Ben chose surgery... how would you take on prostate cancer?
MEN who are newly diagnosed with prostate cancer find themselves with a bewildering array of treatment options – and two major worries.
John Robertson, specialist nurse at Prostate Cancer UK, says: ‘The most-asked questions – after “Will I survive” – are “Will I be left impotent?” and “Will I be incontinent?” No man wants either.
‘The reality is that if we do treat aggressively then there will be at least temporary problems with erectile function and bladder control. But the good news is that we are now better than ever at telling the difference between cancers that will never really grow much or cause problems, and those that are more aggressive.
‘This means we can delay invasive procedures until they are absolutely needed, and there are options that give men a fighting chance of getting back, if not to totally normal, as close to it as needs be.’
So what are the main choices for patients? We spoke to Britain’s top experts about the latest developments in treatment for this guide every man MUST read...
WHY SURVEILLANCE ISN’T DOING NOTHING
THE landmark ProtecT study of British prostatecancer patients reported last month that most men diagnosed at an early stage will survive for at least a decade whether or not they have surgery.
‘With a cancer diagnosis, the instant reaction from patients is often to want it out of their body,’ says Tim Dudderidge, consultant urological surgeon at Southampton General Hospital. ‘Now we have good evidence that surgery isn’t always needed straight away.’
Men with early-stage localised prostate cancer can be monitored – termed active surveillance – meaning they will have regular PSA (prostate-specific antigen) blood tests, which look for a protein produced by prostatecancer cells, and check-ups.
DON’T BE SCARED OF SURGERY
THIS month, Hollywood actor Ben Stiller, 50, revealed that he had been diagnosed with prostate cancer, had surgery in September 2014 – and is now clear of disease.
While early-stage, low-risk patients are typically offered active surveillance, surgery to remove the prostate – a radical prostatectomy – gives the best chances for survival for those with intermediate risk.
The prostate is a walnut-sized gland that sits below the bladder, around the urethra in men, and is part of the reproductive system.
Any operation in this area will, inevitably, lead to some nerve damage. In order to minimise the risk of these complications, Professor Roger Kirby, medical director of the Prostate Centre, advises men to find a surgeon with the right experience: they need to be operating regularly, doing at least 50 to 100 cases a year.
Robot-assisted surgery, which is offered in 30 UK hospitals, has also improved outcomes over traditional procedures, he adds (this is what Stiller had).
The improved accuracy means reduced risk of complications, said Prof Kirby. ‘Any issues with incontinence are likely to resolve with time – and while sexual function may be affected initially, erectile dysfunction goes on improving through the first year and up to four years,
with the use of Viagra.’
SOUND-WAVES THAT BLAST AWAY TUMOURS
THE most promising new development in treatment for prostate cancer is highintensity focused ultrasound, or focal HIFU, in which highenergy sound waves blast tumours while leaving the surrounding healthy tissues intact. A major study announced by the European Association of Urology this year revealed the procedure offers a 93 per cent recurrence-free survival rate at five years, putting it on a par with prostatectomy. Remarkably, just one to two per cent of men in the HIFU trial experienced long-term urinary incontinence, compared to between ten and 20 per cent of men who had a surgical procedure to remove the entire prostate. And just 15 per cent of HIFU patients suffered erectile dysfunction, compared to between 30 and 60 per cent of men who opted for surgery. Only men with small tumours are eligible.
THE ROAD TO RADIOTHERAPY
FOR men with more advanced cancer which might be difficult to remove during surgery, radiotherapy is often the better option.
This may also be offered to older men who are not well enough for surgery.
The treatment involves highenergy X-ray beams emitted by a machine that damage cancer cells and stop them growing.
Short-term side effects include bowel problems for one in ten men and bladder problems for 50 per cent of men. Half will have permanent erectile dysfunction.
GUINEA-PIG TREATMENTS
MORE experimental and newer treatments are available – such as proton beam therapy and irreversible electroporation (which uses electrical fields to kill cells) – but they are very new and without long term evidence yet, warns John Robertson.
Cryotherapy, which uses freezing and thawing to kill cancer cells, is effective for localised prostate cancer in certain cases but only available at specialist centres or as part of a clinical trial.
However, research suggests that it may cause a higher number of complications.
THERE IS LIFE AFTERWARDS
MORE than 47,000 Britons are diagnosed with prostate cancer and over 10,800 die of the disease each year. However, survival is improving: while fewer than 66 per cent of men survived a year in England and Wales in 1971, that figure had risen to 94 per cent by 2011.
In the UK, more than 330,000 men are living with and after prostate cancer. Professor Mark Baker, director of the Centre for Guidelines at NICE, said: ‘Mortality rates are now falling in Britain so we must be doing something right.
‘Treatment is now better than it ever has been, and survival rates prove that.’