer. According to a publication by the Ghana news Agency, Ghana has exceeded the global prostate limits as the country records 200 cases out of every 100,000 men as against 170 world-wide, a survey by the Korle -Bu Teaching Hospital revealed(GNA - August, 07, 2007). This study aims to look at the impact of alternative medicine on Ghanaian men of African descent diagnosed with prostate cancer. This research study is in two forms, firstly an observational study will be used to assess Ghanaian men diagnosed with Prostate cancer and the use of traditional medicinal plant call croton membranaceus to ascertain its anti cancer efficacy. Croton membranaceus root extract marketed as URO 500 at Center For Plant Medicine Research in Ghana (Mampong , Akuapem) 10mg per capsule will be given to about 30 patient diagnosed with Prostate Cancer at the experimental site , De Men’s Clinic & Prostate Research Lab in Dodowa, Akoto House for an observational study to be conducted and cohort for this important research will report after three month of treatment after which their PSA will be assess again as the PSA is the best marker in terms of the diseases monitoring or progressing. Secondly, an extensive research using online search engines to conduct a literature review, summarizing the body of evidence on impact of alternative medicine and prostate cancer use in men of African descent to date will be use for this important second phase of the study. Results will be analyzed using the PSA at the stage at diagnosis and after treatment with the croton membranous. The International Prostate Symptoms score (IPSS) and the international Index of Erectile Function (IIEF) questionnaire will also be assessing before and after. Abdominopelvic Scan using Sonoscape A6 with full bladder to enable acoustic widow to assess prostate Volume before and after will also be access.
  • 3. INTRODUCTION: BACKGROUND Do the prostate cancer disparities seen in Black men around the world follow the path of the Transatlantic Slave Trade? (Odedina et al 2009). Although prostate cancer incidence and mortality rates have been declining in both African American and White men since 1991, possibly due to improved diagnostic techniques, better screening and improved surgical and radiologic treatments, the rates remain comparably higher among African American men. Why does this disparity continue to exist among African American men in spite of the significant research to eliminate this disparity? ( Odedina et al 2009). Thus the variability in risk and mortality across these populations of West African descent suggests a potential and important influence of environmental/lifestyle factors acting on prostate cancer risk in these already susceptible populations. Can this my PhD research work data hold the key to my better understanding of the etiology of lopsided burden of this disease in men of African descent such as Ghanaian men? There are more questions than answers at this time: Does the similar genetic characteristic of Black men of West African ancestry put them at higher risk for prostate cancer compared with other groups? Are there common environmental conditions/lifestyle factors among these men that may be responsible for the prostate cancer burden experienced by this group? What is the relative contribution of genetic, lifestyle and environmental factors in prostate cancer incidence and mortality among this group? (Odedina et al 2009). In Ghana, It is also opined that men with numerous or promiscuous men get this dreaded cancer. However numerous researches also prove the benefit of frequent sex and prostate health. So does frequent sex causes prostate cancer in men of African descent as most of the research black men are not involve and even if they are they are only made of a few percentage. Prostate cancer comes with lots of disparities from screening and treatments. It is also know that black men have about 60% chances of getting prostate cancer than white men and according to the Prostate
  • 4. Cancer UK(Prostate Cancer UK 2014) 1 in 4 black men will get prostate cancer in their life time which involve men of west African continent. Men of African descent have been label as endangered species and black ancestry have been implicated as an established risk factor for the high rates of prostate cancers in the black communities. However race and genetic specific evidence is still missing. Also according to the American cancer society genetic prostate cancer accounts for only 5-10% of prostate cancers so the question now lies is the high rates of prostate cancers in the black communities linked to genetic or lifestyle or what I call De Jure or De Facto judging from the fact that cancer cells lies dormant in all of us. There are also great geographical variations in prostate cancer incidence between western societies and eastern societies. If cancer is a disease that starts in our cells and our bodies are made of up of trillions of cells, group together to form tissues or organs such as muscles and bones, the lungs, or the liver and genes inside each cell order it to grow, work, reproduce and die and normally our cells obey these orders and we remain healthy then is lifestyle or De Facto the major factor. If sometimes a cell’s instructions get mixed up and behave abnormally and after a while, groups of abnormal cells can circulate in the blood or immune system, or they can form a lumps or tumor then the health of Ghanaian men of African descent cells is crucial if they want to live a long, healthy and vibrant life. Why? Because cells provide the power for everything these men do–from thinking to growing. Simply put, these men cannot be healthy unless their cells are healthy. So I have been wondering if Ghanaian men of African descent lifestyle or de facto influence or promote prostate cancers or even put the prostate cancer cells in their dormant stage in the management of the disease? Yes because the body is jus t like a computer and it does exactly you tell it to do and not often how you want it to do and it’s adapt to changes this is what is call compensatory adaptation at work. For instance in the northern region in Ghana it has been observe that crops in the region cannot yield high without using chemicals because the soil is used to the chemicals the farmers use to grow their crops. This is one reason why the Okinawa’s and Humzas and it pertains to men in the Asian enclaves who live to 145years stay freely from chronic degenerating diseases like cancers and live happily healthy lives partly because of their way of life and the most important lifestyle factor is the dietary habit. Men of African descent have buy into the ideal of modern devitalized cheap foods and the result is the modern day civilization disease like cancers. In Ghana prostate,
  • 5. breast cancers and now sky rocketing kidney diseases are on the increased the result poor health and early death. This cheap food results in low enzymes levels in Ghanaian men depriving the cells of good cellular nutrition resulting in sky rocketing prostate diseases because the prostate is a deep inside organ just like the breast and uterus in women. The prostate sits between two organs of elimination, the urinary bladder and rectum so the more toxic your urine and feces the more the prostate is vulnerable in absorbing the toxic and toxic build up is one of the reasons there is high sky rocketing prostatic diseases in Ghana and black communities. Every single process is controlled and regulated by an enzyme produced by the body specifically for that process. According to medical dictionaries, “life “is the regulated interaction of all the processes performed by enzymes in the body it follows that disease is the disruption of this harmonious interaction between enzymes. The body’s enzymes work together. If a single cell becomes active, a whole cascade of enzymes is immediately prepared for action. The enzyme matrix is genetically differentiated. In other words, Europeans have and need different enzymes than Asian. Statistics show that a person’s life expectancy and quality of life is directly proportional to the efficiency of the body’s enzyme. At birth and during breast feeding, every infant receives a large supply of enzymes for his or her future life. The infant’s future vitality and health depends on this supply of enzymes being properly maintained. This is guaranteed by unprocessed foods that ensure the supply of enzymes components so low enzymes levels cause of today’s civilization or lifestyle diseases that have being implicated that black men have 60% chances of getting prostate cancers than their white counterparts. According to world wide studies, over 80 of the population suffer a lack of vital nutrients or low enzyme levels. As early as 1991, the “declaration of Santa fee”, leading nutritional scientist stated that poor nutrition and the severe exposure of our food to pesticides, processing and conservations are the main reasons for serious illnesses. Hence the reason for the low enzymes in Ghanaian men of African descent would the early of fast foods stuffs, long storage periods and additional processing in today’s food factories using methods such as irradiation , heating , sterilizations and conservation have a massive and negative impact on essential enzymes and other vital substances. Fast food crazes in Ghana for example has a nutritional value dangerously close to zero and serves virtually no other purpose than to make individuals feel satiated. It has also been
  • 6. revealed that black men have low level of Vitamin D level and the darker the skin the lower the vitamin D level in black men STATEMENT OF PROBLEM Very often you find elderly male patients in Ghana above 40years complaining of a feeble urinay stream, hesitancy, dribbling, having to urinate frequently and urgently, feeling that they can’t empty their bladder completely and loss of libido. These observations are usually on the increase whilst little or no effort is made to raise awareness for early detection and treatment (Obu 2014). In Ghana and most African countries, prostate cancer is the most common cancer in males after hepatocellular carcinoma. Whereas in the advanced countries, screening for prostate specific antigen (PSA) has led to early detection and management of the disease, screening has been very low in Ghana, thus leading to low detection rate, poor management and increased mortality( Arthur et al 2006) A survey conducted on the prevalence of the disease as reported at five major hospitals in the country. It was observed that 83.6% of the subjects had their PSA levels above the upper limit of the reference range (4 ng/ml), with their ages ranging between 56 to 85 years. Coincidentally, the survey also revealed that 96.5% of those who had the disease within the period of study were above 50 years (Arthur et al 2006). Most research in prostate cancer is based on how the disease behaves in white men and not black men yet it is black men who are hit hard with this disease. The quality of treatment men received and the health related quality of life of prostate cancer patients will differ according to race and access to health care, even after accounting for patient and disease characteristics, type of primary treatment and other factors (Obu 2014). Not all men diagnosed with prostate cancer will need treatment and men needs different treatments option in Ghana to make their inform decision on treatment options. Conventional treatment only target the symptoms or kill both normal and healthy cells and about 30-45% of men diagnosed with prostate cancer will have recurrence. There is the need for a holistic treatment to target cancer dormancy to prevent recurrence. 76% of all men diagnosed with prostate cancer will suffer either permanent or temporal erectile dysfunction and could go on to
  • 7. about 95% after radical prostatectomy and the quality of treatment for prostate cancer men received and survival rates also depends upon where men leave. According to the men’s charity in Ghana, Men’s Health Foundation, 1 in 5 Ghanaian men will get prostate cancer in their life time. The charity work out the Ghanaian men life time risk factor and was published during the world cancer day , February 04, 2015 with their supporting statistics, 95% of Ghanaian men are not aware of prostate cancer Closed to 1000 men are diagnosed with prostate cancer yearly in Ghana 1 in 5 men will get prostate cancer in Ghana 7 out of 9 men diagnosed with prostate cancer will die in Ghana 3 of 4 men will get enlarged prostate Unspecified number of Ghanaian men are living with and after prostate cancer in Ghana almost 10 out of 10 adults (100) in Ghana don’t know what the prostate gland does 95% of Ghanaian men didn't know the Prostate sits underneath the bladder. 5% correctly thought it was the size of a golf ball. 95% of Ghanaian men don’t know that closed to 1000 men diagnosed with Prostate Cancer yearly in Ghana and closed to 800 men died of the disease. 100% of Ghanaian men said that not enough is being done in Ghana about it to raise awareness on the disease. Not enough Ghanaian men know about their risk of prostate cancer. 98% are not even aware that being black is a key risk factor. 100% said it was time for Ghana to consider a specific policy on prostate cancer in Ghana and men must screen for free under the National Health Insurance Scheme (NHIS) Statistics areas we used: churches, corporate institutions and communities Total of 100 Men answered the Men united V Prostate Cancer Questionnaire form The screening involved ultrasound and PSA simultaneous Highest PSA level =3756ng/ml Age group=45-75years 12 referred Men who came after biopsy 5 confirmed with prostate cancer 99.99% of Ghanaian men were not happy with their sex life
  • 8. The clergy and fire service had excellent prostate health at Dodowa Highest Prostate Volume -=274g Lowest prostate volume=8.75g 90% of Ghanaian men prefer herbal medicine because of media advertisement and bogus treatment claims 5% had family history of the disease , Some also don’t know 90% also don’t know that the PSA test is not a test for prostate cancer but it is a test to know your risk of prostate cancer simply it is a prostate cancer risk test and normal result doesn’t mean that you are cancer free! 90% men also don’t receive the right treatment information regarding prostate cancer treatment. 92% also don’t know that there is no evidence of using traditional herbal medicine to cure prostate cancer and they are only move by media advertisement of false cancer cure! 90% also don’t know the benefits of using complementary medicine in the management of prostate cancer and it right use 95% are not aware of the PSA test for prostate cancer screening 90% also don’t know the work of the prostate gland also thought that it is a taboo for a man to have prostate because of the education they received. Almost, 100% of Ghanaian men don’t know that not all men diagnosed with prostate cancer will need treatment and also don’t know that watchful waiting and active surveillance is part of the management process of prostate cancer Almost 100% of women also thought that promiscuous men or womanizers get prostate cancer 90% of men also thought that frequent sex, multiple sexual partners get this dreaded disease 90% of Ghanaian men don’t know the difference between enlarged prostate, prostate cancer and prostatitis! 98% of herbal practitioners in Ghana don’t have much knowledge in the disease and it management and would also not refer patients to see urologist or prostate cancer medical expert hence there is the need for collaboration between this practitioners and the
  • 9. Traditional and alternative heath practice council must organized programs in cancer management to members who want to specialize in the field. 98% of men also don’t know that the quality of treatment received, rate of survival and support also depends upon where men live Almost 100% of men also don’t know when using the natural approach for prostate cancer management it may takes time and hence they must not expect immediate result (Men’s Health Foundation Ghana, 2015) The research proposal implies the impact of alternative medicine in Ghanaian men of African descent diagnosed with prostate cancer. It is also estimated that by 2030, prostate cancer will be the most commonly diagnosed cancer. In Ghana among males, the mean age at diagnosis for cancers was 48.4 compared with 53.0 years for females and Prostate accounts for 13.2 %(Laryea et al 2014). Another study that estimate the prostate cancer burden in West African men the study authors performed a population based screening study with biopsy confirmation in Ghana. They randomly selected 1,037 healthy men 50 to 74 years old from Accra, Ghana for prostate cancer screening with prostate specific antigen testing and digital rectal examination. Men with a positive screen result (positive digital rectal examination or prostate specific antigen greater than 2.5 ng/ml) underwent transrectal ultrasound guided biopsies. In their results of the 1,037 men 154 (14.9%) had a positive digital rectal examination and 272 (26.2%) had prostate specific antigen greater than 2.5 ng/ml, including 166 with prostate specific antigen greater than 4.0 ng/ml. A total of 352 men (33.9%) had a positive screen by prostate specific antigen or digital rectal examination and 307 (87%) underwent biopsy. Of these men 73 were confirmed to have prostate cancer, yielding a 7.0% screen detected prostate cancer prevalence (65 patients), including 5.8% with prostate specific antigen greater than 4.0 ng/ml. the study authors concluded that in this relatively unscreened population in Africa the screen detected prostate cancer prevalence is high, suggesting a possible role of genetics in prostate cancer etiology and the disparity in prostate cancer risk between black and white American men. According to the authors further studies are needed to confirm the high prostate cancer burden in African men and the role of genetics in prostate cancer etiology.
  • 10. The editorial of Today Newspaper, the Daily Democrat and the New statesman on 4 February 2015 called on the Ghanaian government to wake up on Prostate cancer. The same editorial on 1 September in the Today Newspaper also called for a prostate cancer policy for men in Ghana. There is lot of conflict of interest exciting between traditional, alternative medicine practitioners and conventional practitioners in Ghana in the management of prostate cancer (Obu 2014). There is a long standing issues whether there is current evidence in using traditional or indigenous herbal medicine to cure prostate cancer as most indigenous practitioners in Ghana make lot of claims using the media to advertise their ability to cure prostate cancer using local herbs as there is no pragmatic measures from the traditional medicine council to regulate the practitioners in the field in the case of medical advertisement. Some conventional practitioners called on the Ghanaian government to institute a policy to punish herbal practitioners who advertise their treatment for prostate cancer because they believed that these practitioners are rather amassing wealth and killing Ghanaian men. In the chronicle paper Jan 21, 2015, according to the story, Dr. James Edward Mensah, head of the Urology department at the Korle-Bu Teaching Hospital has called on government to institute measures to prosecute practitioners in the herbal sector who claim they have treatment for prostate cancer. According to him, these self-acclaimed herbal doctors do not have scientific knowledge about the disease; rather they are amassing wealth out of the ignorance of people who visit their facilities for treatment. Dr. Mensah explained that these herbal doctors are just misinforming and killing people in the country, as a result of their activities. PURPOSE OF THE STUDY In Scientific research the purpose of statement indicates ‘why you want to do the study and what you intend to accomplish’ (Locke, Spirduso, and Silverman, 2000). According to this; the purpose of this research study is to first explore the impact of alternative medicine in Ghanaian men of African descent diagnosed with prostate cancer as most prostate cancers are slow growing and men diagnosed with prostate cancer die of other cause and not from the disease.
  • 11. It has also been revealed that prostate cancer can be very aggressive in black men who are on active surveillance or watchful waiting as a form of prostate cancer management because of tumor biology and therefore present with more complications before surgery(Ha et al 2013 ) so this study intends to reveal whether Ghanaian men of African descent diagnosed with prostate cancer can benefit from alternative medicine as a form of prostate cancer management if they for go conventional treatments and also solve the long standing controversy in the health sector between the conventional practitioners, traditional and alternative medical practitioners claim in the media of finding cure for prostate cancer using the herb plant call croton membranaceus in Ghana. It will also assess the anti cancer efficacy of croton membranaceus and prostate cancer. This research will also prove whether Ghanaian men relying solely on alternative therapies alone are gambling with their cancers. The research study will finally also show the benefits of integrative approach in the management of prostate cancer in Ghana to reduce the prostate cancer related mortality rates in the country. HYPOTHESES OF THE STUDY 1. Impact of alternative medicine in Ghanaian men of African descent diagnosed with prostate cancer. 2. The barrier face by Ghanaian men diagnosed with Prostate cancer who are considering relying on alternative medicine in Ghana 3. Conventional doctors knowledge, perception and attitudes towards Ghanaian men diagnosed with Prostate cancer 4. Conventional doctors relationship with alternative practitioners in the patients’ cancer journey. 5. No conventional treatment is superior and about 30-45% of all conventional cancer treatment recurred. 6. Conventional cancer treatment cannot target prostate cancer at its dormant stage whether at the cellular level or tumor stage
  • 12. 7. There is significant benefits in using the Integrative approach in the management of Ghanaian men prostate cancer patients diagnosed with Prostate cancer as integrative approach can put the cancer at its dormant stage and prevent recurrence 8. Relying on Traditional or folk medicine and neglecting conventional treatment could also be a calculated gamble for Ghanaian men diagnosed with prostate cancer. 9. Treating Prostate Cancer starts from the cellular or tumor dormant level and conventional therapies have a long way to go to find cure for prostate cancer. 10. Low enzymes level breed prostate diseases in Ghanaian men RESEARCH METHODOLOGY 1. Croton membranaceus root extract marketed as URO 500 at Center For Plant Medicine Research in Ghana (Mampong , Akuapem) 10mg per capsule will be given to patient diagnosed with Prostate Cancer at the experimental site , De Men’s Clinic & Prostate Research Lab in Dodowa, Akoto House for an observational study to be conducted 2. Prostate cancer patients will be made to sign a form and this will form the cohort to take part in the study and will be under medical supervision. The stage of diagnosis and age will be reported. Patients will also be made to report any adverse effects and report them using a help line to be provided. Any Conventional treatment in case the patient has started will also be presented for this important research. Patients will be sought from various hospitals in Ghana for this important research. The Four main research instruments for this observational study will include: 3. The International Prostate Symptoms Score(IPSS) 4. The international Index of Erectile Function (IIEF) questionnaire 5. Blood sample for PSA and special biochemical tests before and after 6. Abdominopelvic Scan using Sonoscape A6 and patients will have a full bladder to enable acoustic widow to assess prostate Volume before and after.
  • 13. The cohort for this research will report after three month of treatment 7. Case study for this research will involved Ghanaian men diagnosed with organ confined prostate cancer who started hormone treatment that were supported with complementary therapies at the De Men’s Clinic & Prostate Research Lab in Dodowa, Akoto House 8. Finally, extensive research using online search engines to conduct a literature review, summarizing the body of evidence on impact of alternative medicine and prostate cancer. The aim is to merely examine the available proof in an effort to better understand the impact alternative medicine used and prostate cancer among men of African descent. A systematic search of the computerized database, MEDLINE, will be conducted for each alternative treatments type from the originating date of MEDLINE to date using the following keywords: alternative medicine, prostate cancer, race, prostate cancer incidence; and the inclusion criteria will be:  Original studies and review articles;  Publication in English;  Relevance to prostate cancer impact, incidence, prevalence or mortality; and  Sufficient quality and quantity of evidence based on study design and validity on men of African descent with good evidence to support study conclusion. 11. Limitations of the study The study is restricted with limited sample and variables straightly to Ghanaian men of West African descent as black men are more prone to and there is research also on tumor biology as black also have more aggressive to prostate cancer than their white counterparts. The Attitude Scale doesn’t include all the dimensions as the quality of treatment and rate of survival also depends upon where men live
  • 14. The Barriers Inventory doesn’t include all the barriers as most Traditional practitioners in Ghana lacks the scientific knowledge in the management of the disease and about 70-8% of Ghanaians depends upon Traditional herbal medicines. FINDINGS OF THE STUDY 1. Alternative medicine has great impact on Ghanaian men diagnosed with Prostate Cancer as most prostate cancers are slow growing 2. Relying slowing on Traditional Medicine and forsaking Conventional Treatment can be a calculated gamble to Ghanaian men diagnosed with prostate cancer and the cancer can latter be very aggressive. 3. Integrative approach in Prostate Cancer Management in Ghana is the best way to tackle prostate cancer in Ghana to prevent the high mortality rates in the county 4. Conflict of interest in the Ghana Health Sector between the Traditional and allopathic practitioners show be solve in transforming the future of prostate cancer in Ghana to support patient quality of life and rate of survival. 5. Most of the Conventional practitioners have little or no knowledge in the alternative approach use in the management of prostate cancer in Ghana. 6. There must regulations in advertisement in medical treatment information by the Traditional and Alternative Practice Council to regulate practitioner’s advertising their treatment in Ghana. 7. Conventional Practitioners have bad attitude towards patients who claim to use some of alternative medicine for prostate cancer in Ghana. 8. More studies on Croton membranacues is needed to ascertain it anticancer properties and also combining it with other plants to have it synergistic effects. 9. Alternative Practitioners should not promise patients cure for prostate cancer as good physician do not promise cure. 10. The Traditional and Alternative Practice Council in Ghana should organize workshop and educational programs in prostate cancer management in both conventional and alternative to its practitioners to know the scientific knowledge in the disease.
  • 15. 11. Future Prostate cancer centers in Ghana should target the integrative approach to the management of the disease as patients have more confidence in that approach. 12. De Facto or lifestyle has great impact on Prostate Cancer cells to become abnormal 13. De Facto or lifestyle has the tendency to prevent prostate cancer recurrence after treatment. 14. The high rates of prostate cancer incidence in men of Africa descent can be reduce if men of Africa descent become more proactive about their health, early screening and practice good dietary habits. 15. The enzyme matrix is genetically differentiated by race? 16. Person’s s life expectancy and quality of life is directly proportional to the efficiency of the body’s enzyme system and we see this in Asians because of their diets. 17. Safe sex is good for prostate health as toxic get out of the prostate which is good for prostate health and a form of exercise for the prostate. 18. Too much of sitting position also not good for the prostate as it puts pressure on the prostate. 19. we all have cancer cells in our bodies 20. About 50% of all men by 50years will have prostate cancer cells at the dormant stage in their prostate gland so the question now is why are there great geographical prostate cancer variations? 21. The recipe for good health lies in our food and water 22. Testosterone is not the cause of prostate cancer in men of African descent but rather the accumulation of synthetic estrogen the body accumulate as men ages from the food and plastic containers 23. The enzyme 5 alpha reductase inhibitor that converts testosterone into the potent form Dihydrotestosterone DHT ground prostate disease. 24. Hormone therapy does not cure prostate cancer
  • 16. FORMAT I intend to structure my thesis as a series of chapters modified from journal articles that have or will result from this thesis. ABSTRACT INTRODUCTION REVIEW OF LITERATURE CHAPTER 1: Aetiology and Physiology of the Prostate Gland Chapter 1will be based on a literature review and I will aim to explain the aetiology and Physiology of the Prostate Gland CHAPTER 2: Role of Endocrinal Regulatory of Prostate Gland. Here, I will discuss the role of endocrinal regulatory of prostate gland CHAPTER 3: Aetiology of Prostatic cancer In this chapter I will focus on causes and established risk factors of prostate cancer in men of African descent as they are more prone to prostate cancer. This chapter will also discuss whether men of African descent cancer risk are as a result of De Facto or De Jure. It will also looks at the influence of low enzyme levels in men of African descent as a possible cancer cause. It will look at whether androgen level plays a significant factor in prostate cancer in black men. CHAPTER 4: Topographical Impact of Prostatic Cancer This chapter includes a summation of the topographical impact of prostate cancer and also discuses why prostate cancer is not universal occurrence as there is great geographical variation
  • 17. in prostate cancer in western men and eastern men. It will also focus on the men in Okinawa and Humzas communities and how they stay off prostate cancer and why aging is not a, major problem in prostate cancer as the centenarian are able to stay free of prostate cancer. It will also look at the disease on the Africa continent in general and lifestyle factors that contribute to Ghanaian men chances of getting prostate cancer in Africa. CHAPTER 5: Pathology of Prostate cancer I will present the modern special pathology of prostate cancer. CHAPTER 6: Clinical Features of Prostate Cancer Here I will discuss my overall findings and understanding of clinical features before and after diagnosis in Africa as even in areas where screening is available, many prostate cancers are diagnosed after the symptoms begin. However, the risk posed by particular symptoms is largely unknown, especially in unselected populations such as primary care. CHAPTER 7: Diagnosis of Prostatic cancer in Africa in Holistic Concept In this chapter it will reveal prostate cancer diagnosis, screening in African men and also agues for separate screening programs for men of African descent. It will show how the cancer is stage CHAPTER 8 Isolation of Alternative Therapies to treat prostate cancer This chapter will concentrate on management of prostate cancer by alternative therapies and will isolate each evidence based alternative approach to treat prostate cancer
  • 18. CHAPTER 9 Justification of Treatment by Alternative Therapies This chapter will present evidence based research that support using alternative remedies to treat prostate cancer. It will also involve using the integrative approach to manage prostate cancer and some notable organization that have supported the use of alternative therapies to manage prostate cancer. CHAPTER 10 Indication of Selection of Alternative Therapies to treat prostate cancer In this I will focus on patients selection in choosing alternative treatment for prostate cancer as also relying on these therapies alone and forsaking conventional treatment could be a calculated gamble for the patient and various side effects from alternative therapies for prostate cancer management. CHAPTER 11 Modus Operandi of Alternative Therapies This chapter will focus on each evidence based alternative therapies for prostate cancer and how they work to manage men diagnosed with prostate cancer and the cost involved. CHAPTER 12 Prostate Cancer Prognoses This chapter will focus on prostate cancer life expectancy rate as it also not universe because the quality of treatment men received also depends upon where men life as Ghanaian men belongs to men of African descent and leaving in West Africa with lack of health care access and mostly relying on Traditional remedies Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good in advance countries but most not counting men with prostate cancer who die of other causes: 99% of men with the most common types of prostate cancer overall will survive more than five years after diagnosis that are not evidence
  • 19. based. In Ghana most of the cancers are diagnosed at the late stage that makes survival rates to be much lower in Ghana. CHAPTER 13 Role of Holistic medicines for treatment of Prostate Cancer In this chapter I will focus on how the integrative program benefits men diagnosed with prostate cancer. Dietary changes and lifestyle modifications for Ghanaian men that can prevent prostate cancer recurrence and especially how some Ghanaian dietary habits can help prevent or allow the cancer to recur. CHAPTER 14. Why This Topic-“Impact of Alternative Medicine in Ghanaian Men of African descent diagnosed with Prostate cancer”. In my years of experience in medical ultrasound diagnosing men with prostate diseases in the Herbal Hospitals in Ghana and who work previously with a medical doctor who specialized in using Traditional medicine to solve Ghanaian men Prostate issues I then developed the interest in prostate issues and after my masters program in Prostate Cancer –Sheffield Hallam University, UK when I was therefore introduced to the real world of prostate cancer controversies and realizing conventional therapies have a long way in finding cure for prostate cancer and the treatment only suppress symptoms I therefore chose this topic to look at the alternative remedies and impact of Ghanaian men diagnosed with Prostate cancer. In Ghana some herbal practitioners also makes lots of claims of finding cure for prostate cancer using traditional medicine and displaying lots of awards on their bill boards that I try to find their work in any scientific journey that I was unable to find which means their claims are only speculative in the media in Ghana. This chapter will focus on why this topic is relevant to solve the controversy in using alternative therapy to treat prostate cancer to give the conventional practitioners the overview in management of the disease using the alternative means and also solve the long standing issues in Ghana on whether there is evidence in using traditional medicine to treat prostate cancer as conventional practitioners in Ghana believe that Traditional or Herbal Practitioners lack the scientific knowledge in the management of the disease. Finally to see if
  • 20. Ghanaian men of African descent that rely on traditional or alternative medicine are gambling with their prostate cancer or not. CHAPTER 15 Three Cases Treated in Ghana at the De Men’s Clinic & Prostate Research Lab in Dodowa, Akoto House. I will discuss the benefit of my prostate cancer program using the integrative approach to treat patients successfully and its impact on prostate cancer dormancy MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES APPENDICE
  • 21. References 1. FKN Arthur, FA Yeboah, M Adu-Frimpong, EE Sedudzi, KA Boateng(2006) Prostate cancer screening in Ghana - a clinical benefit? Journal of Science and Technology (Ghana) 2. “1 in 5 Ghanaian Men Will Get Prostate Cancer In Their ...https://233livenews.wordpress.com/.../1-in-5-ghanaian-men-will-get-pros... Last accessed dated Feb 4, 2015 3. Dennis O Laryea, Baffour Awuah, Yaw A Amoako, E Osei-Bonsu, Joslin Dogbe, Rita Larsen-Reindorf, Daniel Ansong, Kwasi Yeboah-Awudzi, Joseph K Oppong, Thomas O Konney, Kwame O Boadu, Samuel B Nguah, Nicholas A Titiloye, Nicholas O Frimpong, Fred K Awittor and Iman K Martin(2014) Cancer incidence in Ghana, 2012: evidence from a population-based cancer registry. BMC Cancer 2014, 14:362 doi:10.1186/1471- 2407-14-362 4. Hsing AW, Yeboah E, Biritwum R, Tettey Y, De Marzo AM, Adjei A, Netto GJ, Yu K4, Li Y, Chokkalingam AP, Chu LW, Chia D, Partin A, Thompson IM, Quraishi SM, Niwa S, Tarone R, Hoover RN(2014) High prevalence of screen detected prostate cancer in West Africans: implications for racial disparity of prostate cancer. J Urol. 2014 Sep;192(3):730-5. doi: 10.1016/j.juro.2014.04.017. Epub 2014 Apr 18. 5. World Cancer Awareness Day: Why Ghana must wake up ... www.todaygh.com › Editor's Choice last accessed Feb 4, 2015 – 6. The Need for Prostate cancer policy for men .www.todaygh.com › Editor's Choice Last accessed Sep 1, 2014 7. Prosecute Herbal Doctors Who Advertise Prostate Cancer ... Last accessed the chronicle.com.gh › News January 21, 2015
  • 22. 8. Dr. Karl-Heinz Blank, Ekkehard Arnd Wittich Scheller, Johannes Aaron Seidler, Dr.med.vet. Lothar Knopf .Dr. Axel Kohler handbook on Diagnosis: “Healthy at Last!” Spectacular healing success with cascade-fermented enzymes. April 2012 9. Canadian Cancer Society handbook on Radiation Therapy, A guide For People with Cancer 10. Folakemi T Odedina, Titilola O Akinremi, Frank Chinegwundoh, Robin Roberts, Daohai Yu, R Renee Reams, Matthew L Freedman, Brian Rivers, B Lee Green and Nagi Kumar(2009) Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infectious Agents and Cancer 2009, 4(Suppl 1):S2 doi:10.1186/1750-9378-4-S1-S2 11. 1 in 4 stat explained Prostate Cancer UK Last accessed prostatecanceruk.org/about-us/how...make.../black.../1-in-4-stat- explained... 12. Yun-Sok Ha, Amirali Salmasi, Michael Karellas, Eric A. Singer, Jeong Hyun Kim, Misop Han, Alan W. Partin, Wun-Jae Kim, Dong Hyeon Lee, and Isaac Yi Kim(2013) Increased Incidence of Pathologically Nonorgan Confined Prostate Cancer in African- American Men Eligible for Active Surveillance. Urology. 2013 Apr; 81(4): 831–835. 13. Locke, L., Spirduso, W. W., & Silverman, S. (2000). Research proposals that work. 4th Edition. New York: Sage Publishing Co., issued August 1999. 3rd Edition, 1993; 2nd Edition, 1987; 1st Edition, 1976 New York: Teachers College Press 14. Ghana exceeds global prostate cancer records | Health ... www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID... Last accessed Aug 7, 2007 15. Obu Raphael (2014). An evaluation of the factors that might influence the prostate cancer mortality rate and QOL of Ghanaian men; including the impact of a healthy relationship and cultural issues. Global Research Journal Of Health and Epidemiology: ISSN-2360- 7920, Vol.1(2)pp012-017 16. Deborah Mitchell(2012)Black men and prostate cancer last accessed www.prostate.net/2012/.../why-black-men-higher-risk-prostate-cancer/