prostate priorities
by Jenny Bryan
When Eric was told he had cancer of the prostate, he suddenly realised how little he knew about the male gland wrapped around the tube that carries urine to the penis (the urethra). But he had to learn fast.
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Normally the size of a walnut, the prostate gland produces fluid to feed and transport sperm. It is slightly enlarged in a lot of men over 50. As the gland grows it presses on the urethra making it more difficult to pee. Some men find they need to get up in the night several times to pass urine. Others notice that their stream of urine is becoming weaker, or that they dribble between visits to the lavatory, causing embarrassing wet patches on their trousers.
In most cases, the extra growth in the prostate is benign, and the condition is called benign prostatic hyperplasia (BPH). But, like about 24,000 other British men each year, Eric found that the lump in his prostate wasn't benign.
'When I was working for a company I had a medical every two years, but when I started working on my own I didn't have medicals. After a while I thought it was sensible to have one and I discovered I had an early cancer. As with any other cancer, the thing is to catch prostate cancer early,' says Eric.
watch out for...
It's impossible to distinguish between BPH and prostate cancer without tests. The symptoms are the same for both conditions, which is why it's important to get them checked out.
In addition to problems when urinating, some men get:
- tiredness
- aches and pains in the lower back, upper thighs or pelvic area
- loss of appetite
- weight loss
- blood in the urine or sperm
- swollen glands.
Find out more about warning signs in don't panic.
testing times
John and Patrick had very similar symptoms, but it was the test results which showed that John's enlarged prostate was benign and Patrick's was cancerous.
The first test is called a digital rectal examination (DRE) and this can be done by a GP. As the prostate isn't easy to get at, the GP will put their finger into the rectum so that they can feel the shape and size of the prostate through the rectal wall. If it seems enlarged or lumpy, you will be referred to see a specialist who can examine the prostate with an ultrasound scan.
The specialist may also take a small sample of the prostate and check whether the cells are cancerous. A blood test will be done to measure the level of prostate specific antigen (PSA). PSA is a substance in the blood, raised levels of which may indicate prostate cancer. But results may be high for other reasons, such as prostate infection, and a negative test does not rule out cancer altogether.
facts and figures
- One in three men over 50 have a prostate problem
- Eight out of ten men don't know where their prostate is!
- 2.4 million men have an enlarged prostate
- One in twelve men develop prostate cancer, making it the most common of the cancers that can only affect men
- Each week about 300 men are diagnosed with prostate cancer
- The proportion of younger men developing prostate cancer is increasing rapidly
- Each year, over 9500 men die from prostate cancer in the UK.
treatments
benign disease
Like most men who are found to have BPH, John was prescribed drugs to shrink his prostate gland. In about half of cases, this treatment is effective. But John wasn't so lucky and his symptoms didn't improve.
So his specialist advised him to have an operation called transurethral resection of the prostate (TURP). It's a common operation for men with BPH. John was awake throughout. He had an epidural anaesthetic to block the nerves to his lower abdomen. A fine tube was then passed up through the urethra in his penis so the surgeon could see his prostate through eyepieces. Also inside the tube was a heated wire that the surgeon used to cut away the excess prostate tissue pressing into the urethra.
At the end of his operation, John's surgeon showed him a jar containing 41 grams of prostate tissue that had been removed. Sometimes there are 100 grams and more.
John was able to go home a few hours after his operation and three weeks later, he had a big smile on his face:
'I'm thankful to a friend of mine who said to go and see a doctor. It's a relief now to go to the toilet because you know you can go and walk out of there quite happy, without leaving a stain in your trousers. For me it was worth it.'
treating cancer
Eric and Patrick weren't so lucky. Their tests showed that the growths in their prostates were cancerous and they had to make some tough decisions about what to do next. Without treatment, prostate tumours grow slowly and many elderly men die of something quite different before their prostate cancer becomes a serious problem. However, younger, fitter men may have their lives cut short by prostate cancer if it is not treated.
surgery
At 64, and an active playmate for his nine grandchildren, Eric decided that he would prefer surgery for his tumour, rather than watch and wait to see what happened.
'I did agonise over which treatment to have because there is no clear choice. I decided to go ahead with surgery on the basis that the damn thing would be out and should no longer trouble me,' he explains.
The operation to remove his prostate was a tricky one, as surgeons wanted to get rid of all his cancer without damaging any of the important nerves near his prostate, as this could make him incontinent or impotent.
Five weeks after his operation, Eric felt fine and the good news was that his PSA level, which was high before surgery, was now almost undetectable. His surgeons are optimistic that they have removed all the cancer and that Eric will not need further treatment. But they will be watching carefully over the next few years.
radiotherapy
Patrick chose radiotherapy to get rid of his prostate tumour – and a novel way of giving it. Instead of a course of external X-rays aimed at his cancer, Patrick decided on brachytherapy, a technique in which radioactive 'seeds' are placed inside the prostate so that they will kill the cancerous cells but, as there is no surgery, there is no risk of damaging key nerves.
'Brachytherapy means that we inject radioactive material into the middle of the tumour, so the big advantage is that we can get a bigger dose into the tumour and spare the surrounding tissue because the dose of radiation which gets out of the prostate is very small,' explains Dr Dan Ash, from the Yorkshire cancer centre in Leeds.
Dr Ash made 3D pictures of Patrick's prostate so that he knew exactly where to put the seeds and Patrick was able to go home almost immediately after the procedure. He had been warned that he might get a stinging, burning sensation, rather like cystitis, four or five days after his treatment as the radioactive seeds started to destroy his cancer. He also needed a catheter in his urethra to empty his bladder because of the inflammation around his prostate resulting from the radioactive seeds. This proved more uncomfortable than he had expected.
Three months later, when the catheter was just a distant memory, Patrick felt much better and, for the first time for a while, he was able to take up his old hobby of playing the bagpipes.
further treatment
Hopefully, neither Eric nor Patrick will need any more treatment. For men whose cancer does come back or has already spread by the time it was diagnosed, there are anti-cancer drugs to keep their tumour under control for months or years. As prostate tumours grow in response to the male hormone, testosterone, the anti-cancer drugs aim to block the activity of the hormone.
The alternative is to remove the main source of testosterone production – the testicles – but many men prefer drug treatment.
problems after treatment
Both surgery to remove the prostate and anti-cancer drugs to block testosterone production can lead to impotence. Fortunately, the growing range of treatments available to combat impotence are making this less of a problem than it used to be.
Drugs such as Viagra, injections and pump devices can all help improve erections and it is well worth finding out what treatments are on offer, before or after embarking on prostate cancer treatment.
to screen or not to screen?
Some specialists have been pressing for a national screening programme for prostate cancer for middle aged and elderly men – much like the breast cancer screening programme for women. Prostate screening would be based on two or more of the tests used to diagnose the condition (ie: DRE, ultrasound, PSA).
But the government has to date consistently decided against such a move because of the lack of consensus on the best way to treat prostate cancer and, in some cases, whether any treatment is necessary. Medical opinion is divided over the viability of a screening programme because of the high costs involved and question marks over how many lives it would save. It doesn't help that PSA is a far from perfect test. Although a high level can indicate cancer, there are many other reasons why it can be raised. Research is underway to improve the predictive powers of current PSA tests and to decide whether a screening programme for prostate cancer could be viable in the future.
Even so, the government has recently ruled that men should get easier access to PSA testing. Since 2001, men who are worried about their risk of prostate cancer have had easier access to a blood test to aid diagnosis. The NHS informed choice programme Prostate Cancer Risk Management enables men to get information about the value of PSA testing through their GP. Having considered the advice contained in the scheme, men who are still concerned that they could have prostate cancer can request a test through their GP.help and info
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organisations
CancerBACUP
3 Bath Place
Rivington Street
London EC2A 3JR
Helpline: 0808 800 1234 or 020 7739 2280 (Mon-Fri 9am-8pm)
Tel: 020 7696 9003 (Mon-Fri 9am-5.30pm)
Website: www.cancerbacup.org.uk
Provides up-to-date information, advice and support to cancer patients, and their families and friends on all aspects of cancer and its treatment, and on the practical and emotional problems of living with the illness. The helpline, above, is staffed by specialist cancer nurses.
Everyman – Action Against Male Cancer
The Institute of Cancer Research
Freepost LON 922
London SW7 3YY
Tel: 0800 731 9468
E-mail: everyman@icr.ac.uk
Website: www.icr.ac.uk/everyman
Everyman is The Institute of Cancer Research's national campaign to raise awareness and fund research for prostate and testicular cancer. Informative factsheets can be found on the website.
Prostate Cancer Charity
3 Angel Walk
London W6 9HX
Helpline: 0845 300 8383 (Mon-Fri 10am-4pm)
E-mail: info@prostate-cancer.org.uk
Website: www.prostate-cancer.org.uk
Provides support and information for anyone concerned about issues surrounding prostate cancer. Have a telephone helpline and nationwide network of support contacts. Produce a wide selection of literature and carry out research into the causes and treatment of prostate cancer.
PSA (Prostate Cancer Support Association)
BM Box 9434
London WC1N 3XX
Helpline: 0845 60 107 66
Website: www.prostatecancersupport.co.uk
Provides support and information to men with prostate cancer, their wives, partners and families, people who are concerned and those who want to know more.
websites
NHS Cancer Screening Programmes
www.cancerscreening.nhs.uk/prostate
More information about the NHS informed choice programme – Prostate Cancer Risk Management.
Cancer of the Prostate
www.royalmarsden.org.uk/ ...
Informative online booklet on cancer of the prostate, produced by The Royal Marsden Hospital.
Check-em
www.check-em.com
Aims to provide men with the information they need if they are concerned about their health. The site looks specifically at prostate and testicular cancer, outlining the causes and symptoms and treatments available, but also covers men's health issues and steps you can take to get yourself in shape.
DIPEx.org
www.dipex.org
This site offers a unique support service for patients affected by a range of conditions and is designed to provide a true insight into the impact of illness, offering personal experiences on many issues and the answers to those questions patients are sometimes too afraid to ask.
Orchid Cancer Appeal
www.orchid-cancer.org.uk
Dedicated to funding research into diagnosis, prevention and treatment of testicular, prostate and penile cancer and to increase public awareness of these previously neglected diseases. Website features information on prostate cancer and the PSA test.
PSA Test
www.psate.st
An information centre for sufferers of prostate cancer, their families, loved ones and friends of prostate cancer sufferers. Information about prostate cancer – particularly the PSA test.
Scottish Association of Prostate Cancer Support Groups
www.prostatescot.co.uk
Gives excellent advice about what questions to ask once diagnosed, plus a database of local Scottish support groups.
Prostate Research Campaign UK
www.prostate-research.org.uk
Fighting all prostate diseases through research and information.
reading
 |
Coping Successfully with Prostate Cancer (Overcoming Common Problems) by Tom Smith (Sheldon Press, 2002) |
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The Prostate Cancer Book: The definitive guide to the causes, symptoms and treatments by Jonathan Waxman (Vermilion, 2000) |
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The Prostate: Small Gland, Big Problem: A guide to the prostate, prostate disorders and their treatments by Roger Kirby (Health Press, 2002) |
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(September 2003, resources updated January 2005)
