Expert urges doubling prostate cancer specialists

UrologyOne of the leading consultant urologists dealing with prostate cancers has called for the number of specialists working in the area to double as awareness of male cancers increases.

Thomas Lynch, consultant urological surgeon at St James's Hospital, Dublin said there are about half the required number of urologists in Ireland.

"If we make a comparison with our colleagues in the UK, per head of population, there just aren't enough consultant urologists in the country.

"Hopefully over the next number of years consultant urologist numbers will be increased as men's health takes a higher profile."

Mr Lynch, speaking ahead of the launch of a National Prostate Health Awareness Campaign, said that due to improved diagnosis the number of men being identified with prostate cancer was increasing, leading to growing demands on urology services.

A report from the National Cancer Registry last week found the number of prostate cancer cases has risen from 1,000 a year in 1994 to 2,100 in 2002, largely due to increased use of PSA (prostate-specific-antigen) screening.

More than 540 men died from the disease in 2001. After skin cancer, prostate cancer is the most common male cancer, accounting for 15 per cent of all cases.

However, in the absence of a national screening programme the onus remains on men to get themselves checked. But fear of the condition was resulting in many men "sticking their head in the sand and doing nothing about it," said Mr Lynch.

"It is very sad when I meet a man of 60 with an advanced stage of the disease who could have been diagnosed five or six years earlier and could have had it cured by an operation.

"Prostate cancer is, if caught at an early stage, potentially curable. Just like breast cancer in women."

Mr Lynch said 10 years ago men were diagnosed at a later stage of their prostate disease. Now, greater numbers are being diagnosed earlier.

"We advocate men between 50 and 70 years of age should get themselves checked out. Causal factors for prostate cancer are unclear but there is a genetic link.

"If you have a close relative, brother or father, with significant prostate cancer over the age of 55, you are at a slightly higher risk of getting prostate cancer yourself and should get yourself checked out.

"As a surgeon I deal with men with prostate cancer all the time. So I know what they go through. I am not scaremongering . . . the vast majority of men won't have it but rather than sit at home worried sick, get it checked."

Symptoms can be hard to detect. "Just like a woman may not notice any symptoms until she develops a lump on her breast, whereas a mammography can pick up discrete lesions. It is the exact same with prostate disease.

"One warning sign we recommend men look out for is changes to their urinary pattern. Are they going more frequently, or at night? In that case he should get his prostate checked out."

A test usually involves screening for PSA, a protein generated by cells in the prostate. A high PSA level means cancer may be present but a biopsy is required to confirm the presence of cancer.

"Only 25 per cent of men with an elevated PSA level will turn out to have prostate cancer. A whopping 75 per cent of men with elevated PSA readings will not have cancer. I refer to this group as the "worried well", said Mr Lynch.

Asked if a national screening programme was needed to ensure early detection of prostate cancer, he said such a programme was not being advocated at the moment.

"However, I am not saying it won't be worth our while in a few years time. There are ongoing studies in centres in the UK into this issue. And because the population in England and Ireland is so similar, whatever we learn from England we can extrapolate and apply to this country."

Mr Lynch also said not all prostate cancers require treatment. "There are certain prostate cancers, particularly in older men for which radical surgery would be totally inappropriate.

"A lot of older men tend to die with the disease rather than from it."