A disservice to those with prostate cancer - Telegraph

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Last Updated: 3:27am GMT 16/12/2007

Commentary

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Current draft guidance from Nice suggests that as a one-off measurement,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 Kirby is chair of the charity Prostate UK.