SOMETHING ABOUT MEN:

PROSTATE CANCER

Prostate cancer diagnosis has been going up for some time. Since 2003, it has been the most commonly diagnosed cancer in men in the UK, with over 27,000 new cases each year. The latest information from the Office of National Statistics reveals that one in 11 men has a lifetime risk of developing prostate cancer.

But only half of us know that prostate cancer is the top male cancer, according to a poll commissioned by the Prostate Cancer Charity. And nearly 90% of people polled don't know what the prostate gland does. This highlights the urgent need for more public awareness.

The aim of Prostate Cancer Awareness Week is to make the most common male cancer common knowledge.

Embarrassed?

A big part of the challenge is overcoming men's embarrassment and unwillingness to talk about problems in the trouser department. Research by Men's Health magazine, carried out for the Institute of Cancer Research, found that over a quarter of men have trouble talking to their doctor about potentially embarrassing problems. Professor Peter Rigby, Chief Executive of the Institute, said, 'There is still a great taboo around prostate and testicular cancers. We want men not to be embarrassed about their bodies, but to go to their GP if they have concerns.'

Ask!!!

Men may find it hard to talk to their doctor, but some seem to feel more comfortable about contacting 'just ask' for advice about sensitive subjects. In the last few years lots of men – and a few women too – have sent us questions about the prostate. Many people were concerned about benign prostatic hyperplasia (BPH) and prostatitis – two conditions of the prostate that can be unpleasant to live with but are not life-threatening. Others were concerned specifically with cancer.

Starting with the most basic question of all, Sam wrote in to ask what prostate cancer is.

Robin, aged 59, had a similar question, asking for straightforward information about the disease.

Andy was more concerned about the symptoms of prostate cancer. He was experiencing a frequent need to pee during the night but, like so many men, was nervous about going to see his GP

Testing and diagnosis

Quite a few visitors to the site were concerned about testing and diagnosis. One of the few women to ask a question about prostate cancer wanted to know if there was a blood test for the disease.

Jim knew about the test for prostate-specific antigen (PSA), which is done as part of the diagnostic process, but he wanted to know more about interpreting the results of a test.

Michael, 51, was also aware that a blood test was available but was having trouble persuading his doctor to do the test for him. This was a particular worry because there was a history of prostate cancer in his family.

Causes

Some questioners wanted to know about the causes of prostate cancer. Information about the causes is rather sketchy: genetics appears to have some influence, though perhaps not as much as the effect of diet and lifestyle.

51-year-old Ade was interested in finding out whether there was any connection between benign prostate enlargement and the development of cancerous cells.

Colin, aged 47, had an unresolved problem of pain in the pelvis. He thought it might be an ongoing infection of the prostate and wondered if this might make him more likely to develop prostate cancer in the future.

One 27-year-old questioner had heard that prostate cancer was caused by too much sex. Fortunately we were able to reassure him.

New approach to treatment

In fact, most prostate cancers grow so slowly that treatment is not necessary at all. Unfortunately there is currently no good way of telling the difference between a slow cancer and a fast one that needs radiotherapy, surgery or hormone treatment. This could mean that many men are opting for invasive treatment they may not need.

To try and tackle this problem, The Institute of Cancer Research is running a research project at The Royal Marsden Hospital in Sutton, Surrey. The research is investigating an approach to prostate cancer called 'active surveillance'. Rather than going straight for a treatment option, men are given a PSA test and a rectal examination at regular intervals. They also have a biopsy (where a small sample of the tissue from the tumour is removed) every two years. If during this time a man's PSA level rises significantly, his prostate cancer will be treated.

The research is led by Dr Chris Parker, who says, 'Active surveillance may spare two thirds of men the side-effects of treatment, without compromising survival.' That's important news for men when you consider that the side-effects can include impotence, incontinence and infertility.

'Active surveillance' might sound just like another way of saying 'watchful waiting', which is the long-standing approach to many cases of early prostate cancer. Watchful waiting involves periodic examinations and tests, with hormone therapy if the cancer appears to be developing. As Chris Parker explains, active surveillance is different: 'Whereas watchful waiting involves relatively lax observation with late, gentle treatment for those who develop symptoms of progressive disease, active surveillance involves close monitoring with early radical treatment for those with signs of progression.'

Over 60 men have joined the study in the last 12 months, the team plan to recruit another 200 over the next few years.