When Ricky Gervais's radio advert about prostate cancer was initially banned until after the watershed for going a "squelch" too far, it spoke volumes about our society's embarrassment about this disease.
Admittedly the sound of a finger going up someone's bottom isn't a pretty one. But it is sad that we are still too prudish to cope with risqué humour, even when it is aimed at relieving the anxiety that stops many men having their prostates checked. In fact, it is our poor treatment record that should cause embarrassment. A survey published today by the Prostate Cancer Charity shows that thousands of men with the disease are not getting appropriate care, support and information about what will happen to them. And what happens can be quite unpleasant.
First, there's that finger up the backside, plus a blood test for prostate specific antigen (PSA). If these checks detect abnormalities, the next step is a referral for a prostate biopsy, where samples of the gland are painfully removed for analysis. If they show cancer, there's radical surgery, chemo- and radiotherapy to look forward to.
The survey found that during this process, one in five men was given his diagnosis insensitively - some by telephone or even letter. More than a third had no access to a specialist nurse to discuss their diagnosis and 43% were not told the basics about the disease, its treatments and side effects. Given that these side effects can include impotence and incontinence, that's pretty unfair.
But the news from the frontline of cancer treatment is not all bad. At the Prostate Cancer Charity's annual conference in London today, Professor Roger Kirby, an eminent prostate cancer specialist, will outline some of the new leading-edge treatments. First, there's a genetic test, the UPM3 test. It would replace the controversial PSA, whose lack of specificity leads to many needless biopsies. The new test, which in contrast is highly specific for prostate cancer, instead requires a urine sample, avoiding the need for a biopsy. It is currently available via Bostwick Laboratories in the UK (bostwicklaboratories.com; 020-7255 9700), but you will have to pay.
Another genetic test under development is for the gene E2F3, which will give an indication of how aggressive a cancer is. Currently, we can't be sure which tumours will spread quickly and require immediate action and which we can afford to simply watch. This test could answer that question, allowing thousands to avoid an unnecessary prostatectomy.
Radical surgery itself may also become a thing of the past thanks to the ongoing development of a robotic method of operating. The robot in question has three arms that are guided remotely by a surgeon. The procedure is carried out through five small holes, eliminating the need for a whopping incision, and the magnification provided by the robot allows the prostate to be carved out more carefully, with less blood loss than the current pro- cedure and with the nerves - and thus sexual function - left intact. But it's still a question of if, not when, these robots become NHS employees.
There's good news, too, for men with advanced disease. A seven-year trial monitoring the hormone blocker Casodex (which is taken in pill form) has shown it cuts the risk of disease progression by 60% and studies with drugs such as Zometa have shown that they can stop the disease spreading to the bones by up to five months.
That's not all. Kirby says there are also around 100 more molecular approaches to treatment and diagnosis in the pipeline, which look at individual cancer-causing genes. But many of these advances may be a decade or so in the future. As things stand - with at least one man dying of the disease every hour in the UK - we need to do a better job of helping people with what we've got. Early diagnosis is vital, so if men are worried, they should get checked out as soon as possible. They will certainly need a rectal examination and there may well be a "squelch", but if it leads to quicker treatment, the embarrassment has to be worth it.
