He set a surgery date for 3 December and asked me if I'd like to attend the operation. Its principal function — the liquefaction of semen — helps create life: without it a man becomes infertile. But its extreme malfunction may also hasten death. The incidence of prostate cancer has increased markedly over the past 20 years, although this is largely due to greater vigilance and earlier detection. Nearly two-thirds of cases are diagnosed in men of 65 or more, and it is extremely rare before the age of Kirby knows of four other urologists afflicted with prostate cancer, three of them advanced, one with little hope of survival.
He says many of his colleagues remain dubious about the value of PSA screening and surgical intervention to remove a gland that, even if cancerous, may not kill you. It's easier not to know, just as it's easier not to screen for heart disease.
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Or breast cancer in women. But when I began in the s, before all these tests became available and refined, I only saw patients whose cancer had already metastasised , and many lived only a few weeks. It is a debate peppered with issues of priorities, medical expertise, money and robotic technology, and complicated by the fact that we are still in the early days of a new science.
PSA tests have only existed as a debatable marker of health since the s, and have only been widely available since the late s. Charities dedicated to prostate research and education have been campaigning since the mids. In January , Britain's leading charity in the field, Prostate Cancer UK , still claimed the disease was getting less attention than other illnesses with a lower mortality rate.
Education and awareness were still vital, it argued, and it set about launching what it called the Sledgehammer Fund as "a call to arms". Its celebrity patron was the comedian Bill Bailey , whose father-in-law had suffered from prostate cancer, but the most prominent name on the roster of experts was another one: Roger Kirby. In a recent email, Kirby sent me a set of articles from medical journals that laid out the arguments for and against the procedure he was about to undergo. The debate is fairly simple and exists primarily because prostate cancer lacks the historical pathology of other diseases, and thus the near-certainties that permit a relatively unchallenged course of medical action.
Instead, we still have an unsatisfactory and incomplete set of evidence from small-scale trials, anecdotal observations from doctors, and a subjective collection of hunches and gut instincts. And there is another difficulty: prostate cancer — unlike breast or lung cancer — is frequently a natural disease of ageing.
Many men in their 70s and 80s will develop it with only minor symptoms; it may not present a threat to life, and is likely to be overtaken as a cause of death by something else. But how long should you wait to find out? The debate has polarised into two horn-locked camps.
In one, Kirby and his supporters advocate careful surveillance and, if the surveillance prompts it, medical intervention. They are an increasingly vocal unit and their most visible campaign, gathering momentum each year since its founding in Australia in , is Movember , the month-long festival in which men are urged to grow a jokey moustache.
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In the other camp sit those who argue that prostate problems are being overpublicised, overdiagnosed and overtreated, causing men to be unduly alarmed by an illness they never worried about much before. They argue that PSA scores ought to stand for Producer of Stress and Anxiety, as they are not a sufficiently accurate indicator of disease to be helpful, and that making tests more available not only places an unnecessary strain on health providers' funds, but may put overly worried patients in conflict with their doctors. The NHS and the World Health Organisation both state that there is no evidence that universal non-symptomatic screening saves lives.
The arguments are one thing, the personal dilemma another. In one sense, macabre as it sounds, Kirby's cancer could only be good for business. Kirby practised urology within the NHS for 20 years — "longer", he points out, "than you get for murdering your wife". The list of clients who have benefited from the centre's care includes many famous and wealthy names, most of whom wish to keep their medical history to themselves.
In America men tend to bandy about PSA scores as if they were sports results. In America the list of well-known men treated for prostate cancer is far longer. Kirby and I first met in , when he was due to operate on a friend and former boss of mine, Tony Elliott , the founder of Time Out. At 58, Elliott had begun to feel dizzy. A battery of blood tests revealed a PSA score of 5.
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His choices were manifold, and most patients face the same ones today. And then there is radical prostatectomy, whereby the entire gland is cut out — something that has the slashing air of the Victorian operating theatre about it but may still be the most thorough and containing treatment. Tony Elliott chose this last option, performed by Kirby with a 10cm incision beneath what he called the bikini line. The procedure was a success; Elliott remains well, occasionally boosting his resistance with hormone therapy.
But had Elliott presented today, he would have benefitted from a new option: the da Vinci robot. This is a machine that has brought a far less invasive and more refined method of performing a prostatectomy, and involves making six 10mm keyhole incisions in the abdomen, into which thin steel arms, known as ports, are inserted.
This is the robotic element: the arms are fitted at their tips with a variety of instruments for cutting, sewing and sealing, as well as a camera that allows the surgeon to operate the ports remotely from a console a few yards from the patient while looking at an enlarged 3D image on a screen. Which brings us to the fifth floor of the London Clinic in Devonshire Place at the beginning of December , and a year-old patient awaiting a trip to the basement. Roger Kirby, already in his gown when I arrive, is busy maintaining the air of a man about to take a stroll in the park.
We talk about Chelsea's chances in the league and how he broke the news of his cancer to his three adult children: "They felt if I had to have any cancer, this was probably the best one.
At 1pm a chief nurse arrives to accompany us to the operating theatre. We all scrub up. The anaesthetist, Richard Morey, puts a large needle into the base of Kirby's back and injects slowly. Pads and wires are applied to monitor his heartbeat and blood pressure. A nurse shaves his stomach. In a standard routine, everyone in the room introduces themselves and their reason for being there. The precise nature of the procedure is announced. The abdominal cavity is distended with carbon dioxide to lift the walls from organs and create more space, x-marks are applied to the points where the ports will be inserted, the robot is pulled into position, and the first incisions are made.
The process of delicately slicing the prostate away from the bladder, urethra and fatty lining begins, and a mixture of pumping and hissing reds and yellows flood the screen as metal pincers pull and cut and seal. We joke that Kirby could have performed this operation in his sleep.
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Instead his team is led by Professor Prokar Dasgupta. He will repeat the procedure on several other men later in the week. Gastrointestinal stromal tumor. General Financial Topics. General Psychosocial Aspect Topics. Metastatic Breast Cancer. Neuroendocrine Cancer. Psychosocial Issues. Side Effect Management. About Us.
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Comments From Our Readers- Winter Currently Viewing. A cancer diagnosis is a life-changing event for anyone, but for men with prostate cancer and other pelvic malignancies, the long-term effects of the disease and its treatments can be particularly challenging.
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In the aftermath of treatment, men not only can experience distressing physical and psychological effects, but many also have their first experiences with sexual dysfunction. This distressing side effect can result from treatments for bladder, colon, rectal or penile cancer, but men treated for prostate cancer have especially high rates of sexual dysfunction, as high as 75 to 85 percent, depending on the situation.
Causes across this spectrum of cancers can include low testosterone levels due to hormone therapy, chemotherapy or radiation; damage to nerves near the prostate as a result of surgery or chemotherapy; compromised blood flow to the penis due to surgery or radiation; and surgical damage to nerves that control semen outflow. But in , after studying ways to lessen the bleeding that often accompanied the procedure, Johns Hopkins Urologist in Chief Patrick C. Walsh, M. Walsh subsequently developed what have become standard nerve-sparing techniques for the operation, performing the first one himself in Nerve-sparing techniques can also be used in radical cystectomies and in lymph node removal for testicular cancer.
The complicating factor in nerve-sparing prostatectomy is that the nerves are microscopic, which presents a significant challenge to the surgeon, says Andrew Matthew, Ph. In addition, the nerve bundles are extremely delicate, and any manipulation inevitably results in some damage. The amount of inflammation and nerve injury directly translates to how long it will take for the nerves to recover, and until they do, men will experience erectile problems.
To say that this is distressing for most men is an understatement, especially for younger men. While it represents a non-surgical alternative to prostatectomy in prostate cancer, it still comes with a risk of sexual dysfunction.
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