Webinar: Tackle your prostate

It is estimated there are nearly 12,000 prostate cancer deaths in the UK each year, making this the second most common cause of cancer death and accounting for 13% of all deaths in men. Yet, at the same time, there can often be confusion - and misplaced fear - over the connection between prostate cancer and having an enlarged prostate, something common in men aged over 50.

These sobering statistics, and the value of health promotion and education in this area, lay behind a highly informative WPA webinar that examined prostate cancer and prostate diseases. Led by consultant urological surgeon Mr Ben Challacombe, the event highlighted that:

Ben, a surgeon at Guy's and St Thomas' Foundation Trust and Trustee of the Urology Foundation, opened the webinar by welcoming the fact that celebrities such as actor and writer Stephen Fry and TV presenter Bill Turnbull have put a public spotlight on prostate cancer in recent years by talking about their own experiences of the disease.

Nevertheless, in 2018, UK prostate cancer deaths for the first time overtook UK breast cancer deaths; some 52,000 men are diagnosed with the disease every year in the UK - "That has gone up in the last few years, probably due to increased awareness but, on the plus side, far fewer men are presenting with metastatic, in other words, advanced disease, only 13%. So, we are finding more men but at an earlier stage and therefore cure rates are higher," Ben pointed out.

However, and worryingly, we are also seeing a 'Covid effect' as we come out of the pandemic, he warned. "What we've found is there are men missing, many, many men missing. People are not getting in to see their GP and having those casual chats about family history, risk factors or awareness; those sort of low-level case-finding discussions."

This is where employers can potentially have a valuable education and health promotion role, as we shall come to shortly. However, it was also important to dispel some common misconceptions around prostate cancer, Ben emphasised.

To that end, he first explained what the prostate is - "The prostate is like a doughnut under the bladder. When you pee, your water pipe goes through the middle of the prostate and at the back of it are the sperm ducts, and they come through the middle of the prostate as well." He also highlighted that all prostates grow as men age.

However - and this was important - this natural enlargement over time is not necessarily a sign of prostate cancer - "Just because you have an enlarged prostate, you are no more likely to have prostate cancer than if you didn't have an enlarged prostate. They are not linked, they are both common and you can have both. Or you can have one or the other, or none," Ben said.

Despite this, it is still important for men to get tested for an enlarged prostate through a PSA, or 'prostate-specific antigen', blood test. This should normally happen once someone hits their fifties, though Ben highlighted a range of additional risk factors.

"Family history puts your risk up twofold; so, if your father, uncle or brother have had significant prostate cancer, or if you're from an Afro-Caribbean background that will put your risk up by twice, roughly. There is also a slightly higher risk if you're obese," he said, adding that, for men who fall into these categories testing from their mid-forties may be a good idea.

The PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). As the NHS highlights, if you're aged 50 to 69 raised PSA is likely to be 3ng/ml or higher. However, the fact PSA tests are also jokingly referred to by urologists as 'promoter of stress and anxiety' tests, this highlights the difficulty here - "If you are going to have a PSA test, you should remember that it could just show that you've got an enlarged prostate," Ben said.

Another challenge is the issue of symptoms. Symptoms of prostate cancer can include needing to pee more frequently, often during the night; needing to rush to the toilet; difficulty in starting to pee (hesitancy); straining or taking a long time while peeing; weak flow; feeling that your bladder has not emptied fully; and blood in your urine or semen. Equally, however, these can be symptoms of otherwise benign prostate enlargement. Prostate cancer in fact can be asymptomatic, or show no symptoms until the cancer is advanced, at which point, sadly, it is much harder to treat.

This difficulty of diagnosis emphasises why it is imperative for men to be checked and, if need be, followed up with a specialist - 'Active surveillance' - so regular MRI scans, PSA tests and even a biopsy - is a common treatment approach now within the NHS, Ben added.

Brachytherapy, or the placing of small radioactive seeds in the prostate, radiotherapy and surgery (now predominantly robotic) are also used as treatments. For later-stage prostate cancer, hormone treatments or chemotherapy may need to be considered.

When it comes to an enlarged prostate, the better news is that, while surgery can be a treatment option, other less invasive approaches are normally used in the first instance. These can include lifestyle changes, such as drinking less tea and coffee, restricting fluid in evenings and ensuring the bowels do not get constipated. There also various medications that can help.

"The man with urinary symptoms is often worried about prostate cancer but usually doesn't have it. This is because the prostate cancer grows on the outer part of the prostate while enlargement happens on the inner part, which is the part that squeezes the pipe that causes your symptoms" Ben explained.

"The partner is always worried and often the GP is [too]. So, if you do have urinary symptoms, it's fine, come in, see a urologist and get checked. We'll do the tests, hopefully reassure you and make a plan. The only way to know you're OK is to be checked," Ben said, adding that 'prostatitis', or an infection or inflammation of the prostate, is also something to watch out for.

"Effective treatments are available now on the NHS for both prostate cancer and a whole range of other urinary symptoms. And urologists are friendly; we hang around with cool gear doing cool stuff. We are a technology-driven specialty and it is nice to look after people. So, come and see us if you're worried," Ben added, in conclusion to the main presentation.

The question-and-answer session that followed highlighted the important part that employers can potentially play in raising awareness and knowledge of prostate cancer and prostate diseases, as well as encouraging testing.

Ben reiterated the fact that, often, men are simply not proactive about coming forward to get themselves checked out, and this is a problem that has been exacerbated by the pandemic.

"Across south London, where I work, we have only got 50% of men with prostate cancer than we had last year. Covid has not cured those men; they are just not coming forward," he pointed out. "It is still there and we know there is going to be a big upsurge. So, if you're in an at-risk group, you need to get checked. A PSA test, and a subsequent MRI scan, may just save your life."

Employers can have a key role in running health promotion campaigns and education, including potentially linking to events such as 'March the month' run by the charity Prostate Cancer UK every March. "I think it is just about encouraging men, if they're worried, to get checked. If you have got symptoms, get checked," Ben said.

Targeting partners and loved ones can be another good way to kickstart conversations and raise awareness, he highlighted. "Men are not good at coming forward. We need our partners to be talking about this stuff and encouraging us to go and get checked," Ben said.

There can also be value in recognising and offering support around the mental health aspects of dealing with this kind of disease. "For some men it will hit them really hard. It can be tied up with virility, sexuality, with libido; prostate cancer is not just the same as taking out a piece of bowel or kidney. We need to be picking that up, to be aware of that and, if need be, offering additional counselling," Ben advised.

"Prostate is the commonest male cancer; it is really the commonest lethal cancer for men," Ben concluded. "All men have a prostate, all men have a PSA that can be measured. If you have symptoms, in the most part it's probably not going to be prostate cancer. But it could be.

"So, get checked because you're going to be reassured and the doctor will probably be able to give you something that is going to improve your quality of life - and put your mind at rest," he added.

Nic Paton is one of the country's foremost journalists on workplace health, safety and wellbeing, and is editor of Occupational Health & Wellbeing magazine. He also regularly writes on the health and employee benefits and health insurance markets.