At Home Christian Jessen 2014 - 213
PROMOTION
P
rostate cancer is the most
common cancer in males in
the UK. Around one in eight
men will get this type of cancer
at some point in their lives. In addition,
men are two-and-a-half times more
likely to get it if their father or brother
has been diagnosed, compared to a
man who has no affected relatives. With
statistics like this, it is vital that every
man is aware of this illness for early
diagnosis and treatment.
Fortunately, the number of reported cases and
early diagnosis seems to be increasing. This
may be due to a rise in awareness - thanks in
part to Movember, where many men grow their
moustaches to raise money for prostate cancer
research. There's also a growing number of
elderly men who are surviving, and there are
now more efficient ways for medical experts
to make potentially life-saving diagnoses.
A number of factors need to be taken into
account when considering the treatment options
for patients. These include family history, ethnic
origin, life expectancy, the disease stage,
whether it's localised or metastatic and the
types of patient-suitable choices available.
The pros and cons of each different method
of treatment should be explained to the patient.
This is where a team of clinicians, namely
a urologist and a radiotherapist jointly, can
help the patient to reach an informed choice.
It is important to define the patient's risk
status (high, intermediate or low) as this is
how a tailor-made individual choice is offered.
ACTIVE SURVEILLANCE
For some patients, a treatment plan of observation
and monitoring, also known as active surveillance,
might be a preferred option rather than anything
drastic. In an incidental prostate cancer, the
probability of disease progression may be very
'A NUMBER OF FACTORS NEED TO BE TAKEN
INTO ACCOUNT WHEN CONSIDERING THE
TREATMENT OPTIONS FOR PATIENTS'
TRIED AND TESTED
A Prostate-Specific Antigen (PSA) test is, as
the name suggests, prostate-specific and not
cancer-specific. The test measures the blood level
of PSA, a protein that is produced by cells of the
prostate gland. The higher a man's PSA level,
the more likely it is that he has prostate cancer;
but, there are some additional reasons for having
an elevated PSA level and some men who have
prostate cancer do not have elevated PSA.
Other methods of diagnoses include clinical
examinations by the urologists, transrectal
ultrasounds and Magnetic Resonance Imaging
(MRI). Prostate biopsies can also be scheduled
in, though this comes with possible complications.
Once a diagnosis of prostate cancer has
been made (including what stage it's reached
and how aggressive it is), then the consultant
can think about what treatment is needed.
'I'M ENJOYING LIFE!'
Jerry Smith, 84, Highgate, London
chose to have regular PSA tests
Active surveillance:
PSA follow up
low. Therefore, it would be monitored with regular
PSA measurements and only proceed to therapy if
there was clear evidence of it getting worse.
SURGERY: RADICAL
PROSTATECTOMY
Radical prostatectomy is an operation to remove
the prostate and the cancer contained within it. It's
an option for men with cancer that is contained in
A radical
prostatectomy
'A few years ago I had some waterwork
problems. I went to see a consultant
urological surgeon; we had a long chat
and he took specimens from the prostate (a
biopsy) and found a small cancerous area.
'I wanted to improve the way I passed
water, but I didn't want anything that would
interfere with my life. I was 70 years old, fit
and well, and I had (and still have) a stable
relation with a much younger partner. I had
my water pipe in the prostate widened with
a laser alone, after which I started to pass
water well, and continued with all my life
activities without medication. His advice
was to continue to have regular blood PSA
tests. My record is good (pictured, left) and
all has been well since. I'm enjoying life!'
PROSTATE
CANCER
GUIDE
'I WAS ABLE TO RESUME
SPORTS AFTER SURGERY'
Ron Brown, 76, Enfield, London
chose to have radical prostatectomy
'When I discovered that I had prostate
cancer, I was thoroughly investigated
and the results were explained to
me so that I could contribute to the
decision on a management level.
At that time, there were only three
choices - radical surgery,
radiotherapy treatment and expectant
follow-up. I visited a surgeon and
he discussed the possible benefits in
addition to the disadvantages of
surgery. He did not minimalise the
possible risks. A radiologist, who the
surgeon collaborated with, presented
me with a radiotherapy option.
'However, my generation always
believed that the best thing to do
with cancer was to have it cut out.
Fortunately, my wife agreed with me.
I wished to undergo surgery but could
not fault the surgeon's efforts to inform
me and offer alternatives, too.
Afterwards, I suffered disabilities (minor
leaks of urine and sexual function
trouble) but I had been forewarned. I
was able to resume activities, including
my favourite sport, squash. I do not
regret the choice I made 18 years ago.'
the prostate (localised prostate cancer) and who
are otherwise fit and healthy. It may also be an
option for some men with cancer that has spread
to the area outside the prostate (locally advanced
prostate cancer) but this will depend on how
far the cancer has spread. The whole prostate is
surgically removed, by open surgery or key-hole
called a laparoscopy or robot (pictured, left).
Surgery is complex and therefore it requires
general anaesthesia for three to four hours.
Side effects of surgery include incontinence
and potency problems, and patients need to
stay in hospital and take some time after to
recover after the procedure. Men who have
this surgery cannot father children afterwards,
as the prostate gland - which produces some
of the fluid in semen - is removed.
There is a heated debate between those
for and against radical surgery for cancers
that appear to be confined to the prostate.
The arguments in favour of radical surgery
are more of those who survive for 10-15
years after radical surgery do so without
residual cancer. There are also improved
surgical techniques that can achieve both
potency preservation and continence.
The arguments against radical prostatectomy
are that almost every elderly man has a small
cancer in his prostate, but less than 0.5% die
of it. Recent controlled studies showed no
differences in survival after 20 years between
men treated by radical surgery or surveillance.
http://www.thewellingtonhospital.com
At Home Christian Jessen 2014
Table of Contents for the Digital Edition of At Home Christian Jessen 2014
At Home Christian Jessen 2014 - 1
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