Early detection of prostate cancer is key to successful treatment

Dear Dr G,

I am a reasonably healthy chap who went for a routine Prostate Specific Antigen (PSA) blood test a few months ago. Unfortunately, the tumor marker was unexpectedly high at 6.

Sadly, at the age of 55, my biopsy detected prostate cancer.

Naturally, I was devastated immediately after the diagnosis.

However, after seeing the specialists, I understand my cancer is “harmless” at early stages and I can opt for a laidback approach until the tumour becomes more active.

Being sexually active and having a wife in her 40s, I understand the treatment decision I make will have a significant impact on our sex lives.

Truthfully, I am still blissfully ignorant about the prostate.

Am I alone in not knowing too much about the prostatic function?

Can you also explain why the prostate turns cancerous? And is it common?

I understand since my prostate cancer is at its early stages, therefore I have the option to wait. So, how long do I have before I need to take this seriously?

Can you also tell me what sort of impact will it have on my sexual functions?

Warmest regards,
Ignorant Ivan

A survey by the charity Prostate Cancer UK recently demonstrated that nearly one in five men (17%) did not even know they have a prostate and were unaware of the risk of cancer.

The research covered 1,900 British men and found 92% of them were clueless about the role of the prostatic gland, and 54% of the same group were also uncertain where the gland is located.

Such findings are alarming as nearly 40,000 men in the UK are diagnosed with prostate cancer yearly and 11,000 die of the disease. The lack of awareness is believed to have an impact on men delaying cancer diagnosis and compromises the chances of being cured.

In fact, the prostate is a simple gland with a simple role. The walnut-sized gland is located between the base of the bladder and the penis. It surrounds the penile urethra and permits the passage of urine and semen during ejaculation. The function of the gland is solely the provision of secretion that is rich in nutrients for the sperm cells to survive.

The number of prostate cancer cases is rising in most countries. This could be due to the prevalence of diagnostic tests with PSA (Prostate Specific Antigen) and increasing life expectancy overall.

Although the cancer is generally associated with older men, detection in younger men is more common, associated with genetic-linked cancers and sedentary lifestyle. The technology of cancer detection is improving on the whole, but many men are still presented late. This is likely to be associated with lack of awareness and fear of sexual adversity following treatment.

The complete surgical eradication of prostate cancer is radical prostatectomy. Such intervention is performed with open or keyhole approaches, and in recent years a robotic-assisted operation.

As the role of radical surgery is to completely remove the prostate gland, including the healthy tissues, the sexual and reproductive health of the patient will be affected.

Before the radical prostatectomy, most men are counselled for potential complications of erectile dysfunction and sterility. Although intra-operative preservation of the erectile nerves and vasculature is achievable with aa nerve sparing technique, this is not always possible in advanced cancer.

Apart from damaging the erectile nerves, radical prostatectomy also severs the connection between the testicle and the urethra, technically equivalent to performing vasectomy. This results in men being unable to provide sperm through natural ejaculation, hence all men who undergo the operation will be rendered sterile.

A man is still able to have an orgasm without ejaculation, however.

Other treatment modalities of prostate cancer include radiotherapy and hormonal suppression.

In locally advanced prostate cancer, the utilisation of radiation to destroy cancer cells also adversely affects sexual function. The prevalence of erectile dysfunction is observed in nearly 80% of patients after intervention.

On the other hand, hormonal manipulation is technically a chemical castration, effectively depleting men of their testosterone and libido.

Being “prostate aware” is of course important for men to be able to undergo tests to exclude malignancy. Early detection and treatment is naturally key to ensure a better chance of survival, with less unfavorable outcomes of sexual dysfunction.