‘Prostate cancer now rarely the death sentence that many men would fear’

Almost 3,500 men in Ireland are diagnosed with prostate cancer each year and, while the risk of developing the disease increases with age, prognosis is usually good. This is true for Brian Herman who developed the male cancer in 2006 and thanks to swift action by his GP, received treatment and has been well ever since.

“I had no symptoms at all apart from the occasional bout of erectile dysfunction which I attributed to my advancing years,” says the 79 year old. “I had been having routine blood tests annually since I was 60, with no indications. And at that time a PSA reading in excess of four merited monitoring and above eight required action or intervention.

“I omitted to have the tests in 2005 so in July 2006 my GP and I were shocked to find that my PSA was 71, requiring urgent action.”

The Dublin man was referred to a urology consultant who, after tests revealed a malignancy, referred him for a prostatectomy.

Hearing both sides of the debate: What would ‘right-thinking people’ say?

---

‘The silent scream’: why do we yawn?

---

Health Board: upcoming conferences, talks, campaigns and events

---

“Needless to say, my wife and family were devastated by the news and I was in a state of shock for weeks, although we were assured that treatment would most likely have a positive outcome,” says the father of three. “I was referred to an oncology consultant and by this stage my PSA had reached 84. So I was put straight on to hormone therapy (HT) to bring it down and in March 2007, commenced nine weeks of daily radiotherapy.

“During the treatment I suffered from insomnia and was put on sleeping pills to which I have unfortunately become addicted and my energy levels dropped significantly, while some foods, including the pint I always enjoyed, developed a bitter taste. But my PSA, which is checked every six months, has reduced significantly and the most recent reading was 0.67. So now, aside from the natural ageing process, I am glad to say that I am fit and well – I walk my dog twice a day and am enjoying life to the full – even the pint tastes much better.

“I would advise other men to go their doctor if they have any difficulty in urinating and have their PSA checked annually once they reach 50. Prostate cancer shouldn’t be anything to worry about as it is curable and compared to other cancers, the treatment is mild.”

Recent research has revealed the possibility of a new urine test for prostate cancer, which as yet is unavailable in Ireland. But David Galvin, Consultant Urologist at the Mater Misericordiae and St Vincent's Hospitals, says it may be a possibility in the future.

"Select MDx is a commercially available urine test for prostate cancer," says Galvin, who is also the Principal Investigator on the IPCOR (Irish Prostate Cancer Outcomes Research) study, funded by the Irish Cancer Society and Movember.

"Expected results suggest that it will be a more accurate test than the PSA test, but it is expensive, at around €600 each. The Irish Society of Urology, the National Cancer Control Programme and the National Screening Service have put a proposal in to HIQA to use these tests in Ireland, along with a new proposal around MRI and prostate cancer screening, but we have yet to receive a decision."

Dr Robert O’Connor, head of research for the Irish Cancer Society, explains what treatment is currently available. “Treatment guidance will depend on the stage and extent of cancer which will show up from the results of tests,” he says. “Removal of the prostate may seem an obvious solution, but it sits close to many nerves, muscles and other tissues, hence removal may cause damage to these parts of the body and may run the risk of infection, paralysis, incontinence and effects on sexual function.

“With increasing awareness of the often slow and gradual course of prostate cancers, combined with some of the risks of treatment, the diagnosis of an early stage slow growing, non-invasive prostate cancer will often see a recommendation of watchful waiting, where no treatment is indicated other than routine scans to “keep an eye”. So increasingly men live with early stage prostate cancer without it affecting their lives, except for tests to check that it hasn’t changed to a more worrying type. If watchful waiting isn’t recommended, the mainstays of treatment are surgery, radiation therapy and chemotherapy.”

Dr O’Connor says patients may have a number of treatment options and several factors, from the effectiveness of treatment to its possible long-term side effects will need to be taken into consideration to make the best choice.

“Because of the advances in Irish prostate cancer research and treatment and the advent of specialist multidisciplinary teams and rapid access clinics, currently In Ireland almost nine in 10 men will be alive and well 10 years after their diagnosis and this figure continues to improve each year,” he says. “Hence prostate cancer is now thankfully rarely the death sentence that many men would fear.

"But if a prostate cancer patient or a loved one has any questions about their treatment, they should talk to their doctor. They can also get advice and support, from the Irish Cancer Society's Cancer Nurseline on Freephone 1800 200 700 (lines open Monday-Friday, 9am-5pm) or through any one of the 13 Daffodil Centres located in major cancer treating hospitals around the country."

ABOUT PROSTATE CANCER

- Almost 3,500 men in Ireland are diagnosed with prostate cancer each year.

- The prostate gland is only found in men, and sits at the base of the bladder and in front of the rectum (back passage).

- When cells change in the prostate to form a tumour, prostate cancer is diagnosed.

- The disease most often occurs in men in their mid-60s, but it can occur on rare occasions in men as early as their late 40s.

- Roughly one in seven men will be diagnosed with prostate cancer in their lifetime.

- Symptoms can include a number of vague ‘waterworks issues’ including trouble starting or stopping the flow of urine, blood in the urine, passing urine more often, feeling you have not emptied your bladder after passing urine, and pain or difficulty when passing urine.”