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A disservice to those with prostate cancer 2007-12-16
By The Telegraph

A disservice to those with prostate cancer

 

As 2007 draws to a close it is sad to contemplate that during the year another 10,000 men in the UK will have lost their lives to prostate cancer, and that 10,000 families this Christmas will be grieving the loss of a loved one as a result.

Although the annual death toll from prostate cancer is the equivalent to the crashing of a fully laden jumbo jet every fortnight, little is heard about this silent killer, and it is hard to see how the forthcoming guidance from the National Institute for Health and Clinical Excellence (Nice) will do much, or indeed anything, to reverse the situation.

Compared with breast and lung cancer the cancerous cells of the prostate are relatively slow growing, often doubling in number only every two years or so.

This slow growth rate provides a window of opportunity for cure, since prostate cancer can be reliably eradicated while it remains within the gland, but becomes incurable once it spreads to the lymph nodes or bones.

Indeed, every one of those men who have died of the disease this year could potentially have been cured, if only their disease had been recognised earlier.

Yet Nice pays scant attention to early detection of the disease, and the Government has just ruled out the introduction of a mass screening programme.

Current draft guidance from Nice suggests that as a one-off measurement, blood tests marker for prostate disease are not accurate enough.

In fact, if screening happens regularly enough, checks on the rise of Prostate Specific Antigen, rather than its absolute value, enable us to detect the cancer risk increasing.

Meanwhile, the body dismisses new methods of treatment that are so often employed abroad, preferring instead to endorse "watchful waiting" as the disease develops and eventually spreads.

Doctors working in the field want to eradicate the cancer while causing minimal "collatoral damage" to sexual and urinary functions.

We know from experience how central these are to a man's quality of life. New technologies in robotics now permit the removal of a cancerous prostate through a tiny keyhole near the belly button with minimal blood loss, preserving the tiny nerves which protect erectile function.

High intensity focussed ultrasound (HIFU) permits a minimally invasive means of destroying cancer, while cryosurgery kills cancer cells by freezing them.

Nice has the luxury of time to hedge its bets and await the results of long term medical trials, which could take decades to provide results.

The problem for those of us sitting opposite a patient and his family in clinic is what to do here and now.

Nobody wants to die from prostate cancer - often a slow and painful demise - but of course no one wants unnecessary treatment, especially if impotence and incontinence are the result.

New treatment options take us nearer to the "Holy Grail" of effective treatment with minimal side-effects. What is needed is a health service which harnesses today's scientific breakthroughs and focusses on the future.

Unless it does so, the death toll among Britain's men will continue to rise.

• Prof Roger Kirby is chair of the charity Prostate UK.

 

 
 
 
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