As we all struggle with our increasingly busy lives, it’s easy to lose sight of what really matters. There are enough day-to-day problems to worry about without stopping to think about our health, and us men are notoriously reluctant to visit the doctors when we get ill. Whether it’s our male pride or fear of the unknown that’s responsible, it’s an attitude that can have serious consequences – especially when it comes to the early diagnosis of life threatening conditions such as prostate cancer. As the most common cancer in men across the UK, 35,000 men are diagnosed with the disease every year, claiming the life of one man every hour. But if men seek help, it can be treated effectively. Our webchat with by Dr Hilary Jones gives you crucial information on the symptoms, treatment and diagnosis of the disease – that too often suffers from being a taboo subject.

Although prostate cancer mainly affects men over 50, all generations need to be aware of the risks. Many of us are unaware, for example, that our chances of developing prostate cancer are two and a half times greater if one of our close relatives, such as a father or brother, is diagnosed. African Caribbean men are also three times more likely to develop prostate cancer than white men. That’s why The Prostate Cancer Charity is aiming to put the disease on the top of everyone’s agenda to show it really does matter – and this year a whole month has been dedicated to the cause.

This March is the first ever Prostate Cancer Awareness Month. Members of the public and celebrities alike are lining up to show their support. Legendary broadcasters Peter, Dan, and John Snow have been posing in their pants, while hundreds of five-a-side football teams from across the country have been getting involved with the Real Man Cup tournament.

Despite an increased awareness of prostate cancer in recent years, many of us still don’t know what symptoms to look out for. Make sure you are aware of the all the facts by logging onto our webchat with Dr Hilary Jones. He’ll be explaining who is most at risk from the disease, how to recognise the signs, and why it’s essential to attend to them as quickly as possible. He will also be answering any questions you may have live online; just fill in the form to submit yours.

I: Mark Rise, interviewer
H: Dr Hilary Jones
P: Pat Cohen, Prostate Cancer charity

I: Hello there and welcome along to the Health, I’m Mark Rise. Now we all know, us blokes are notoriously reluctant to visit the doctors when we get ill. Whether it’s our male pride or fear of the unknown that’s responsible, it’s an attitude that can have serious consequences – especially when it comes to the early diagnosis of life threatening conditions such as prostate cancer. It’s the most common cancer in men across the UK, with 35,000 of us diagnosed each Well joining me in the studio today is Dr Hilary Jones whose here to offer crucial information on the symptoms, treatment and diagnosis of this disease. Also on the sofa is Pat Cohen from the Prostate Cancer Charity. Pat takes calls every day from men and women concerned about prostate cancer, manning the charity’s free and confidential helpline. We’ll give out details at the end of the show so make sure you’ve got a pen and paper ready. Guys, welcome along. Many people I think presume that prostate cancer is an older person’s disease; that’s not necessarily the case Hilary is it?

H: No not necessarily the case at all. In fact we know that if men are lucky enough to live into their 90s, the vast majority of them will have prostate cancer, but it won’t have bothered them, they won’t even be aware of it in many cases. It becomes the commonest cancer in men overall. But at a younger age we are seeing men sometimes in their 40s for example who develop a prostate cancer, and it can be of the more aggressive type, so their symptoms progress very rapidly. So we should never assume that this is something that only older men get, of pensionable age. It can occur at a much younger age, and some people particularly in certain races and particularly if there’s a strong family history, with two close relatives having had prostate cancer themselves at a young age in the past

I: Is it a question of finding symptoms first, then having it checked out, or if you have those kind of concerns that you go and see your doctor anyway?

H: I think it’s important that people are aware of the symptoms of enlarged prostate, which on the whole is benign but sometimes can be cancerous. Symptoms of either type are very similar, whether the gland is benignly enlarged or enlarged because of cancer, so it’s important to be aware of the symptoms and we can talk about that in a moment, but it’s also I think important for men, certainly over 50 to start thinking about being screened, because like most cancers they often present with symptoms too late in the disease to be effectively treated, to be cured in other words, so if men are screened, and whilst it’s not easy to do prostate cancer screening, it is valuable if all men over 50 were screened we would pick up more early cancer and we would cure more men from it

I: And Pat do you find that you’re getting calls from younger men? I mean I’ll be quite candid with you, I’m knocking 40 now, later on this year, my dad –

H: Surely not?

I: Indeed. My dad had prostate cancer last year

P: Right

I: And fortunately is clear of it now after the operation and we’re all very pleased about that. Should it be something that I am concerned about at 40?

P: You should be aware about it, I think at 40’s still too young, look at how old your father was when he was diagnosed

I: Indeed

P: You know because that would have a big impact on whether you’re getting screened or tested earlier and we’d sort of look at the – as Dr Hilary said – from the age of 50 really, but if you’re aware of the symptoms, then you’ll know to pick it up straight away

I: Well it’s good, let’s bring in the symptoms then. Hilary, is there a list that we should be kind of cross-checking?

H: Yes it’s not a big list and actually if we think about where the prostate is, and what it is, it helps. The prostate gland is about the size of a hazelnut?

P: A walnut

H: A walnut, a walnut – and it sits at the base of the bladder and the water pipe to the outside runs through it, so as it enlarges, as it does as we all get older, it can either enlarge outwardly, or inwardly and compress the water pipe. Now when it compresses the water pipe, it makes it more difficult for a man to empty his bladder. So he might feel that when he passes his stream of urine it’s not as strong as it used to be. He might get the symptoms of a little bit of hesitancy, before he empties his bladder. So he’s standing there waiting and waiting for the stream to come – that’s an early symptom. Another symptom would be a bit of dribbling at the end, he might be getting up at night more often that he used to empty his bladder, and going to empty his bladder more frequently during the day. Blood in the urine sometimes – these are the symptoms that men ought to be aware of, and if they’re persistent, and if he’s noticed them, it would be well worth going to have those symptoms checked because it’s necessary to repeat that 90% of cases the enlargement will be benign, it won’t be cancerous, but in 10% we could find a cancer, and if we do we can do something about it

I: I think a lot of people also think they understand the thing about urinating, but there is often an erectile dysfunction question in men as well, isn’t there?

P: Yes sometimes men find that their erections aren’t as good as they were before, not as strong, so – and that’s sometimes what makes them go and see the GP earlier rather than the waterworks actually

H: Yes that’s right

P: Put it down to their age or –

H: That’s right, and this is because the nerves which control erection are actually running down the side of the prostate gland, so the prostate gland’s enlargement can interfere with the function of the nerves, and that can cause erectile dysfunction, so sometimes that is the reason for a man going to the doctor –

I: We do have a question specifically in from Roland on that, and you can send in questions on the website that you’re watching us on, so please live you can type your question and your name, send it in, it comes up in the studio. Roland says “I’m 63, I have normal DRE but PSE – PSA 13.6” – I’m sure you’ll explain that. He says “I have slight hesitancy at the start of urinating and although I can achieve an erection it’s not as good as it used to be. Apart from that I’m in good health and my urine is straw coloured. What are the chances of me having cancer?” It’s a very bleak, strong question to ask, but on the back-end of those symptoms what would you think?

H: Well I think he’s got some symptoms there, some symptoms of an enlarged prostate gland. He mentions the DRE, let’s explain. That stands for Digital Rectal Examination, and this is the test which doctors perform using a gloved finger to examine the prostate gland manually on the front wall of the rectum. It takes just a few moments to do, and the doctor can determine the size of the gland that way, and the consistency of the gland, whether it’s hard, firm and irregular, or whether it’s of normal shape and consistency. Now that test is suggestive of something going on, if it’s an abnormal gland, and we often do a test on the blood to measure a protein called Prostate Specific Antigen which is the PSA –

I: Ok

H: That Roland refers to. PSA gives us an indication, if we do it on a serial basis, so we do tests at various intervals, if we see an increasing level of PSA it’s suggested that the gland is producing this protein in increased quantities which could suggest a prostate cancer.

I: Without a shadow of a doubt, the DRE test that you’re talking about, the digital rectal examination, is the one that men will be frightened of that they will not want to go to their doctor for, and Pat I’m sure you hear this on your phone line the whole time

P: All the time, they’re so embarrassed, they’ll have the blood test, you know but they’ll, you know want to refuse having the DRE, and really the two should be done in conjunction

H: Of course they should

P: You know because a lot can be told from the DRE

H: Absolutely and anyway this test takes about 20 seconds to do, I say to guys in my surgery –

I: Hilary, ordinary men will go – doctors, you do it all the time. This is me, that is not something – you know?

H: But doctors are guys too, and we have to subject ourselves to the same tests as everybody else. This is what I say to people in my surgery – look, if we’re in the States in the States people are much more health-conscious. People in the States know that the screening is for them not for the doctor. So they come in and they pay their money and they say doctor if you don’t do a DRE I will sue you for negligence. Here they say I’ll sue you for GBH if you it. So it’s – we’ve got to change our attitudes to this, and these days we tend to get them to sign a consent form explain the test, look it takes 20 seconds, let’s do it and protect you, let’s protect your life. Simple as that, and if men had an attitude more like women, where they had internals for having babies and things, we wouldn’t see so many men literally dying of embarrassment

P: Yes

I: And that’s exactly what it is isn’t it? I mean that is a slogan I think that we’ve heard many times and that is true. Is there a simple way of getting men over that one do you think?

H: I think – for me Pat it’s about – this is on the doctors to reassure guys that actually this is like going to the hairdressers. You know, this is – have a chat with them, put them at their ease, let’s get this done, we’re still mates at the end of the day, you know –

P: Yes that’s right. It’s just education really

H: It’s about making it matter-of-fact

P: and relaxing them

H: Education, absolutely

I: So once a man has been diagnosed, and maybe they have got the enlarged prostate and – we then need to work out what kind of treatment is available, because as you say it may be benign, it may not be. Does that come back on the blood test? Is that how we know whether it is or it’s not?

P: No the blood test doesn’t actually diagnose, it’s an indicator that there could be a problem, so to actually get a diagnosis your GP would then refer you on to the urologists at the hospital, the specialist, and the only way to actually get a diagnosis is through a biopsy right, where they actually take a sample of the prostate

I: And then should it come back positive, what kind of treatments are available?

P: There’s a world of treatments –

I: Well that’s always good news isn’t it?

P: That’s the good thing about prostate cancer, because if it is caught early there’s a lot of treatment, I mean the complicated thing is that – probably one of the only things that patients actually get a choice, you know, you choose which –

I: This is one thing my father had to face, absolutely, yes he had – and then it really was a question of –

P: That’s right

I: Of weighing up one against the other. Just take us through what’s available

P: You’ve got surgery which could be done several ways, so you’ve got open surgery, keyhole surgery and robotics, you’ve got radiotherapy and brachytherapy which is radioactive seeds which they put directly into the prostate, and you’ve got medication, so tablets or injections that you can have as well –

H: And – active surveillance

P: Active surveillance

H: And what this means is that if you’ve got a cancer that’s low grade, it’s slow-growing, it’s not doing any harm, it’s well within the prostate gland. If the guy says actually I don’t fancy surgery, I don’t fancy radiotherapy, because of the possible side effects, let’s just wait and see what happens. It might do nothing for 25 years. Let’s just wait and see. Some people say I’m going to adjust my diet, I’m going to avoid saturated fats, red meats, dairy products, I’m just going to go on this very – fairly strict diet of eating lots of plants and a lot of those people do very well. So it’s about choice, being informed, talking about all the options with your doctor and choosing the therapy that suits you best as an individual

I: Well my dad has had it – quote / unquote “whipped out” – is the way that he preferred to put it. It’s quite a long recovery period, but he has now had two scans at 3 months and 6 months and he’s clear of those, so fingers crossed and that’s all very good news. But the treatment can be very effective can’t it?

P: It is very effective. I mean I think the worst thing about the treatment is the side effects that they can bring on, and – so that’s why the active surveillance is a good one, but the main side effect is the risk of incontinence and a risk of impotence you see, so that’s what the men have to consider as well in terms of looking at treatment options

I: Well – let’s move onto what it’s like living with the disease, because I think families will be concerned if they’re watching about what it’s like and how you can support someone. My dad for instance didn’t tell us for a year. He kept it to himself although he had been to his doctor, which you say is relatively unusual.

P: Unusual in terms of a partner, but in terms of telling the children it’s not unusual, or telling family and friends. Not unusual at all. Men – the way men view health, I think they feel it’s taken out of their control and men very much like to be in control. So they want to know that everything’s ok before they actually share the news. T hey don’t want to worry anybody and things like that, so a lot of them, you know they find other areas to share with, so a lot – they’ve got support groups, they’ve got like our telephone helpline, you know they’ve got message boards and things, and a lot of men you find are keen into those ways of getting support

I: And because of the charity of course, many people now have resources available to them that just weren’t there before

P: That’s right, yes. I mean I’ve been with the charity probably – what 7 / 8 years and I’ve seen it grow and develop over the years with more men phoning in, you know more organisations starting up and things like that, but yes it’s – it’s good that we’re getting the word out there. The awareness is growing

I: Of course. And the little blue badges that we’re wearing are available at Marks & Spencers, so that’s for the prostate cancer charity. We’ve had a question in from Jonathan saying “I’m in my mid 40s, how often should I consider going for a check-up?” So that’s kind of a – the whole kind of well man idea, isn’t it really?

H: Well I think it’s great that men are becoming more conscious of their health and availing themselves of screening tests. Probably at – in someone’s mid 40s there are other things they should be getting priority over prostate. I mean certainly cholesterol levels, blood pressure, heart health particularly. Levels of fitness, obesity – I would want to check all those. Diabetes as well. And prostate’s one of the things that a man of – in their mid 40s should be aware of, so being aware of any symptoms, and talking to the doctor. I mean certainly if he’s having a full screening medical then I would think a digital rectal examination would be part of that. Probably PSA – I don’t know, wait till 50?

P: Yes I think so,

H: Unless there’s symptoms

P: Unless there’s family history, or symptoms, or depending on their ethnic origin because –

I: Well it’s interesting you said that because let me just bring in a question from Simon –

P: Alright

I: Because Simon says “my granddad had this, are my chances increased?”

P: Right. Grandad –

H: Not really

P: Not really. But the levels do go up with each family member, so if his father was diagnosed, and depending on what age the father was diagnosed, that would increase his risk. And if his brother was diagnosed again that would increase his risk a little bit more. So it just depends, and as I said ethnic origin is a big thing as well because we know black men are three times more likely to get prostate cancer –

I: And does the black community understand that, do you know? Is that message across do you think?

P: We’re trying, we’re doing a lot of work out there to try and get that message across, but you know you sort of have men with their issues and health and then you’ve got black people with their issues on health, so it’s a hard one to tackle you know, sort of reaching out there, but you know as an organisation the charity’s doing a lot of work in the black communities to try and, you know, raise their awareness.

I: Is there anything that can be done Hilary to kind of prevent experiencing this in the first place? Is general health a good thing? Is there anything that triggers it off necessarily?

H: Well we’re looking at why prostate cancer is on the rise and why it’s so common. Most glandular tissue in the body tends to enlarge and form – degenerate to some extent over the years. It’s just like breast cancer. So many of the glands in the body do this. Prostate gland is subject to hormonal changes, just like breast tissue in men, and I think that what we need to do is to look carefully at diets, levels of obesity, smoking – that many of these environmental factors may be important. We know for example in Japan the incidents of cancer of the prostate is very low, but if Japanese men go and live in America they’re much more likely to develop it. So there are factors in the environment which influence prostate cancer. But I think a healthy lifestyle always helps, it helps not just prostate cancer but a whole host of things. So living, eating well, taking plenty of exercise, not smoking, drinking in moderation. You don’t have to be dull to do all of these things, just being sensible about your health really does help

I: I was going to say I’m glad you added that because it was looking a little dull just for a second there

H: Just for a second

I: It is prostate cancer awareness month

P: Yes

I: Pat – what kind of things are going on for the month that we can look out for?

P: Well as you said M&S are supporting us by providing our badges. We’ve got John, Peter and Dan Snow who’ve autographed some boxer shorts and they’re being sold in M&S as well

I: Ladies of all generations will be looking at the boxer shorts I’m sure

P: And we’ve got a lot of our volunteers that are manning stands in supermarkets and things like that. We had a five-a-side football tournament quite recently, so it’s just – hospitals a lot of the nurses are doing things around the hospitals as well, so it’s, you know just trying to get the information out

I: Excellent, well for more information or to put your questions to an expert like Pat call this number – it’s 0800 0748383, that’s 0800 0748383 or visit prostate-cancer.org.uk. That’s prostate-cancer.org.uk. I hope that you found today’s program interesting, Pat and Hilary thank you so much for joining us and we’ll see you soon again on the Health Show. Bye bye