The Real Villains of Prostate Cancer

MY life’s ambition is to play a James Bond villain. I have the cat and the eye patch. So, I am just waiting for the call. For some reason though, the phone hasn’t rung,” said Toby Young, the Oxford-trained British journalist and educationalist whom I adore.

Young, a contributing editor at Vanity Fair, has that British sense of humour. The man is also a renowned food critic who has served as a judge on the TV show Top Chef.

So, why would a proper English gentleman like Young want to be a Bond villain?

Then there is Thomas Frank, the witty American political analyst, historian and columnist for Harper’s Magazine and the Wall Street Journal.

Frank once said: “In the James Bond movie, the villain was a culture captain, a tycoon of culture, a Murdoch figure. It’s not as if people don’t know what is going on?”

I don’t know what is going on? Why would two respected journalists choose to be villains rather than the hero? I am intrigued and fascinated as I have an equal affinity to Bond villains.

Over five decades and more than 20 movies, the Bond franchise has indeed churned out its fair share of great villains. Although, many have been parodied in productions such as Austin Powers, the baddies have enthralled several generations. So which of the villains is the most memorable and iconic for you?

For me, Jaws was, without doubt, the scariest of them all. The 7-foot tall bad guy, introduced in The Spy Who Loved Me, was larger than life (literally). The steel biting giant was so memorable that he was even brought back in Moonraker, which allowed him to exhibit a softer side.

In this third instalment of the Movember series, we are going to dissect the good, the bad and the ugly faces of prostate cancer. And decide which are the “villains and heroes” of the disease.

Dear Dr. G,

I am confused!

I am 65 years old and have recently been diagnosed with prostate cancer after a slightly high PSA result was recorded.

My doctor told me the Gleason score was not high and therefore I have the option to choose the types of treatment.

He proposed either an operation or radiotherapy for the cancer.

Strangely, he also asked me to consider doing nothing. Apparently, this is called active surveillance.

It seems that since I am sexually active, the radical treatments will impair erectile function.

First of all, I don’t understand why someone would leave the cancer untreated. Wouldn’t that cause it to spread with time?

Secondly, can you also explain how the treatment would result in Erectile Dysfunction?

How serious is my problem? Can you help?

Jason

Prostate cancer is a strange disease, and its natural history is not really fully known. The cancerous changes in the prostate occur with advancing age in men. When men live long enough, well into the 90s, a cancerous mutation appears to often occur. The fact is most men die with prostate cancer and very few die of prostate cancer.

The elevation of the cancer marker PSA (Prostate Specific Antigen) will give some indication of the stages of the cancer, if a biopsy turns out to be positive. The other important parameter that determines the seriousness of the cancer is the Gleason Grading. This grading system allows the prediction of the aggressiveness of the mutation, which will be useful to assist in management decisions. The higher the number, the faster the lesions are expected to grow.

In recent years, clinicians have been trying to prevent over treatment of prostate cancer, which may bring upon negative impacts to the quality of life of patients. These include urinary incontinence and sexual dysfunction. The strategies of “active surveillance” or “watchful waiting” have been introduced for low and early stage cancer. Such an option is only feasible in older men who are agreeable to regular clinic visits.

The prostate is closely linked to the nerve and vasculatures (neurovascular bundles) which determines the integrity and the rigidity of the penis and sexual function. Radical surgery or radiotherapy can often adversely affect these important structures. Thankfully, modern technology such as Robotic Radical Prostatectomy and brachytherapy can potentially spare patients form nerve injury, hence less sexual compromises.

In Act One of Shakespeare’s Merchant of Venice, Bassanio is worried when a villain acts nice. He says: “I like not fair terms and a villain’s mind”.

In the spirit of Movember, when it comes to prostate cancer, indeed the key to management is to tease out the aggressive tumours (horrible villains) from the dormant ones (Nice Villains). Even though this is the big C (Cancer) it may not necessarily lead to the big D (Death). We need men to be aware of the importance of early diagnosis to help them to make treatment choices.