As a Prostate Cancer Surgeon, Here’s What I Wish Every Man Knew About the Disease

Prostate cancer will affect at least one in eight men during their lifetime. One expert, Professor Prabhakar Rajan, shares his knowledge from the frontline of combating this increasingly common condition and what men can do to lower their risk

Of all the health conditions facing men as they get older, there is no doubt that prostate cancer is the most widely discussed, emotive and challenging. It is also fairly controversial, given the UK National Screening Committee’s recent recommendation to limit screening to a few thousand men with a gene that puts them at higher risk of prostate cancer, though the Health Secretary has expanded a screening trial to black men, who run twice the risk of developing it.

As a London-based consultant urologist and robotic surgeon at University College London Hospitals (UCLH) and Barts Health, I specialise in researching prostate cancer and treating men with the disease, so have been on the frontline of combating this increasingly common condition.

My experience is not limited to the professional. My father was diagnosed with the disease 13 years ago and was successfully treated, so I know how important it is to get the message out to men about a cancer that sees more than 56,000 new cases diagnosed annually in this country, and will affect at least one in eight men during their lifetime.

Thanks to some high-profile personalities who have spoken about their own diagnosis, such as cyclist Sir Chris Hoy with his recent documentary, Cancer, Courage and Me, film director Sir Steve McQueen with his short film Embarrassed, and most recently Jeremy Clarkson in his Amazon Prime documentary Clarkson’s Farm, more men than ever are requesting a PSA test. The test measures the levels of a prostate-specific antigen in your blood, a protein made by cells within the prostate gland.

A raised PSA level can serve as a biological signal for the presence of a tumour. However, high levels of PSA don’t automatically mean a bad cancer. This is one of the reasons why I think it is so important for men to have a better understanding of this disease and why it is so important for us to discuss it.

I have lots of patients, and their knowledge and understanding of prostate cancer – the causes, the symptoms, the treatments available, the survival rates – varies wildly. For example, if you have a family member with prostate cancer, you are at an increased risk of developing the disease. Rather than a one in eight risk, you are looking at around one in four risk. One in four is also the risk factor for black men.

So here are a few things for all men, their partners and their families to know when it comes to prostate cancer.

Don’t be afraid to ask your GP for a PSA test

Raising awareness is vital for people to understand their risk, and men need to be able to have an open and honest conversation with their doctor about the PSA test. Currently, any man aged over 50 years can request a test whether or not they have symptoms. This is important because prostate cancer is often symptom-free until it has escaped the prostate, at which point it is harder to treat. Red flags of advanced prostate cancer include pain around the back, pelvis or in the hips, any surprising weight loss, any blood in your urine or semen, as well as problems getting or maintaining an erection.

Problems with urination are also common as men get older, but you should also speak to your GP if you develop difficulty urinating or feel as though your bladder isn’t empty when you finish. Having a weak flow when you urinate, feeling the urge to go to the toilet more than usual – especially if you suddenly feel desperate to go – and leaking, either before urinating or after emptying your bladder all require investigation.

Having one or any of these symptoms doesn’t necessarily mean you have prostate cancer, nor does an absence of symptoms mean you do not have cancer. Talk to your GP or urologist about it. And don’t worry – they don’t need to stick their finger up your backside to check.

The PSA test for prostate cancer – everything you need to know

There are ways to improve the health of your prostate, like drinking green tea
You can lower your risk of prostate cancer by staying physically active and maintaining a healthy weight. Eat a Mediterranean-style diet rich in vegetables, especially tomatoes and broccoli, as well as fruit, wholegrains, and fish.

Limit red meat and excess dairy. Don’t smoke and limit your 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 pomegranate.

Good news

Diagnosis doesn’t mean you are going to die or suffer life-changing problems
As soon as patients hear the word cancer, it can be shocking and many fear the worst. But prostate cancer can be treated successfully, especially if it is caught early. And as doctors, we are more sympathetic to post-treatment outcomes.

It used to be simple. As doctors we believed we had to cure all cancers. The view was that cancer is bad, therefore we need to cure you and deal with the consequences afterwards. But patients have to live with the consequences of our work. And while we think that we’re doing a wonderful thing by offering 99 per cent cure rates, if that means a man becomes either impotent or incontinent, that’s a significant impact on the quality of life.

Prof Rajan says the risk of permanent damage from prostate cancer surgery is far lower than it used to be, thanks to advances in technology Credit: Hattie Ellis
We understand that saving a life is simply not enough if people feel their new life is not worth living. Incontinence and impotence are both possible side effects from prostate cancer surgery, but the latest advances in robotic surgery mean that the risk of permanent damage is far less than it used to be.

NOP NIGERIA