Consultant Urological Surgeon Prokar Dasgupta offers exclusive advice on sensitive healthcare issues for men...

Even the strongest of men don't like to admit when there's something physically wrong with them, particularly not when it's...'down there.' But some of the worst illnesses can start 'down there' and in the long run dodging the doctors could end up costing you your life.

Prostate cancer is just one of many male taboos. It doesn't get as many column inches as breast cancer but it is just as common and just as serious. The disease kills 10,000 men every year in the UK and although chances of survival are better than they were 30 years ago, if it is not caught early these chances are severely reduced.

To offer advice on what signs to look out for and who is most at risk we are hosting a live webchat with Prokar Dasgupta, a trustee of the Prostate Cancer Research Centre. He will be explaining what action you need to take if you are concerned about prostate cancer and the factors that can increase your chances of developing the disease.
Certainly one risk factor is the illness already being in your family. If your father or grandfather have or have had prostate cancer it doubles your chances of developing the disease. Even if they haven't had the illness it is still worth broaching the subject in case they aren't aware of what they should be checking for.

With Father's Day approaching we're reminded of just how much our family means to us. Although talking about any kind of cancer, especially prostate cancer, is tricky, it's also really important to make the effort, get over the awkwardness and do everything you can to take care of yourself and your family.

Prokar Dasgupta joins us live online on Friday 13th June at 3pm to discuss prostate cancer – signs, symptoms, risk factors and treatments.

www.prostate-cancer-research.org.uk

H: Murray Norton, host
P: Mr Prokar Dasgupta, urological surgeon
L: Liz Adlen

H: Hello and welcome to the Healthcare Show, I'm Murray Norton. Now even the strongest men don't like to admit when there's something physically wrong with them, you know it's that whole thing of something down there – I'm sure you know what I mean. But some of the worst illnesses can start down there, and in the long run just dodging the doctors is going to end up costing you your life. Prostate cancer is just one of the many male taboos and it doesn't get as many column inches as breast cancer, but it's just as common and it's just as serious. Here's the wake-up call – the disease kills 10,000 men every year in the UK and although the chances of survival are much better than they were say 30 years ago, if it's not caught early enough these chances can be severely reduced. Now to offer advice on what signs to look out for and whose most at risk, I'm joined by Mr Prokar Dasgupta, whose a consultant urological surgeon, and Liz Adlen whose husband passed away last year as a result of prostate cancer, so sadly knows only too well what a devastating disease this can be. Well thanks to both of you for joining us, thank you for coming in – can we just start off Prokar by talking about the prostate itself? What is a prostate, where is it and why do we have one?

P: Well the prostate Murray is a very male thing, women don't have it, thank goodness. There are other things like breast but not a prostate.

H: Ok

P: So the prostate is a little chestnut-like gland, it sits just under the bladder, the bladder is the bag into which we fill urine, otherwise we all would be peeing all day

H: Yes

P: So the prostate in men is sitting just under the bladder from where the tube comes out through which we pee, and this gland you could say, why only in men? Well there are various theories behind it, people think it adds thing to the semen so it keeps the little sperms happy and healthy but in the end it's not just there for no reason, it can get diseased, about 1 in 3 men after the age of 50 will have something wrong with it, and if you look at prostate diseases all together, almost half of men at some point or the other will have something related to the prostate

H: You'd think we would know a lot more about it, with those figures, if half of all men are going to have something wrong with their prostate, you'd think we'd all know instantly about this. Why don't we?

P: Well thankfully some of us don't and those of us who don't merrily live along forgetting that they have it, and don't discuss it with anyone else. For those that do it can be an embarrassing problem, it's not very nice to have to stop going somewhere because you are going frequently to pee, it's not very nice to wake up 20 times in the night because you have to pee, because it's not just you whose not sleeping, it's also your wife or your partner whose awake with this, so there is a taboo around the prostate, also because we are men and we are macho and we don't want to talk about it

H: Now we're big and brave and we don't talk about things like that, that's what it is apparently.  Liz thanks very much for joining us, thanks for coming in and thanks for being so prepared to tell your story, I know it's very close to almost the anniversary or your late husband's death now – from your perspective hearing all of this, you know only too well how devastating it can be, but where did it all start for you, when were the early signs for you?

L: Well my husband was very brave and never really told anybody an awful lot, but went to our GP and sadly the PSA reading was not as high as perhaps it should have been for any other tests to go any further, so therefore he didn't have any other tests done and the month that followed, things got a little worse, and it was as you say, a night time problem, or as Prokar says, night time problems, going to the loo etc. And eventually when it was eventually discovered it had then gone into the bone, so it had escaped from the prostate and there was no chance of – it was inoperable, no chance of surgery

H: Right

L: And he had to go on through various therapies, chemotherapies etc, and from the day that we actually found out, you know what it really was, up to his death was only 18 months

H: Wow. That's pretty short isn't it?

L: Yes it is, but we had a good 18 months

H: Ok we'll come back and talk about those 18 months and indeed more to do with prostate cancer in just a second. Before all of that let me tell you that this is a live show, and that does mean – there's a little box at the bottom of the screen which you can put your question in to either Liz or to Prokar as well, so please do fill out your question in there, send it into us, it'll come up on the screen just by the side of me here and we'll be able to ask your question this afternoon, so don't delay, get the question in as soon as you possibly can. We've had questions in already, I'm going to turn to some of those straight away – Adam, thank you very much indeed for your question. Adam says “what are the symptoms of prostate cancer?” Now I know we have already talked about a couple of them. Let's just list them nice and clearly. What are they?

P: They can be divided into two bits. Firstly dealing just with the “waterworks”. For example slowing of the stream or going more frequently particularly at night or even having urgency. Some men, because they have obstruction at the level of the prostate, remember it is just sitting under the bladder, will leave a lot of urine in their bladders and they feel they are not emptying their bladders. Occasionally because of stagnant urine in the bladder you will develop a urinary infection. So those are the main things which are related to the “waterworks”. Occasionally you may even have blood in the urine and then you find that you have prostate cancer. The other bit is not related to the “waterworks” which men often times ignore. An elderly man if he comes with pain in the bones, then this is something you have to suspect. In fact when I went to medical school I was told by ex-chief “look if a man has pain in the bones and he turns up you must examine his prostate.” This is very sound advice because as Liz knows only too well the cancer may have gone into the bones. In some men that will be the first time that they know something is wrong with them, by that time it is possibly too late.

H: So tell-tale signs are waterworks as you said but it could be waterworks are fine but it is the bones already, aching bones that could be another sign?

P: Indeed

H: Alright. Hopefully that deals with the question from Adam. We will have more questions coming in as well. Mark's question is about it being genetic – “Is it genetic or is it something that smoking or other such social habits and age can bring it to be?”

P: It is a combination of two things and that is true for most diseases. It is not just the genes it is not just the environment it is a combination of the two. So if you have a first degree relative, say your father or an uncle who has prostate cancer, and the younger that relative it increases your chance by twofold. If you have two such relatives it goes up by fourfold and now of course people are, with the discovery of the human gene, people are more and more looking at it as a “systems” disease rather than just a one single hit gene which you look for. So it is more of a “systems” disease but at the same time there are environmental factors. We know that prostate cancer is not that common in the east. In India it is much less common than it is here. But if you bring an Indian man and keep him here for a number of years his chances go up almost the same as a man living in the west. So there is an influence of environment along with the genes.

H: OK. I did read some figures somewhere that Afro-Caribbean's have a higher….

P: Indeed. Afro-Caribbean men do have higher incidence. You know, that is the way it is and if you look at American men a lot of them are Afro-Caribbean.

H: Ok obviously we are going to uncover more of that as time goes on. What about age? Can I touch on the age subject because for most men when they get near to fifty they get a little bit touchy about age anyway. So this is even more bad news?

P: Absolutely. It is more common, over 60% are still above the age of 70 and between 70-79 is when the majority of patients are being diagnosed. But when I was a senior resident many years ago 3 in 4 men were coming in that age group with the cancer already being in the bones. Now there is a paradigm shift towards the other end where we are picking up prostate cancer in younger men. In their 50s, in their 60s or even in their 40s

H: Right

P: And therefore it is no longer true to say that it's only a disease of older men. There are younger men getting the disease, there are younger men in whom we are detecting it and perhaps we are getting better at detecting it, and therefore the treatments that we are able to offer to these men is changing at the same time as the diagnosis

H: Liz, as we've already discovered, the prostate cancer had moved into the bones for your late husband

L: Yes

H: Which meant that treatment was always going to be virtually impossible, it was going to be difficult. There were hormone treatments and the like –

L: Hormone treatments, my husband had that which was very successful in the first 6 months. And he seemed very very well. And then chemotherapy kicked in 6 months after that which wasn't, sadly, as successful.

H: And much harder on him as well?

L: Yes

H: On both of you for that matter

L: It was very, very difficult, yes

H: In – let's just go to the point of detection early, because it seems to be, from what I was saying in the introduction, that early detection is so important. How do we detect it early? Should people volunteer and go and have tests? Even if there's nothing wrong with them?

P: Well that's a controversial topic as you know only too well – and it's the issue of screening.  Do we screen, do we not screen and you know every country and its health systems will look at whether it is the right thing to do or not, and there is no absolutely correct answer to that

H: Ok

P: In countries where screening is very popular, such as the United States, if you're 50 and above you will start having an examination of the prostate – unfortunately it has to be done through the rectum and the PSA test once a year. Here, if you had symptoms, you would certainly go and have that done. Or if you had any family history then you would start even earlier, in the 40s. No one knows for certain, there is a lot of argument about this. If you look at the Americans, and if you look at the data from there, they are saying that they're bringing the death rates from prostate cancer down because they're detecting it earlier, they're treating it when it is localised to the prostate – unfortunately not like your husband where it's already gone too far, and trying to cure the cancer before it goes somewhere else

H: And there's a good chance of that if they can get it early enough, yes?

P: Indeed there is, and in fact only just a few years ago there was a trial and this is – this was a landmark trial and I mention this to my patient because it has an important message.  The trial, from Scandinavia, essentially compared men in two categories. All had localised cancer. Half of them were watched very carefully, not ignored, watched very carefully, and the other half had their prostates removed, an operation which we call radical prostatectomy where is the prostate is completely removed. It showed that while overall survival may be not much different, slight difference, the disease specific survivals, specific of the disease was better in those that had surgery, which simply means if you're a fit, young man who has got a number of years to live, you're probably better off having active treatment, unless you have a very small, insignificant cancer which is not going to harm you anyway

H: Ok, right

P: That doesn't of course necessarily mean that you should screen all patients, but that does give you a handle on things which we didn't have until a few years ago

H: Alright. Liz how did you get your husband to go for the test to find out, because one of the things that's always, always comes up whenever you talk about prostate cancer is that men are reluctant to go to the doctors

L: Very much so

H: They're reluctant to have a test, and I'm going to talk about this test, physically, in just a second, but in terms of going and discovering whether you've got prostate – something wrong with your prostate or not – it's a difficult thing to get men to do isn't it?

L: It is, but he did actually go without me badgering him, he did actually go, but at the Christmas time when we were trying to make appointments, I then pushed and pushed for the appointments to come forward a lot sooner than –

H: Sure

L: Than perhaps what we – than they would have done. But he did go originally on his own accord, I didn't have to badger him

H: I think the thing I was going to get across was we can talk about men's Health Awareness weeks which we have plenty, Father's Day, families should be talking about this.  Fathers and sons possibly should be talking and communicating with each other, and almost encouraging each other to have this test done. In terms of – I mean obviously you'd be for all of that, more communication within the family?

P: Yes absolutely, I mean I'm very lucky, my father and his older brother both had TURP which is for benign disease where you put a telescope through the water passage and take pieces of the prostate from the inside, it's not a cancer operation, and I saw both of these men in hospital when I was a medical student, so I know everything there is to know about this gland and the way they suffered.  Thankfully they didn't have cancer but I'm all too aware that in the long term this is something that might affect me and other members of my family, and absolutely I think awareness is all about talking to each other within the family, I think there's no point in hiding it out of embarrassment because that is of no use to anybody

H: Let's just talk about that embarrassment for a moment if I may – if I was to go to my doctor and say I just want my prostate checking, what's going to happen to me, because I haven't got a clue – I still to this day have not really got a clue what would happen. So what happens?

P: Well your doctor will take what is called a medical history, so he will probe a bit more into the symptoms that are already described, particularly in relation to your waterworks, your doctor will take a family history as to whether there were others who had it, and then offer to examine your prostate. Unfortunately that's not the most comfortable test, it has to be done with a finger up the bottom, and you know although that may sound awful, done carefully by an experienced person it's not that bad, and that discomfort is worth putting up with because if there's something to find, then it is better found rather than ignored. You will then have a urine test, and most likely a PSA test and a flow test where you pee into a machine

H: PSA test means what?

P: PSA is a blood test

H: Right

P: It stands for prostate specific antigen, people argue that it is neither prostate specific, so it is what we call a misnomer so he it is not male specific, it is not prostate specific but it is at this time the best test we have, and it has revolutionised the way we detect prostate cancers, not just detection but also measurement of how a patient responds to the cancer, so in all the excitement about detection, often times we forget as to how we measure the response to treatment

H: Right

P: So if I have taken someone's prostate out, and typical you know do this with robotic surgery, that patient would have PSAs 3 monthly for the first year then 6 monthly then annually. And that's the way we would detect that the cancer is away from the body, and if it has come back, then we can detect it at an early point so that we can put in a short treatment. Same with your husband, after hormone therapy we would check on that, same with every other patient. So it's not just for detection, it's also for monitoring patient care

H: Removal of the prostate, normal life after that or is it much more difficult?

P: It –

H: Can you live without a prostate? You obviously can

P: Yes absolutely, absolutely it is not an essential organ like the liver or the bowel, yes you can live very well without the prostate and we would be happily in the right patient, we would happily remove the prostate. There are a number of things – now with technology has obviously developed since it was 10, 20 years ago

H: Sure

P: So would – I would typically remove the prostate with robotic surgery through small holes rather than a big cut, so the patient would recover very quickly, but because the prostate has gone, they would then have the water passage join back, so they would have a join there

H: Yes

P: And we would put a little catheter tube for about a week, and then it would come out. Patients bounce back from this kind of surgery, which is very precise, quite easily

H: I think it's the fact that there are great figures to show good recovery from this which should be encouraging other people

P: Yes, yes, indeed

H: Let's – Ainsley has a question, Ainsley thank you for your question. “Can prostate problems affect my chances of having children?”

P: Well yes it can, it depends on how old Ainsley is, but often some of these prostatic infections can involve other parts of the water tract and cause scarring and blockage to the flow of semens, so yes that is one situation which yes it can affect the chances of having children. Also if a man is very young and you remove the prostate, you are also removing the gland called seminal vesicle which – it is like a bunny rabbit, the seminal vesicles are like the two ears of a rabbit

H: Sure

P: So you're removing that bit so you're removing the channel through which semen passes and comes out, and is used for fertilisation, so you then would need, in a very young man if they wanted to have children, you need to store the sperm before you remove the prostate. Usually not an issue because most men who come for this have completed their chapters

H: Ok. I'm just going to finish on one final question which is something you can both answer if you like as a reminder for people to check, to go to the doctor, to talk about this, to not be embarrassed about this because it is one of men's most embarrassing diseases if you like, prostate cancer, and it's the biggest killer for men as well. It came from Neil actually who sent a question in saying “do you have any tips about bringing up the subject with my dad?” This is going back to this whole family connection thing again. “I don't think he's been to the doctor for years, can't get him to go to the doctors to see if there's anything wrong with him” – so what would your message be back to somebody whose saying I'm worried about my dad, or if you're a dad maybe worried about your son, but it's more likely to be the other way round – how would you go about that?

L: Well if he was worried about his father I would go to the GP myself, I would advise him to go to the GP myself first of all and then explain that he's got, that his father possibly will have problems and then perhaps the GP could call out and speak to him, but he must, he must make sure that his father does see somebody, and I also if I just may add, there's a lot of people of our age, or my age group in their 50s and 60s who don't know what our fathers had, our grandfathers had

H: Ye

L: And they may have been suffering with prostate problems, so I have two sons, so I have to look back at what my father-in-law's lifestyle was like, and now my husband and then obviously I'm very concerned that both my sons would be tested – I understand when they're about 40

H: And again you'll sit down and talk with them about that, obviously? As something that's touched your family so –

L: Oh yes

H: Closely

L: Oh yes, to everybody out there, yes, no please, please all you chaps go and get tested. I'm sure listening today there must be somebody amongst however many people are watching us that's going to stop and think oh, I go to the toilet a bit too much or in the night, or I've got a bit of a pee problem. Go to the doctors. Please

H: See you've even got me thinking about this now. Prokar, final word with you please – it's about getting in there early isn't it?

P: Absolutely I would have a gentle chat with dad and possibly, possibly the most important thing there in his mind is that he's scared. He thinks that if the cancer is not detected it's not there, well that's not true. We are human beings and if there is something wrong with us then it's going to turn up sometime or the other, so not knowing it doesn't mean it's not there. The second thing to tell dad is that there are good treatments now. It is no longer the case that if you have prostate cancer, it's a death wish. It isn't. there are good treatments which can cure it, and there are charities who are increasing the awareness of this disease so I would certainly get dad, as you said Liz, to go and see the GP, I would, if necessary go with him, maybe a helpful hand ,a bit of encouragement might help. Certainly get dad checked because you never know what's going to be found, and if it is found, God forbid, then it can be treated.

H: Prokar and Liz thank you very much indeed for joining us today

L: Thank you Murray

H: Pleasure to have you both with us. Thank you very much indeed for your questions as well. If you want more advice then you can go to a website, it's www.prostate-cancer-research.org.uk. Thank you very much for joining us and we'll catch you again next time. Bye bye