Prostate cancer: Living with Ireland's everyman illness
Every year, over 3,000 men discover - like Gay Byrne - that they have the illness. With fast diagnosis and the latest modern treatment, the vast majority will survive.
Michael Daly is a long-haul truck driver from Ballinasloe, Co Galway. He had been in fine health for all his adult life and then, at 52, he got news that was little short of a hammer blow.
"I just couldn't believe it when they told me I had prostate cancer," he says. "I'd been going for annual check-ups and everything had been fine, then in 2009 the PSA results were high and they found the cancer when they did a biopsy."
The prostate-specific antigen blood test - commonly known as PSA - has detected cancer in thousands of men like Michael since its introduction in 1994 and, if caught early, the prognosis is usually excellent. "I'm doing well seven years later," he says, "and I'm just very glad that the test picked it up when it did."
Prostate cancer is on the minds of many people this month thanks to the Movember charity that in its novel, moustache-growing way, raises awareness about men's health issues, such as prostate and testicular cancers.
But it's also in the public mind as a result of Gay Byrne's admission at the weekend that he, too, is suffering from the disease. "I shall not be with our listeners on this day next week," the veteran broadcaster calmly revealed on RTÉ's Lyric FM on Sunday. "Have to go to hospital... They think they may have discovered a bit of cancer in the prostate and they think it may have moved up into my back."
The shock of Byrne's news was lessened somewhat that he has prostate cancer, and not cancer of the lungs or pancreas. It's generally seen, however glibly, as one of the 'better' cancers to get.
Prostate cancer is the most common type of cancer that is specific to men, and comprises almost a third of all male cancers. Every year, an estimated 3,400 Irish men are diagnosed, and improvements in detection have meant the number being told they have prostate cancer has gone up significantly in recent years. The increasing age of the population is also partly responsible for the increase.
Like many cancers, prostate survival rates have improved greatly. In 1976, just one in three survived five years or more, according to research by the Irish Cancer Society, whereas today the figure stands at nine out of 10 and the rate is getting better all the time. Some cancer specialists, including Dr Antoinette Perry, believe that within 20 years, the survival rate figure will stand at virtually 100pc, assuming enough at-risk men are checked.
"There have been great advancements in recent years," says Dr Perry, lecturer in Cancer Biology at UCD's Conway Institute, one of Ireland's leading chronic disease research centres. "Even in the past five years or so we've seen new hormone therapies and drugs like Enzalutamide and Abiraterone come on stream that have proved hugely effective.
"There's so much more awareness about prostate cancer than there was. It used to lag behind breast cancer because of the huge advocacy behind it, but campaigns like Movember have been hugely instrumental in getting people to talk about it and to bring it into the open that bit more."
And campaigns, such as the Marie Keating Foundation's Heroes for Hope, ensure that public awareness stays all-year round. Among those featured in the poster campaign - currently at Dublin's Connolly Station, but set to move around the country next year - are ex-rugby international Tony Ward, who wrote movingly about his prostate cancer in the Irish Independent this week, former Meath football manager Seán Boylan, and the former RTÉ newsreader Michael Murphy.
Yet, despite the greatly raised awareness and the huge improvements in treating the disease, roughly 500 men still die from prostate cancer in this county each year. Their number has included such high-profile people as ex-Taoiseach Charles Haughey and playwright John B Keane.
It is still known in oncology circles as 'the Silent Killer' because there are often comparatively few warning signs, and some symptoms may simply go unnoticed for years.
According to the world-leading research hospital, the US-based Mayo Clinic, some of the most common symptoms of prostate cancer include: trouble urinating; decreased force in the stream of urine; blood in the semen, discomfort in the pelvic area, bone pain and erectile dysfunction.
Although, such issues can indicate another problem, or none at all, affected men are advised to see their GP.
A digital rectum examination coupled with a PSA test is usually the next course of action, although while both can only indicate a prostate problem - they do not specifically diagnose prostate cancer. PSA levels in the blood stream can rise for those who have prostate cancer but it can rise for other reasons as well.
It is seen as crucial that a PSA test is undertaken as part of an overall assessment of the likely presence of prostate cancer under clinician guidance and typically followed up with other more specific diagnostic tests.
A couple of generations ago, if a man was suspected of having prostate cancer, there was no specific clinical pathway he would follow. Today if the GP suspects prostate cancer, they will refer their patient to a urology department, often through one of the Rapid Access Prostate Clinics. These special clinics, established over the past decade, provide a fast, efficient service for men who need further tests done to assess for prostate cancer and are located in the eight designated cancer centres in Ireland.
At these clinics, a man will typically have a trans-rectal ultrasound scan followed by a trans-rectal needle biopsy of the suspect prostate gland. From these biopsy results, a diagnosis can then be made. Newer imaging techniques may also be used to deliver more detailed information. All such techniques make obtaining a detailed diagnosis easier and less invasive than in the past.
The treatment a prostate cancer patient receives depends on factors including how early the disease is detected, how the cancer cells look under the microscope and the patient's health.
Surgery is still thought to be the most effective way to treat prostate cancer that hasn't spread, and the technique has become ever more sophisticated. Initial surgical procedures led to the removal of the whole prostate, and consequently, the surrounding nerves and blood vessels were often damaged, leading to impotence and incontinence issues.
In 1983 a modified surgical technique was developed that avoided damaging these vital nerves and blood vessels supporting normal working of the penis. Along with the advent of the ultrasound-guided 'biopsy' diagnostic tool, it led to a large increase in the number of successfully treated prostate cancer patients who were treated by prostatectomy.
Today, the removal of prostate cancer is more commonly done by keyhole surgery, which is far less traumatic for the body than open surgery. The main advantages of this less invasive surgery are that patients lose less blood, have less pain, spend less time in hospital and heal more quickly.
Other treatment options include: radiotherapy, which can get rid of the cancer completely in more than six out of 10 men with early prostate cancer; hormone drug therapy, usually for stage three prostate cancers and for men with high PSA levels; and chemotherapy, for advanced prostate cancers.
"One in seven men will be diagnosed in their lifetime," says Dr Robert O'Connor, head of research at the Irish Cancer Society, "but for some, the diagnosis doesn't happen until it's too late. People could have it for years and not be aware of it."
Dr O'Connor says the chances of developing prostate cancer increases with age to the point that when it comes to octogenarians - Gay Byrne's cohort - eight out of 10 are likely to have the disease.
"The increase in survival rates for prostate cancer patients over recent decades is a testament to the work of research scientists in Ireland and across the globe," says Professor Ray McDermott, consultant medical oncologist at Tallaght and St Vincent's University Hospitals, Dublin and clinical director with prostate cancer research initiative iPROSPECT.
"But survival rates only show one side of the journey a patient with this disease goes through. For survivors, their diagnosis and treatment often impacts their physical and mental well-being in ways men rarely speak openly about."
For Michael Daly, those words ring very true. "There are significant effects that affect an awful lot of men, me included," he says. "For me, the three things that I had to cope with were inconvenience, erectile dysfunction and depression. Seven years on, I'm still learning to live with the first two although the depression has lifted."
Michael is remarkably upfront about the side-effects that, he believes, are not spoken about enough. "To have a nappy put on me for the first and to have virtually no control at all was a moment I won't forget in a hurry."
The operation hit him hard, too. "I was out of work for 11 months," he says. "I was lucky to have an employer who kept my job open."
Even now, though, there are daily reminders that he had prostate cancer. "You have to learn to live with the incontinence - which isn't the nicest thing to have when you're a truck driver. When you're healthy and going about your life you don't think that you might one day suffer from that, or from erectile disfunction."
Michael is part of a cancer support group for men in east Galway and says he has met prostate cancer survivors that are far younger than him. "The youngest man I've come across was just 32," he says, "and they say that men should get checked out from 40 on. While it is seen as an older man's disease, that's not always the case."
Dr Robert O'Connor says he is heartened to note that the days of men staying away from the doctor are largely confined to the past. "Many men used to be very fatalistic," he says, "but now they realise that the earlier they get diagnosed, the better and this form of cancer is especially treatable."
Michael Daly has advice for men who have been recently diagnosed: "Stay away from Dr Google. You can worry yourself sick on it. I would say to anyone who is about to go on a cancer journey to be aware that there's lots of help out there, and you are not alone.
"A cancer diagnosis is not just hard on you, but also on your loved ones. It can cause problems for relationships but I was lucky because my wife supported me all the way. You also learn who your friends are - often, it's the people who you may not have thought you were good friends with who would phone you to see how you're doing. They might have only been short phone calls, but they meant so much."
In numbers ...
estimated number of Irish men diagnosed with prostate cancer each year
the likelihood of surviving prostate cancer today
the likelihood of surviving prostate cancer in 1976
the percentage of men diagnosed with prostate cancer who go on to develop metastatic prostate cancer - where their cancer has spread to other parts of the body
Irish men initially diagnosed with metastatic prostate cancer - of those, one in five is expected to be alive after five years
Prostate cancer is the second most common cancer in men after non-melanoma skin cancer