Busting myths around prostate cancer 

Living in an era of information overload is challenging; and in the case of healthcare the sheer quantity of information ranging in quality is overwhelming at best and harmful at worst. Prostate cancer is no exception. Our patients tell us some incredible things that they’ve been told and advised in their journeys to our clinic.

Last week Prostate Cancer UK raised this question on social media:

“What myths do you hear most often about prostate cancer? What misconceptions stop men speaking to their GP about their risk? What do people say that winds you up?”

The answers included

 “The PSA test does more harm than good”

“It’s a good cancer to get”

“It’s an old man’s disease”

This inspired us to go through patient notes and share some of the myths our patients have heard, and which have been successfully busted in their experience with us.

Here are our top 5.

  1. Prostate cancer will ruin your sex life

This “warning” was recounted by former TFTC patient Tim in our recent blog, whose father had endured hormone therapy for his prostate cancer and encouraged his son to seek alternative treatment if possible. Brian did exactly that and, following NanoKnife treatment last year, maintains healthy sexual function.

Brian and his dad sum up the reality of prostate cancer and sexual function – prostate cancer treatment can, and often does, negatively impact sexual function. But non-invasive treatments such as focal therapy — suitable for men with localised prostate cancer – will treat cancer leaving sexual function intact.

A recent European study showed the harsh reality of invasive treatment for prostate cancer treatment, concluding “The outcomes of the unique, patient-driven EUPROMS study revealed the significant and non-negligible impact of prostate cancer treatment on sexual function”

Prostate Cancer campaigner Elvin Box speaks openly and honestly about the impact his prostate cancer surgery has had on his sex life, and urges men to be aware of these effects and to be tested early so they can avoid radical treatment. He is often featured in the media and tirelessly shares his message  here and here.

The best chance of avoiding the risk of a ruined sex life from prostate cancer is early detection and noninvasive treatment .

For many men, radical treatment for prostate cancer can be avoided through regular PSA testing, a diagnostic pathway led by MRI including precision fusion biopsy. Those found suitable can undergo noninvasive focal therapy, whose beneficiaries experience high levels of satisfaction and low levels of regret as compared to those undergoing radical treatments – evidenced in a recent multicentre study.

Those who have undergone radical treatments can benefit from advice and support from sexual health professionals like Lorraine Grover and bloggers such as Recovering Man.

  1. Prostate cancer will put you in nappies for the rest of your life

This concern is what drives many men to our clinic, and the reasons why it doesn’t have to be the case are similar to the ones outlined above for sexual function.  

Radical treatments for prostate cancer will impact continence, but this can be avoided with noninvasive treatment such as focal therapy.

All men should be counselled about the possible impact of prostate cancer treatment on their continence, and men who are impacted should be directed to specialists who can help.

  1. PSA testing is ineffective

Before the precision diagnostics we use now were available, the risks of overdiagnosis from a simple PSA test were high and felt by patients and clinicians alike as “blind” biopsies led to too many men having their lives harmed through prostate surgery.

It was also acknowledged that an elevated PSA did not indicated cancer per se, and often indicates non-cancerous inflammation or infection of the prostate.

Now that the diagnostic pathway has changed so significantly, and the evidence for focal treatments are building, the risks of overdiagnosis and overtreatment from a simple PSA test have reduced considerably.

The MRI pathway is now well established and has demonstrated it can reduce the number of both lifetime biopsies and overdiagnosis by approximately 50%, according to a recent study published in JAMA

Just this week Prostate Cancer UK has announced a new approach to PSA testingbased on this argument, presented visually here:

  1. Your doctor always knows best

While your doctor is almost certainly a well-trained and committed professional who bases decisions on evidence, s/he doesn’t necessarily have access to all evidence, and doesn’t know you as well as you know yourself.

You are the best advocate for your health. You also have a legal right to a second opinion.

The majority of our patients come to us for a second opinion, often following treatment recommendations and sometimes diagnoses that have been questioned by our clinicians and which didn’t feel right with patients. None have regretted this decision.

  1. You’re an old man at 70

Most men in the UK at 70 can expect to live another 12 years, based on current life expectancy data. If you’re an active 70-year-old, you can expect to live significantly longer.

The old adage “you’re as young as you feel” is beginning to build evidence as we enter an era where one’s biological age – as distinct from one’s chronological age – is becoming measurable.

So, for example, a man who has a chronological age of 70, or has lived for 70 years, may have a biological age of 50 as measured by biomarkers which in turn are influenced by lifestyle factors which include diet and exercise amongst a range of other factors.

The point here is that while chronological age is a given, biological age is manageable. We explore this in more detail our recent blog.

So 70 is not necessarily “old” at all.

And it’s important to realise that not everyone in healthcare subsribes to this view and we have seen age discrimination occur, even in the persistent tendency to describe prostate cancer as an “old man’s disease”. Fortunately advances in geroscience are beginning to change attitudes about ageing.

Have you been told things about prostate cancer that you question or doubt? We’d love to hear from you.