No 7: Prostate cancer
Is surgery, radiotherapy or 'watchful waiting' the best option?
The problem: Men with symptoms of prostate cancer are increasingly likely to be offered surgery or radiotherapy. Yet both carry substantial risks of causing impotence or incontinence. Keeping the problem under surveillance - known as 'watchful waiting' - appears to be equally successful, but has its own drawbacks.
How likely am I to get prostate cancer? Cancer of the prostate - the small gland that surrounds the urethra - mainly affects older men. About a third of men over 50 and a half of men over 80 have been found to have it. But most do not die of it and many do not even know it is there because it usually grows very slowly.
How is it diagnosed? Symptoms include difficulty passing urine, but there may be no obvious signs. Many men now undergo screening tests to look for prostate specific antigen (PSA) which is sometimes higher in men with cancer, but two thirds of men with high PSA do not have cancer and is not clear whether screening does more harm than good. Further tests, including an ultrasound scan or a needle biopsy, can confirm cancer. These tests are uncomfortable and carry small risks.
What should I do if cancer is found?There are three options: surgery to remove the gland, radiotherapy to kill the cancer and watchful waiting, where the cancer is only treated if it grows quickly or causes problems. There have been no reliable tests to compare which works best. The best evidence so far suggests they have about the same success. Between 85 and 90 per cent of men survive 10 years after surgery, 83-90 per cent after radiotherapy and 70-90 per cent through watchful waiting.
So how do I decide? It has to be a personal choice weighing up the survival rates against the side-effects. Surgery carries a 1-27 per cent risk of incontinence and a 20-85 per cent risk of impotence. Radiotherapy causes incontinence in 1-6 per cent of patients and impotence for around 40 per cent. On the other hand, watchful waiting can cause anxiety, and occasionally the cancer may grow too fast to treat successfully. Reliable trials of the options are finally underway but the results will not be known for a few years.