Transcript generated automatically by AI and may contain errors.
Chapter 1: What is the main topic discussed in this episode?
A major new all-Ireland radiotherapy trial aimed at reducing the side effects of prostate cancer treatment has recently launched and is looking to recruit patients across the island of Ireland.
Here to help us open up an important conversation about men's health and share information that every man and every family needs to know about prostate cancer is Professor Brian O'Neill, Radiation Oncologist at St Luke's Radiation Oncology Network in Beaumont Hospital. Bit of a mouthful, there you go, I got it out. Brian, thanks. Good morning, thanks a million for coming in.
Good morning. Thanks for having me on.
Start with the big picture, if you would. How prevalent is prostate cancer?
So prostate cancer is a major issue for Irish men and men internationally. On the island of Ireland, there's more than 5,000 new diagnoses a year of prostate cancer. It's about 4,000 for the Republic of Ireland. Now, a lot of these, it's important to say, are actually very low-grade forms of prostate cancer, and many of these can actually just be surveyed safely.
But, of course, there are more high-grade forms which can be a threat to men.
Okay. Explain to me what the prostate is.
So the prostate is a walnut-sized gland. It sits below the bladder in the male reproductive system. It has a reproductive function. And importantly for us treating the prostate, there's a tube that runs through the prostate called the urethra, which delivers urine from the bladder through the prostate out.
Right. Okay. Do we know what causes prostate cancer? Are there risk factors?
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Chapter 2: How prevalent is prostate cancer among men?
So that's an important point about symptoms, that the majority of patients that develop prostate cancers don't actually have symptoms. Oh. So men, as they get older, their prostates get larger and they develop symptoms naturally from that.
If a man develops symptoms quickly, like any urinary symptoms, getting up more at night, having to go more often during the day, having to rush to the toilet, it is important to seek medical advice based on that.
Okay, so a sudden onset is really important.
So the general advice is that at the age of 50, if there's no risk factors, it is very useful to have a discussion with your GP about prostate cancer, whether or not you should get the prostate blood test, call it PSA, or not, whether that's right for you. If there's risk factors, we said that conversation should happen between the ages of 40 and 45.
Okay. The blood test, the PSA blood test, I think a lot of men who go for a regular checkup would have that tested regularly. Is that a good thing or a bad thing?
Well, it's probably a good thing. Prostate cancer screening, population screening, is actually quite controversial. The difficulty with screening large numbers of men, there's been a number of trials in this area, is that you pick up lots of guys with very low-grade disease, and that can lead to over-diagnosis and over-treatment, and that can have significant side effects on young men.
On the other hand, you can pick up important cancers by PSA screening. So the advice remains to have that conversation at the appropriate age.
Okay. There is, I mean, the blood test, there is the old style physical examination as well, which is not pleasant for anyone. How accurate is the blood test, the PSA test?
Well, the examination, you know, does take 30 seconds. So while it's not something people relish, it is a simple test. But the blood test, the problem with the blood test, it is very sensitive to picking up significant prostate cancer. But other things can raise it, like your age, an enlarging prostate, an infection, even an examination raises it. So it's not the most reliable thing.
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Chapter 3: What is the function and location of the prostate gland?
and measure it against the population. And you get a score, and if that score is in the top 5 or 10%, you have an increased risk compared to the average population developing with prostate cancer. And in the trial this came from in the UK, they brought many men in, and some of those men needed to start treatment immediately. So it's a kind of a smarter way of looking for prostate cancer.
It's only a cheek swab. So that's being tested in a much larger trial in the UK now called the Transformer trial, and I think that, I'm hoping, that will be the future.
Great. OK, we have a couple of questions, actually. Do male Kegel exercises help keep the prostate in check?
So definitely everyone encourages a healthy lifestyle and not smoking and all those things and keeping healthy. But there's no definite evidence that we can avoid prostate cancer by physical exercise.
OK. And another Trish is wondering whether mobile phones kept in trouser pockets are causing a problem.
I've never been asked that, but there's no evidence that they do. Okay.
I mean, we're having this conversation and there's a lot of men listening who probably haven't had their health checked. And this is only one aspect of having their health checked. And there's probably lots of partners and wives out there who are going on at them about doing that. I mean, what would you say to them? I mean, are men bad about keeping up with their health?
I think, I mean, certainly men can be bad and women are probably better and Irish men sometimes can be bad at this. But I think a lot of this stems around going to your GP and have a conversation about your general health.
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Chapter 4: What are the risk factors for developing prostate cancer?
And in the context of our discussion today, talking about whether a PSA and perhaps an examination is the right thing for you. But the key thing is go and see your GP and have those conversations.
And the important thing from what you're saying, like you were talking about low-grade cancers that, you know, can be monitored and are treated problems. Even if you get a diagnosis, it's not necessarily a catastrophe.
No, not at all. In fact, an awful lot of patients that are diagnosed by prostate screening, it's somewhere between up to a half of those men, if they're diagnosed that way, actually can be suitable for surveillance. And we have very large numbers of men on surveillance. They're seen every six months. They get an MRI every two years. And many, many of those, the majority, never need treatment.
But the good thing is that those that do need treatment, we detect it and we go and treat them.
Okay, and how do we treat them?
Well, there's a variety of options. The majority of prostate cancers that are detected are localised to the prostate. There's no evidence of disease outside the prostate. Okay. And so those men need a prostate treatment. That is usually radiotherapy or surgery.
And it's really important that there is an unbiased conversation with all the appropriate people about what that man's options are, what the pros and cons are. And in many cases, what's strange for the patient often is they decide what they want rather than us telling them what they want. And it's important we give them time to make those decisions on the right information.
Yeah, because there are side effects and they can be very unpleasant.
Because there are side effects, they can be unpleasant and the treatments are different. And we don't want someone finding out afterwards about these things. We've got to inform them before. And the good thing is in prostate cancer is actually you often have time. We often see people four weeks after the initial appointment to give them time to make the decisions and think about it.
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Chapter 5: What symptoms should men be aware of regarding prostate health?
it has a higher risk of urinary side effects compared to standard radiotherapy.
So this would be urinary incontinence?
Not necessarily incontinence. That's not that common actually with this treatment, luckily. But things like urinary frequency or having to rush to the toilet. So it is more common with prostate sabre than standard treatment. Now, prostate sabre, like surgery, treats the entire gland. So in this trial, this is called the INSPIRE trial,
which is sponsored by Cancer Trials Ireland and strongly supported by IROG, the Irish Research Radiation Oncology Group. It's second generation prostate sabre where we're treating the tumour, there's often one or two tumours visible in the MRI, to the same or higher dose, but...
we're reducing dose to critical areas in the prostate to reduce side effects, in particular the urethra, the urine tube running through. So the key point is that we're going to maintain the excellent results we've been seeing with Prostate Sabre, but we hope to do so... and reduce side effects, especially urinary side effects.
So it would be really helpful if people would sign up to the trial and they can do that on www.cancertrials.ie. Absolutely. Okay, very, very quickly before I let you go, a couple of quick questions that have come in. Does bike saddle irritate the prostate?
It can do minorly, but it won't have an impact in terms of prostate cancer risk.
Okay. Does regular sex help prevent prostate cancer?
That's been looked at, actually. And the answer is that none or regular neither have an impact. Oh, okay. So that's disappointing. Would a PSA detect other problems? It's actually quite specific to prostate. It may detect prostate infection or inflammation, but it's specific to prostate.
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