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Time for Action Against This Killer of Men We Need More Research into Prostate Cancer - and National Screening

Posted on: Saturday, 26 March 2005, 09:00 CST

WHILE this is always a girl-friendly column, my effort this week is aimed very much at the boys. OK, lads: what does your prostate gland do for you? If any girls can answer, fair enough, but contrary to what some folk think, the prostate is not part of the female equipment.

According to a recent survey of British men (and women), 90 per cent of you have no idea what the prostate is for, though 27 per cent of you guessed it was for peeing, which it definitely is not. At least 48 per cent of you knew roughly where it was, but I'm seriously worried about the one in five who think it is just another name for the testicles.

Now, if you find this line of questioning a bit much for a family newspaper, or at least a trifle embarrassing outside of the medical pages, here's where the politics come in. Some 15,000 British women die from breast cancer every year. This is a scandal, and rightly the government is investing heavily in seeking better prevention and cure.

Yet only a third as much is spent on researching prostate cancer, which affects one in 11 men in the UK. This year, some 27,000 men will be diagnosed with the disease, and 10,000 will die. Prostate cancer is now the second most common form of cancer among Scottish men. It is also an international scourge: it is now the single leading cause of cancer deaths among American men.

The traditional big killers, lung cancer and heart disease, are very much lifestyle afflictions. Cut out smoking and take up jogging and much of the problem goes away. The trouble with prostate cancer is that no-one is quite sure what causes it, and while it might have some links to high cholesterol, it seems to strike across the class and lifestyle divide. Nelson Mandela, Stirling Moss and Robert De Niro have all been diagnosed with the disease. And if you are wondering why the latest season of The Sopranos hasn't been filmed, it's because the director, John Patterson, died in February from prostate cancer.

What prompted me to write this column was the dawning realisation that not only was I semi-ignorant about my prostate, but the scientific and medical world is not so clued-up either. We can get to the Moon or find the Titanic, but the traditional male taboo concerning our own bodies has left us very badly informed about a disease that kills one man in the UK every hour.

To the facts (such as they are): what is your prostate gland for? Worryingly, scientists have some idea, but there is still a lot of mystery. The big thing it does is manufacture and secrete 30-40 per cent of the milky fluid that comprises semen, thereby providing male sperm with a liquid means of getting to the female.

But it ain't as simple as that: the prostate is a veritable chemical factory, producing lots of hormones and enzymes, the functions of which are not well understood. It is also the case that tiny amounts of the fluid from the prostate are released regularly into the male bloodstream, but it is not clear if this is a bodily malfunction or a necessary process.

Contrary to what many ladies have told me about the seat of male consciousness, we actually seem to know more about how our brains work than about the prostate.

Lesson No 1: we need more scientific research, which means more money. That is not necessarily a call for the Executive to puts its hands in my pocket. Rather it is a query to us men to ask ourselves why are there only 23 registered charities with prostate cancer in their remit, compared with 81 for breast cancer.

On to the next issue: what exactly goes wrong with the prostate? A healthy prostate gland weighs around 20 grams and is the size and shape of a large chestnut. God was not at His best when he designed the prostate, or else He has a wicked sense of humour. First, it is hidden away underneath the bladder: like a Fifties car engine, actually getting to it is a job in itself. The gland is so hard to reach that it can only be located physically via a procedure known as the "urologist's handshake". I will spare you the details.

Worse, the prostate is wrapped around the urethra - the tube through which beer flows to the sea from your bladder. Unfortunately, God made a major design flaw here: with increasing age, the prostate starts to enlarge. This squeezes the urethra tubing and interferes with the urinary flow. Ouch.

As for prostate cancer, the problem is that half of all men with the disease display no warning symptoms. Those who do, usually attribute their urinary problems - for example, going to the toilet every two hours - to old age. After all, most of them either don't know they've got a prostate or have lost it somewhere in the plumbing.

THIS ignorance is not helped by the uncertainty in the scientific community as to what exactly the prostate gland does and what causes it to become cancerous. Which in turn means that the medical establishment is divided on the best way to diagnose and treat prostate cancer.

Another problem is that prostate cancer is slow-growing. This often fools our immune system into not mounting an effective counter- attack. By the time the disease is diagnosed properly, it can be too late.

Lesson No 2: we need a national prostate-cancer screening programme on a par with the one for breast cancer. This is made more urgent by the fact that there is no self-check method for prostate problems. There is also the problem that current biopsy techniques can miss as much as 20-30 per cent of potential cancers. Cue more research.

Caught in time, most prostate cancers can be treated effectively, using radiation treatment. And new medications are on the way, including vaccines. This means that a decent national screening programme could radically reduce the number of prostate-cancer deaths.

So why has the great prostate crisis crept up on us? It is not just male machismo refusing to be sensible about bodily functions. A bigger problem is that prostate cancer is overwhelmingly an old man's disease. Seventy per cent of those diagnosed are over 70, and it is extremely rare in men under 50. For a long time in our youth- oriented culture, the elderly have been ignored culturally and politically.

Last year, Scotland got its very first prostate-cancer specialist nurse, thanks to support from the Prostate Cancer Charity and staff at Standard Life, who raised GBP 150,000 for the project. Well done them. But just one specialist nurse for Scotland?

Fortunately, the times they are changing. We of the post-war baby- boomer generation are now in our fifties and facing the prospect that we are not immortal. The prostate gland in each of us is a ticking political time-bomb. The World Health Organisation estimates that in coming decades, 80 per cent of men will need treatment for prostate problems and that one in three will need an operation.

Forget the coming row over pensions: my generation of males will make demands for research and treatment of prostate cancer a major political issue.

Prostate Cancer Awareness Week runs until 27 March.

Source: Scotsman, The

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