سرطان پرستات - بیشترین سرطان معمول در مردان
Famous men who've battled prostate cancer include: Lord Andrew Lloyd Webber, the creator of musicals such as Evita and Phantom of the Opera.
But the disease, which affects the walnut-sized gland that produces seminal fluid, is still not discussed very much – even though it's the most
common cancer in men.
There are 35,000 men diagnosed with this cancer each year.
There are 35,000 men diagnosed with prostate cancer each year in the UK.
Results of a recent survey carried out by theprostate cancer charity showed that many men are still taking an ostrich-like approach to their health – with 47 per cent of men aged between 50 and 70 still unaware of the PSA test, a simple blood test for prostate cancer.
We talk to the experts: Professor Roger Kirby, director of the Prostate Centre, and chairman of Prostate UK, John Neate, chief executive of the Prostate Cancer Charity and Dr Thomas Stuttaford, vice president of Prostate UK.
What is the PSA test?
This is a blood test to measure levels of prostate-specific antigen (PSA) in the blood.
PSA is a protein produced exclusively by the prostate gland, and all men have a small amount of PSA in their bloodstream. Although many men with raised amounts of PSA in their blood will not have prostate cancer, the higher their PSA level, the more likely it is that they have cancer.
Any man can request a PSA test from his doctor.
If a man has a close relative, such as a father or brother who has had prostate cancer, it's advisable to ask for a PSA test if he's aged over 45.
But the disease is also often diagnosed in men in their 40s – so the age when at risk men should begin testing is debatable.
Should there be a PSA screening programme?
John Neate, chief executive of the Prostate Cancer Charity says, 'We're not calling for a national screening yet because there are disadvantages, as well as advantages'. He's in favour of 'universally informed choice', ie men deciding for themselves.
The UK government has introduced a PSA Informed Choice programme and is keeping the situation under review.
Professor Kirby says screening is a good idea: 'Early diagnosis offers hope of cure.'
'Treatments have changed, so the downsides of treatment have been minimalised,' he says.
Dr Thomas Stuttaford, who has been diagnosed with prostate cancer himself, says, 'Each year 35,000 men in the UK are diagnosed with prostate cancer, and more than 10,000 men die from the disease. Without screening and treatment I wouldn’t be alive today. For those who fear impotence, remember there's no sex in the graveyard.'
Or not to screen?
The UK National Screening Committee doesn't automatically recommend screening all men over 50 for prostate cancer yet.
This is because they say that screening may increase the number of false alarms.
Men will be anxious about their health unnecessarily, and they could be treated for early disease that would not otherwise have become a problem.
Current survival for men with prostate cancer after diagnosis
Around 98 per cent of men, who are diagnosed when the cancer hasn’t spread beyond the gland, will live for more than five years.
But this figure drops sharply to 30 per cent, when the cancer has broken out of the gland and migrated to other parts of the body.
Latest gold standard treatments for prostate cancer
Dr Thomas Stuttaford says: 'Radical prostatectomy or radical radiotherapy, including brachytherapy, are still the two gold standard treatments for those tumours that haven’t spread beyond the gland.
'An elderly frail patient, or someone with ill health which would make surgery undesirable, would be excluded. But they could have radiotherapy.
'If the cancer has spread: hormone treatment, usually followed by radiotherapy is recommended. As well as hormone therapy, chemotherapy may be used.'
One great advance has been the introduction of the robotic radical prostatectomy, which has improved in the last 15 years. But this isn't widely available yet.
Professor Kirby, who has carried out more than 650 robotic prostatectomies, explains that the new technique means, 'Bleeding is kept to a minimum. It has become standard treatment to perform a nerve sparing operation – a procedure that will enable many men under the age of 70 to retain their potency.'
Active surveillance is only an option for older men with less aggressive tumours, whose life expectancy is thought to be less than ten years.
Photodynamic therapy (PDT), which isn't widely available on the NHS, has not undergone large scale scientific trials. PDT uses laser, or other light sources, combined with a light-sensitive drug to destroy cancer cells.
Another relatively new, not widely available, treatment is a high intensity focused ultrasound that destroys cancer cells by heating them with ultrasound energy.