As the marker for prostate cancer is measured more frequently Doctors are finding more indications of cancer. In three years time it will have become the commonest male tumour. What should we do?
The prostate specific antigen (PSA) is the chemical marker of prostate activity. At high levels it indicates increased risk of cancer. More usefully if we measure the PSA serially, say once a year, we can show the rate of increase in PSA which will tell us if the activity of the gland is dangerously speeding up. This, with an ultra-sound of the gland accompanied by a biopsy, gives the best available means of telling if cancer cells are present. The histology of the gland, as with cervical cancer, requires pain-staking examination by an experienced histologist. The cellular changes they observe indicate which of the tumours are high risk.
It is this interpretation of cellular change which informs the decision to operate or ‘wait and watch’. The British have a reputation for more conservative management than the Americans who not only operate to remove cancer at an earlier point but have also a better five-year survival rate. However, the operation is not without possible complications, from impotence and urinary incompetence in particular.
If the cancer is more advanced then the option of radiotherapy is likely to be chosen. Techniques for the accurate placing of radiation at the tumour site have reduced the risk of damage to non-cancerous tissue, and the treatment gives excellent short-term results.
Since the tumour is hormone dependent radiotherapy may be combined with anti-androgens to oppose its further growth. By means of this combined therapy the prognosis is good. The snag with anti-androgens is that libido is lost but, given that the problem arises in older men, this may be considered a small price to pay. Combined therapy is then the treatment of choice and life expectancy will be little changed.
What may cause prostate cancer in you? There are certainly genetic factors: if you have a first degree relative who has had prostate cancer your risk of getting it too is increased.
What can you do to reduce the risk of it developing? We know that a high fat, low vegetable, diet increases risk and conversely a high vegetable intake has been estimated to provide protection against one-third of all cancers, including cancer of the prostate.
But measuring your risk, by annual screening of your PSA is the immediate step you should take. If you are over 50 we recommend you get it checked. Why not do it this week? Care for your health in this Month of Male Awareness!