Industry news: Options for prostate cancer broaden

One in six men will develop prostate cancer in their lifetimes. That's a frightening fact, and one that instantly needs to be qualified: we don't really know what the incidence of prostate cancer in South Africa is, so we rely on stats from the UK, Europe and the USA as guides.

Prostate cancer is the most common cancer in men. In Europe, every twenty minutes one patient is diagnosed with prostate cancer and it is responsible for 67 000 deaths every year.

However, any doctor you care to ask will agree that prostate cancer is more prevalent today than in earlier generations, even than just a decade or two ago. In part, urologists say this is because men are living longer; in part, it's because more men are aware enough to have regular check-ups; in part, it's because doctors have become better at making the diagnosis.

Typically patients with prostate cancer experience no symptoms and it is for this reason that it is vital that all men over the age of 45 should have annual screenings,” says Dr Marek Borkowski, Urologist at Netcare Rosebank.

So it's good to know that there are options for treatment of prostate cancer. In the past, a patient with this diagnosis really had only one option, prostatectomy - which is the removal of the prostate or external beam radiotherapy. And considering that for many men, the side effects could be impotence, and possibly incontinence as well, that was a very serious prospect to face.

Medical scientists and oncologists have for many years sought a treatment which would sidestep these horrifying possible consequences. In brachytherapy, a form of therapy that is now available at Netcare Rosebank Hospital, they appear to have found at least one solution.

Brachytherapy involves the insertion of tiny pieces of radioactive material (known as ‘seeds') into the prostate, where they work rather as radiation therapy (external beam radiotherapy) does, by damaging the DNA of the cancerous cells. (Brachytherapy is, a number of published papers indicate,

a more promising treatment for prostate cancer than external beam radiotherapy.) Brachytherapy is not new: it was first used, without much success, in the 1970s, but in the intervening decades, the technique has been honed and honed again. It is now well established as a therapy which is as effective as surgery. But not so harsh!

“Brachytherapy is less invasive and less aggressive,” says Dr Borkowski, who is part of the team providing this therapy at Netcare Rosebank Hospital. It is not, he points out, a treatment that will be suitable or effective in every case - like the prostatectomy, it will not work for every man - and it has some potential side effects of its own.

But it does boost the patient's chances of avoiding those dreaded fates, impotence and incontinence. At the same time, says theatre sister Sharman Chenery, from Netcare Rosebank Hospital, it requires a little less time in theatre, much, much less time in hospital - and much less pain. “It's an overnight stay, and home again the next day,” she says. “This means that patients have less pain, too; I visited some of our first patients the day after their ops, and they said the only soreness they were experiencing was a slight discomfort from their catheters!”

Cancer of any kind is a chancy thing; there's no such thing as one-size-fits-all treatment. Every patient will need to spend time with his doctor, his oncologist, his urologist and any other specialist who can shed light on the subject to decide what's the best course for him. But the fact that there is another facility able to offer this well-tried, minimally invasive therapy will give hope to many men wrestling with a diagnosis of prostate cancer.

Fact box

What is prostate cancer? The prostate is a gland that forms part of the male reproductive system. It secretes liquid to energise the sperm to fertilise the egg for procreation. Prostate cancer occurs when cells in this gland begin to multiply uncontrollably.

Prostate cancer is often a slow-growing cancer, but it is possible for these cells to spread, or metastasize, outside the gland and into the lymph system and bones.

This cancer usually develops in men over the age of fifty, and commonly in men in their sixties, seventies and beyond. Many men who develop prostate cancer will never have symptoms, which is why regular screening is so important.

Men over forty five should have regular check-ups, at least once a year; it would be beneficial to have regular blood tests for the PSA (prostate specific antigen), which would indicate whether any cancer was present.

While you can have prostate cancer without symptoms, some men will experience symptoms such as frequent urination, difficulty starting urination and keeping it going in a steady stream, painful urination, difficulty achieving erection, more frequent desire to urinate at night, and pain with ejaculation.

There are three primary treatments: surgical removal of the prostate, brachytherapy and external beam radiation. In the case of older men, doctors may suggest watchful waiting: doing nothing, but having frequent tests to ensure the cancer has remained slow-growing.