Of all the health issues men face as they age, prostate cancer is without a doubt the most widely discussed, exciting and challenging. It is also controversial given that the National Screening Committee recently recommended against implementing a national screening program for this disease. I should know. As a London consultant urologist and robotic surgeon at University College London Hospital (UCLH) and Barts Health, I specialize in prostate cancer and treating men with the disease, so I am always on the front line in the fight against this increasingly common disease.
My experience is not limited to professionals. My father was diagnosed with the disease 13 years ago and successfully treated, so I know how important it is to get the message out to men about this cancer, which has more than 56,000 new cases diagnosed in this country every year and will affect at least one in eight men during their lifetime.
Thanks to some well-known figures speaking out about their diagnoses, such as cyclist Sir Chris Hoy’s recent documentary, cancer, courage and me, and film director Sir Steve McQueen with his short film embarrassingmore men than ever are asking for a PSA test. This test measures the levels of prostate-specific antigen, a protein produced by cells within the prostate, in the blood.
Elevated PSA levels can serve as a biological signal of the presence of tumors. However, high levels of PSA do not necessarily mean severe cancer. That’s one reason why I think it’s so important for men to better understand this disease and why it’s so important that we talk about it.
I have many patients, and their knowledge and understanding of prostate cancer—causes, symptoms, available treatments, survival rates—vary widely. For example, if a family member has prostate cancer, your risk of developing the disease is increased. You’re looking at a risk not of one in eight, but about one in four. One in four is also a risk factor for black men.
So here are a few things all men, their partners and families need to know about prostate cancer.
Don’t be afraid to ask your family doctor for a PSA test
Raising awareness is crucial for people to understand their risks, and men need to be able to have open and honest conversations with their doctors about PSA testing. Currently, any man over the age of 50 can request a test, regardless of whether they have symptoms. This is important because prostate cancer often has no symptoms until it escapes the prostate, at which point it is more difficult to treat. Red flags for advanced prostate cancer include back, pelvic, or buttock pain, any surprising weight loss, any blood in the urine or semen, and problems getting or maintaining an erection.
Urinating problems are also common as men age, but you should also talk to your GP if you have trouble urinating or your bladder feels like it’s not empty after urinating. A weak stream of urine when urinating, a need to go to the toilet more than usual (especially if you suddenly feel the urge to go to the toilet), and leaking urine (either before urinating or after emptying the bladder) need to be checked.
Having one or any of these symptoms does not necessarily mean you have prostate cancer, and the absence of symptoms does not mean you do not have cancer. Discuss this with your GP or urologist. Don’t worry—they don’t need to stick their fingers up your butt to check.
There are several ways to improve prostate health, such as drinking green tea
You can lower your risk of prostate cancer by staying physically active and maintaining a healthy weight. The Mediterranean diet is rich in vegetables, especially tomatoes and broccoli, as well as fruits, whole grains and fish.
Limit red meat and excess dairy products. Don’t smoke and limit alcohol intake. Get enough vitamin D from sunlight, food, or supplements. Some foods also appear to directly protect the prostate, including green tea, soy foods, turmeric, and pomegranates.
A diagnosis does not mean you will die or suffer life-changing problems
Patients are shocked when they hear the word cancer, and many fear the worst. But prostate cancer can be successfully treated, especially if it’s caught early. As doctors, we are more sympathetic to the outcome of treatment.
It used to be simple. As doctors, we believe we must cure all cancers. People think cancer is bad, so we need to cure you and deal with the aftermath. But patients must live with the consequences of our work. While we think it’s a great thing that we offer a 99% cure rate, if it means a person becomes impotent or incontinent, that can have a significant impact on quality of life.
Professor Rajan says risk of permanent damage from prostate cancer surgery is much lower than before thanks to technological advances – Heidi Ellis
We know that saving lives is not enough if people feel their new lives are not worth living. Incontinence and impotence are both possible side effects of prostate cancer surgery, but recent advances in robotic surgery mean the risk of permanent damage is far lower than before.
Surgery may not be the best solution
For years, there has been controversy over the ways in which prostate cancer patients may be overtreated. In the past, surgeons operated on patients with low-risk cancers that we now know will never spread, but we no longer do that.
We are able to offer different treatments such as active surveillance (closely monitoring a slow-growing cancer rather than risking immediate treatment), local treatment (freezing the cancerous area, heating it with ultrasound or blasting it with electricity) and radiation therapy (using high-energy focused rays similar to X-rays to kill cancer cells).
By tailoring treatments to individual patients—taking into account criteria such as age, overall health, and aggressiveness of the cancer—the results are more likely to be positive.
Technology is helping transform prostate cancer care
One of the firsts we’ve pioneered at UCLH is that, thanks to advances in magnetic resonance imaging (MRI) technology for initial diagnosis, every patient who comes to us will have a tailor-made plan that tells us exactly how the surgery should be performed.
In each case, radiologists and surgeons hold a meeting to discuss how best to operate on the patient, based on the location of each tumor on the MRI scan and the grade (or aggressiveness) of the disease on the biopsy. These plans guide decisions to safely preserve delicate nerves that affect continence and erection, providing patients with a better quality of life after surgery.
Lack of prostate cancer screening strategy part of larger discussion
What we really need is a screening strategy that can reliably identify patients with aggressive prostate cancer at any early, curable stage, rather than simply rolling out a comprehensive PSA test that is not accurate enough. This is why the National Screening Committee does not recommend universal screening of all men. However, they do suggest that PSA screening may benefit men who have inherited mutations (or misspellings) in the BRCA gene (also linked to breast and ovarian cancer). But they don’t recommend screening for black people or people who have family members with prostate cancer, even though those groups are at higher risk.
The challenge we faced was that BRCA mutations and family history were not well documented in GP records. Many people simply don’t know if they are carriers of the gene or if they have a relative with prostate or other cancers. The bottom line is that if we were to roll out a screening program across the UK tomorrow through the NHS, we’re not really ready to identify everyone who’s most at risk, and we don’t have complete confidence in the PSA test.
But we need to start taking action now. This is where the UK’s TRANSFORM and IMProVE screening tests come in. Both compare different types of MRI scans with PSA and genetic tests to find the best screening strategy. But the results won’t be available for several years, so in the meantime we need to improve GP recording of risk factors, ensure men understand their individual risks and continue an open dialogue about PSA testing.
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