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Prostate cancer: the facts

  May 2008   

Prostate cancer – the facts

 

What causes it?

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old.     There are suggestions that high dietary fat intake including dairy products and increased testosterone levels may be one cause of prostate cancer. 

What are the symptoms?

    * Excessive urination at night

    * Incontinence

    * Bone pain or tenderness

    * Haematuria (blood in the urine)

    * Abdominal pain

    * Anaemia

    * Unintentional weight loss

    * Lethargy

How do you test for it?

It’s tricky.  The most common test is PSA (prostate specific antigen), a simple blood test that has been seen as a   diagnostic tool for prostate cancer and continues to be used as a routine screening tool in men over 50 in the USA.  Yet there is now a consensus that PSA can do no more than ring alarm bells for further tests to be carried out – tests that in two out of three cases will prove unjustified.   A high proportion of men who test positive for PSA have a ‘low risk’ slow-growing prostate cancer and would ending up dying in old age of something else. 

Treatment can be controversial. Surgery, radiation therapy, and hormonal therapy can all cause impotence and incontinence – and is therefore best used as a last possible resort. 

 

So far doctors are unsure whether prostate cancer gives off signs that it may be more aggressive in nature, giving doctors the option of making a more informed decision as to when to start treatment.

Today, many hospitals adopt a ‘watch and wait’ policy – based on the finding that a sudden jump in PSA levels indicate that a cancer is becoming dangerous and needs treatment.

‘We have a multi-disciplinary team that review every patient we see,’ explains Chris Ogden of the Royal Marsden Hospital in London and Surrey that is blazing a trail for an evidence-based prostate cancer journey for its patients. Two out of three of the hospital’s patients will continue to have PSA tests every three months without any other treatment because they are judged to have low risk prostate cancer.

What about new treatments?

Low dose rate (LDR) brachytherapy is a new style of radiation therapy in which radioactive pellets are inserted directly into the prostate, releasing targeted, localised radiation over a period of time. The treatment is effective: ten year cancer-free rates are at least as good as radical surgery with a far lower rate of side effects including impotence and incontinence. But it’s expensive and is the victim of a postcode lottery: currently one in six prostate cancer sufferers do not get LDR brachytherapy even though it has been approved by both the Department of Health and NICE (the National Institute of Health and Clinical Excellence).

‘We get hundreds of calls from men who, quite simply, are not being given the information they need to make an informed choice,’ says John Anderson, chief executive of the Prostate Research Campaign UK who says more patients should demand treatment that will give them a better quality of life.     ‘What worries men and sometimes makes them delay seeking treatment, is that they may no longer be sexually active after therapy.  They need to know that this is much less of an issue with treatments such as LDR brachytherapy.’

The da Vinci S Robot, a highly effective and safe surgical treatment for prostate cancer that allows faster recovery and shorter hospital stays. With its robotic arms, extended vision and 3D imagery, the robot enables surgeons to carry out high precision keyhole surgery to remove cancerous tissue in the prostate, -without trembling hands and thereby causing minimum trauma to the patient.  A tumour can be removed and the bladder and the urethra put back into place without disturbing erectile function or continence. 

The robot has been approved by the National Institute for Clinical Excellence but it’s expensive and only a handful of NHS hospitals have the technology.  The Royal Marsden is one of these and is able to accept referrals from all over the UK.

Need more information? Contact The Prostate Cancer Charity at www.prostate-cancer.org.uk or phone 0800 074 8383

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