Let’s talk about cancer

Men are reluctant to open up about their health, but with early diagnosis and targeted brachytherapy treatment, prostate cancer doesn’t have to mean the end of the world, says Deborah Wain

It was, says William Gillies, like “being hit by a sledgehammer”.

The property landlord was fit and well, had no symptoms when he was diagnosed with prostate cancer, following a routine cholesterol check. Like many men, he preferred not to think or talk too much about “that side” of his health, he admits.

Gillies, then 62, faced three treatment options: surgery to remove his prostate gland, having his cancer closely monitored, or a highly-targeted internal radiotherapy called brachytherapy.

Having the cancer cut away felt like the best option initially, but he was warned that surgery could leave him with impotence problems and urinary incontinence. So, after careful thought, he became one of a growing number of people who opt for brachytherapy. Five years on, having been given the all-clear by St Luke’s Cancer Centre, Guildford, he has no regrets.

“My thinking was that if the brachytherapy didn’t work I still had other options – but it does work,” he says. “I can’t speak highly enough of the treatment and want men to know about it.”

Every year in the UK, 37,000 men are diagnosed with cancer of the walnut-like prostate gland that sits beneath the bladder and surrounds the urethra, or tube that urine and semen pass through.

Often slow-growing, prostate cancer may never cause harm in a patient’s lifetime and side-effects of treatment can sometimes be worse than problems caused by the disease. However, it is not always possible to tell how quickly the cancer could grow.

Brachytherapy suits patients whose cancer is expected to be confined to the prostate gland. Unlike external beam radiotherapy (EBT) – usually given five days a week for around two months – brachytherapy is a single procedure. It offers the same chance of a cure as EBT or a radical prostatectomy yet with far fewer side effects.

Brachytherapy involves permanently implanting up to 120 tiny radioactive capsules into the prostate gland using fine needles, guided by ultrasound and 3D computer images. The seeds give off low levels of radiation for up to a year which kills the cancer cells. Most patients are home in a day or two and recovery is generally fast. The procedure is now available on the NHS at 22 cancer centres.

Graham Robson, 58, from Aberdeen, was also given the all-clear after brachytherapy. Robson, head of a recruitment business, was planning to opt for surgery until he found out about the newer treatment, and he now represents patients with the Prostate Brachytherapy Advisory Group.

Robson wants to see men take control of decisions after diagnosis, when, he says: “You’re thinking you might die, so quality of life simply means living. It’s human nature to make the best of what you have, but you want to be making good decisions.”

Consultant urologist Professor Stephen Langley co-founded the renowned Prostate Brachytherapy Centre at St Luke’s, where 2,000 patients have undergone the procedure since 1999. Of the first 700 patients, 92 per cent have been given the allclear. A total of 83 per cent of men who were potent before receiving treatment are able to have an erection afterwards and less than 1 per cent report incontinence problems.

Professor Langley stresses that difficulties with sex or incontinence can have an “emotional impact more devastating than one might expect” on a man.

Prostate cancer is only curable if it has not spread beyond the prostate gland, but is almost always symptomless at that stage. A PSA blood test can indicate if there might be a problem. Men aged over 50 are urged to discuss being tested with their GP.