Even if you're lucky enough to be correctly diagnosed, getting prostate cancer treated is rather like having a game of Russian Roulette. It's very much a hit-and-miss affair because the medical profession doesn't really know why cancer of the prostate occurs, and can't agree upon a common method of treatment.
A major study of radical prostatectomies (where the cancerous prostate is removed altogether) shows patients who undergo the operation can die from a number of major heart-related complications which usually occur within 30 days of the operation being performed (JAMA, May 26, 1993). Those who do survive often have weeks of recuperation.
Furthermore, it is grossly overused, even though it is supposed to be used with those with very early cancer only affecting the prostate gland itself and no tissue or the capsule surrounding it. It is particularly risky for for men over 70, when it has been shown to kill one in 50 (JAMA, 1993; 270: 948-54),
However, prostate cancer is unique in that the majority of cases perhaps as many as 90 per cent never become "clinically significant". "There is variance in the way a cancer develops in each individual," says Philip Dunn, founder of the Prostate Help Association, a charity to provide sufferers with more information about prostate-related disease. "Many men are never diagnosed with prostate cancer and it is only after death, from some other reason, that the condition is discovered. With others, you can't tell whether the cancer is one which will spread quickly, or grow very slowly," concludes Dunn.
In the main, however, prostate cancer is very slow growing and doesn't spread; two studies have shown that 86 per cent of patients with prostate cancer survive 10 years after diagnosis and in two-thirds of cases, the cancer hadn't spread (New Eng J Med, January 27, 1994 and JAMA, April 22/29, 1992). Particularly if you are over 70, you are far more likely to die with prostate cancer than of it. Autopsy studies in Europe have shown that a third of European men have prostate cancer, but only 1 per cent died from it (The Lancet, February 13, 1993).
The biggest problem with surgery is that it makes most men impotent and a fair number incontinent. In surgery, the latest rage is the "nerve sparing" technique, which is supposed to preserve sexual potency. Several studies report excellent survival rates (National Cancer Institute 1988; 7: 117-126) because just the inner gland and the capsule of the prostate are removed; most of the nerves are spared and patients are supposedly able to maintain a normal sex life.
Reginald Lloyd-Davies, Senior Consultant Urologist at St Thomas' Hospital in London, says 80 per cent of patients can now expect to live for a further five to 10 years with the new technique, but half of all patients still lose potency and around five per cent become incontinent. This is also major abdominal surgery, performed above the pubic bone, and so must be done by an experienced surgeon.
Drug therapy is now the less invasive alternative. Prostate cancer appears to depend on the male hormone testosterone. Anti-testosterone drugs are used to shrink cancerous tissue, but how long the patient remains trouble-free depends on how fast the tumour has been growing. Hormone treatment can become ineffective as the famous example of musician Frank Zappa showed a couple of years ago. He died at 52 after his fast-growing tumour slipped out of hormonal control.