Britain has become breast cancer-savvy, and rightly so. After all, some 15,000 British women die from the disease annually. It is rather baffling, though, that we hear so little about the 10,000 men who lose their lives to prostate cancer in the UK each year. There are no special ribbons or supermodel-endorsed T-shirts on sale to show support for them. With at least one man in the UK dying from the disease every hour, the only cancer that kills more of the nation's males is lung cancer, yet 90% of adults in this country apparently do not know what the prostate gland does. Why?
There is never a simple answer to such questions, but in this case one word goes some way to summing it up: ignorance.
First, there is ignorance among the male population, which has not yet come to terms with talking openly about intimate issues. Then there is ignorance in the education system, accounting for the alarming 10% of Britons, who, according to a survey by the Prostate Cancer Charity (PCC), were under the impression that women had prostate glands too. Last, there is ignorance among the medical establishment in the UK, which has not yet agreed on the best way to diagnose and treat prostate cancer patients. This is not helped by scientists' ongoing uncertainty as to what exactly the prostate gland does and what causes it to become cancerous.
No wonder it is hoped that Prostate Cancer Awareness Week, which began yesterday, will educate more people on these complicated and conflicting issues.
Men really do have an acute lack of knowledge about how their bodies work, according to Phil Baldy, a prostate cancer sufferer who now mans the phone lines at the PCC. "Women take care of their bodies in a way that men just don't," he says. "Before my diagnosis I had a basic idea of anatomy, but I'd have had a problem pointing to my prostate gland on a drawing."
He is not alone. A survey by the PCC revealed that fewer than half knew that the prostate gland is actually part of the male reproductive system; located at the base of the bladder surrounding the urethra, it produces some of the fluid that makes up semen. It is the gland's sexual function that makes many men so reluctant to talk about any problems they might have with it. "Men like to think of themselves as super studs," says Baldy, "and anything wrong below the belt they just ignore."
While male pride certainly seems to play a part, often men don't go to the doctor's early enough, simply because they had no idea that they were at risk. Unhelpfully, half of all men with the disease display no symptoms. "And those who do," says Dr Chris Hiley of the PCC, "often attribute their urinary problems - getting up in the night to pass water, going to the toilet more than every two hours and experiencing hesitancy or intermittency - to plain old age." Whether they have cancer or not, Hiley is insistent that they shouldn't put up with these symptoms: "Why does old age have to be such a dreadful compromise?"
Yet prostate cancer is overwhelmingly an older man's disease. Seventy per cent of those diagnosed are over 70, and it is extremely rare in men under 50. It is an underreported fact that men of African-Caribbean origin are three times more likely to develop the condition than their Caucasian counterparts. Genetic makeup is thought to influence prevalence, as is a diet high in animal fats, but neither theory has been conclusively proven.
These two factors of age and race perhaps contribute to the lack of publicity for the disease. In our youth- and image-obsessed society, a cancer that hits predominantly elderly and black men can't match the poster appeal and tearjerk-factor cultivated by the breast cancer lobby - of young, vivacious women having their lives cut off in their prime. (This, of course, despite the fact that the vast majority of breast cancer sufferers are also over 50.)
When Horace Parry's father died of prostate cancer in 2001 aged 61, neither father nor son was aware that, as African-Caribbeans, they were at an increased risk. Since his father's death, Parry, a teacher and single father of 11-year-old twins, had been going for annual PSA tests. These measure levels of prostate-specific antigen, a protein produced by the prostate gland. Last April he was told that he had begun to develop prostate cancer. He was just 40.
But Parry's main gripe is the way in which he was treated by his doctor. "I was initially told quite aggressively that a total prostatectomy was my only choice," he says, referring to an invasive operation that removes the cancerous prostate gland. "It was only when I went to see my father's doctor for a second opinion that I was made aware of the alternatives."
This is a common complaint. According to a recent report from the National Audit Office, prostate patients are more dissatisfied with their medical treatment than those suffering from any other ailment, and are almost twice as likely than other patients not to be informed about the side-effects of their treatments, even though they can cause long-term problems, including, most commonly, impotence and incontinence.
An issue here is that the medical profession is not in agreement as to which treatment is best, and even how prostate cancer should be diagnosed. Even PSA testing is controversial - researchers at Stanford University last year wrote off the screening method as all but useless, concluding that the test indicates nothing more than the size of the prostate gland, and does not necessarily prove the presence of cancer. This has, they said, led to false-positive results and numerous unnecessary biopsies.
For this reason, and despite the fact that no other nationally available test will detect the cancer in a man without symptoms, the NHS has opted not to roll out a national screening programme. Instead, it gives information to men so that they can choose to have it if they are concerned. Unlike testicular or breast cancer, there is no self-check for prostate problems. The gland is so hard to reach that it can only be located via a digital rectal examination - an unpleasant procedure nicknamed the "urologist's handshake".
Then there is the question of treatment. Until recently, if the cancer was aggressive or diagnosed in a relatively young man, surgery or radiotherapy was the usual treatment. For men over 70, the normal treatment was a prostatectomy.
Yet the disease can now be treated in many, less invasive ways; there are more than 10 different types of treatment available. One is brachytherapy, involving the insertion of tiny radioactive iodine seeds into the prostate, which give off cancer-killing radiation; another is cryotherapy, a process to rapidly freeze and thaw the prostate, destroying cancer cells. Parry opted for brachytherapy and is pleased with the results. "The operation was a bit uncomfortable, but not painful," he says, adding: "I had it done on Tuesday and was back at work by the Friday."
To make matters more confusing, says Hiley, in many cases, the prostate cancer "while curable, doesn't always need to be". This is because many cancers are very slow-growing and never cause any real problems. These, she says, are the "pussy-cats", and make up as many as 80% of all cases of prostate cancer. The other 20% are the "tigers", which can go on to be fatal. Frustratingly, it is this group that is most often missed by PSA testing.
Given these contradictions and murky areas, why isn't more known about prostate cancer? Why does the government provide just £4.2m for prostate cancer research, and up to three times as much for breast cancer? Why do breast cancer patients receive as standard a specialist nurse to help them through their treatment, when men with prostate cancer have no such guarantee? Why are there only 23 registered charities in England and Wales with prostate cancer in their remit, compared with 81 for breast cancer?
It's not a case of one cause receiving an unfair amount of money, says Hiley. "The Prostate Cancer Charity does not believe that breast cancer, or indeed any other cancer, is getting too much. We just believe prostate cancer should receive more."
The hidden cancer
Peter Loader, 58, was diagnosed with advanced prostate cancer in 2000
I'm not actually supposed to still be here. According to my doctor, I had a maximum of five years to live, and we're coming up to that now, so I'm doing a half marathon in two weeks to celebrate my survival.
It was a stroke of luck that I got diagnosed. I did have some of the urinary symptoms but I just put it down to getting older. I actually went to the doctor's because of an awful pain in my shoulder. It was only when the doctor did an x-ray that he saw what was wrong with me. The cancer had spread so far that there were tumours all over my bones, in my back, my upper spine, my ribs, my neck... everywhere. I was stunned; I felt I had so much living left to do. I've got 10 grandchildren and it seemed desperately unfair that I wouldn't see them grow up.
Back then I had no idea where my prostate was, let alone what it did, so I very quickly had to get up to speed. The reason men don't talk about it is because it's "down there". Especially those from the pre-war generation - they're reluctant to speak about private things. It knocks male pride, too, because treatment does tend to affect sexual performance.
The thing that makes me angry is the variation in care and advice from doctors and urologists. I know of people being refused PSA testing and being told to come back when they're older, but I'm the result of not PSA testing and not being asked about my urinary problems. Things are getting better, but I would like the NHS to be much more proactive. The ignorance of men is tremendous.
· Prostate Cancer Charity: 0845 300 8383; www.prostate-cancer.org.uk
