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Prostate cancer

IT has been the ''secret'' disease that men were too embarrassed to talk about. It recently claimed the life of top QC George Carmen but still there remains an embarrassment phobia about mentioning prostate cancer.

Last year prostate cancer killed nearly 10,000 men in the UK. It is currently the second commonest cancer amongst men and is threatening to take the dubious top spot as the number one cancer killer.

Yet many men are ignorant of the warning signs or embarrassed to act on them and it is their failure to seek medical help which is a major problem.

But with 21,400 new cases and nearly half of them fatal, it is time to for them to ditch the head-in-the-sand attitude.

It is generally regarded as an old man's problem, but the numbers of men dying from prostate cancer have risen substantially and increasing numbers of young and middle-aged men are victims.

Eight out of ten 80-year old men have the disease, but since it often doesn't cause any symptoms for years, many of the elderly never know they have it, and die of something else.

The bigger danger is for the increasing number of younger victims.

Yet it is one of the most treatable cancers if picked up early enough.

The trouble with the disease is that it is ''slow-burning''. It can take years and years to show, and men often ignore warning signs until it is too late. Hoping, wrongly, that it will go away.

What is it?

The prostate is a small gland, about the size and shape of a walnut, found only in men. It lies at the base of the bladder and surrounds the urethra, the tube through which urine passes.

It produces a fluid which protects that tube and mixes with sperm to form semen.

Tumours on the gland may make passing urine difficult and increase the frequency of wanting to urinate.

But there may be no outward sign of any trouble until the disease has spread to the bones of the pelvis, causing intense pain.

Risks

The causes of prostate cancer are unknown, but environmental and genetic factors are suspected. All cancers start by faults developing the genes of a cell.

Men who eat diet high in fat and low in vegetables may increase their risk of the disease. Those with a family history are at greater risk and there is some evidence that black men are more likely than white to develop it.

Though increasingly common in Western world, rates are low in the Far East, prompting speculation the low-fat diet and large amounts vegetables and fish eaten there may be a factor.

Eating lots of vegetables, especially tomatoes and salads may help reduce the risks, say experts.

Detection and Diagnosis

Your doctor is likely to assess your prostate with a rectal examination. If anything is felt during this, you probably be sent for assessment specialist in urology.

You may then have an ultrasound scan to try and detect any abnormality and/or a biopsy - removing a small piece of tissue using a thin needle, which will be examined under the microscope see if any cells are cancerous.

There is increasing pressure doctors to test men for prostate cancer, in the same way that women are screened for breast cancer, that it can be detected at an early stage. But there is controversy how effective this is. A PSA test, which measures the levels of prostate specific antigens in the blood, unreliable, producing false positive results.

Treatment

Some prostate cancers grow very slowly and may not cause clinical problems. In these cases treatment may not be needed, but regular check-ups are important to make sure the situation has not changed.

For faster-growing cancers, there are various treatments.

Surgery: In which the gland is removed entirely
Radiotherapy: Where the cancer is bombarded by radioactive waves. There are trials on-going of radioactive 'seeds' being implanted into the prostate which irradiate the tumour over a period of time. The benefits appear to be fewer side effects but it is only suitable for small tumours.
Hormone therapy: Prostate cancer can depend for its growth on male hormones, mostly testosterone, but when deprived of this the cancer can shrink. This treatment 'switches off' the hormone supply. The development of new hormone therapy drugs is being very actively pursued by bodies like the Cancer Research Campaign.
Herbs: In the USA a treatment based on a combination of five herbs has been found to benefit some men, but it is not yet licensed here.

However, trials may take place in the UK later this year, carried out by the Institute for Cancer Research.

Campaigners have succeeded in bringing this once forgotten cancer to the fore, highlighting its dangers and the scope for early treatment. They are pressing for screening to be made available.

One of them is Roy Nixon, 53, from Bramhall, whose prostate cancer has now spread to his bones and lymph system. As well as fighting the disease, Roy has channeled his energy, and anger at the lack of resources, into battling for a better deal for sufferers, and set up the Prostate Cancer Association North West.

The government has now pledged to increase spending on research to £4.2m over three years, but Roy says more is needed and that there is a need for proper screening tests for cancers which affect men.

He also says that there is a need to ensure that men are given balanced information about prostate cancer screening so that they can decide for themselves whether or not to have a test.

Warning signs

Difficulty in urinating such as delays, stopping and starting
A weak stream
Urinating more frequently than usual, for example having to get up several times during the night
Pain when urinating
Blood in the urine
Pain or stiffness in the lower back or hips

If you have any of these symptoms, see your doctor as soon as you can.

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