What men need to know about prostate and testicular cancer

As part of Everyman Male Cancer Month this month, Deborah Tucknott talks to two cancer survivors about their recoveries.

Prostate cancer.

The most frightening aspect of Tim Staple's story is he had no symptoms to suggest he was suffering from prostate cancer.

It was only a chance visit to his GP which led to his diagnosis.

The average age for diagnosis of prostate cancer is 75. But Tim, who has a partner, Sera, and three grown-up daughters, was only 56 when he was diagnosed last year.

About 10,000 men a year in the UK die from prostate cancer - which is one man every hour - and one man in 20 is diagnosed with the disease.

There has been a slight increase in its diagnosis among men under 50, and it has replaced lung cancer as the most common cancer in men. These increasing figures are largely because there is an aging population and more men are being screened.

The prostate is a male sex gland which produces a thick fluid that forms part of the semen. About the size of the walnut, it is below the bladder and in front of the rectum.

Little is known about what causes prostate cancer, although it can run in families and men with a brother or father who developed it at a young age are at higher risk themselves.

A family history of breast cancer also indicates increased risk.

A diet high in animal fats and milk products may be linked to a higher risk, while green vegetables, lycopene (which gives tomatoes their red colour) selenium and vitamin E may be protective.

In its early stages, prostate cancer doesn't usually produce any symptoms. But when they do occur they can include problems with urinating, and pain and stiffness in the lower back and hips.

Tim, of Robert Street, Brighton, had originally decided to visit his doctor for a health check because he had been feeling tired. He had been working hard at his business, which he runs with Sera, sculpting and producing historic military collectables.

He had blood tests which didn't show any problems but, as he was 55, his doctor suggested he should have a prostate specific antigen (PSA) test - a blood test specifically used to detect problems with the prostate.

Tim's results were slightly higher than they should have been for his age.

When the test was repeated 11 months later the reading had doubled. Six weeks later it had increased by a further 25 per cent. The rate of increase rang alarm bells. He had a biopsy to confirm whether the high readings meant he had prostate cancer, and, last September, was diagnosed with an aggressive type of the disease which, it was feared, could have have travelled to his lymph glands or bones.

"My prostate was absolutely full of cancer,"

Tim, who is now 57, says. Without treatment it was thought he would only have five years to live.

MRI and CT scans showed the cancer had only just broken the wall of the prostate and had not spread into other parts of his body.

Treatments for prostate cancer include radiography, surgery and cryosurgery - where the cancer is frozen out under general anaesthetic.

Tim chose to have 3D conformal radiotherapy to treat the cancer. Before it began he had four months of hormone therapy, in the form of tablets and injections, to shrink the prostate and make the radiotherapy more effective. The injections continued once a month during the treatment.

He then started 36 daily sessions of the radiotherapy. Less than two weeks ago he had his final session. Tim now considers himself a survivor but will return for regular testing to ensure that nothing comes back.

Tim suffered tiredness from the radiotherapy, and the hormones caused him to suffer a loss of libido, hot flushes, memory loss and heightened emotions. He says: "Libido disappears completely with hormone injections. That has a massive mental effect on men.

"I got everything that a woman goes through with periods and menopause.

That is quite disturbing for a lot of men and they won't talk about it with their partners."

Tim isn't afraid to talk about his illness and has had the full support of his partner. But many men aren't as open as he is.

"Men do not talk about illness," he says.

"You can become incontinent on the treatment and men don't like to talk about it.

"We are not supposed to be ill. It's not masculine enough."

Where women are given regular cervical smear tests and, when they are older, regular breast cancer screenings, there is no national routine screening programme in place for prostate cancer. The PSA test is not considered by professionals to be effective enough on its own for a national routine screening programme.

However, Tim believes there should be routine screening in place. "The PSA test is simple and a reasonable indication of possible problems," he says. "Why does the Government continue to refuse to introduce screening for men?

"Many years ago there was considerable publicity about the lack of breast cancer screening in this country - surely the same attention should now be applied to prostate cancer in men.

"The physical and emotional effects can devastate families and relationships. The financial cost to the Government of this and the 10,000 - many avoidable - deaths per year is incalculable.

"How many lives would be saved by this simple blood test? With the help of a caring and considerate GP, mine probably has."

Although there is no national screening programme every man has the right to discuss having a PSA test with their GP and Tim urges every man over 50 to do so.

"Men must be made more aware of the problems," he says. "They must be very open-minded about the whole thing.

"If you are unlucky enough to get prostate cancer do not bottle everything up. The Prostate Cancer Charity have a tremendous confidential helpline. Share your fears with those closest to you.

"Life can return to normal if you find out early enough."

Prostate cancer doesn't usually show symptoms at its early stages. Men should see their doctor if any of the following symptoms, which can be linked to prostate cancer, do occur:

Having to rush to the toilet to pass urine.

Passing urine more often and/or at night.

Difficulty in getting the flow of the urine started.

Stopping and starting while passing urine.

Discomfort such as pain or burning while passing urine.

A feeling of not having emptied the bladder properly.

Dribbling of urine.

Blood in the urine or semen.

Pain or stiffness in the lower back and hips.

Testicular cancer.

When Alastair Fairley came back from a walking holiday with a pain which felt as if he had been kicked in the groin he thought he had put on weight and his jeans were too tight.

But later when he was in the bath he discovered a lump on his testicle and decided he should get it checked out.

Alastair's swift action saved his life because the lump was found to be testicular cancer.

Testicular cancer is the most common cancer among men between 15 and 45, although it is still quite rare, with about 2,000 cases a year in the UK.

However, it is on the increase and has risen by 70 per cent over the last 20 years.

Having a father, brother or son who has had testicular cancer or undescended testes indicates higher risk.

However, the good news is more than 95 per cent of testicular cancer cases - as many as 99 per cent if caught early - can be cured.

When Alistair, then 35, discovered his lump he contacted an old friend who was a cancer specialist and went see him the following day at London's Hammersmith Hospital.

Alastair's lump was not on the side of his testicle but towards the back which was slightly unusual. He had blood tests, scans and procedures which all proved inconclusive and doctors decided they would not operate.

But Alastair, of Tackleway, Hastings, was still worried. Unable to eat or sleep, he rang the doctor a week later, who told him he had already booked him in for a biopsy the following day.

In the operating theatre the biopsy revealed the lump was cancerous and surgeons removed the testicle there and then. Alastair had a form of cancer called seminoma which was not quite as aggressive as some types of the disease.

"I came round after the operation and realised I only had one testicle there," Alastair, now 46, says.

"That could only mean one thing."

It was a painful operation. The testicle was pushed up through Alastair's body and taken out at the abdomen, which meant cutting through three layers of muscle.

He then had radiography five days a week for six weeks as a precaution - if the cancer had moved to Alistair's lymph glands it would have been fatal.

Alastair, who has a son aged 18 and a daughter aged 15, visited a sperm bank before the operation in case the radiography left him infertile and unable to have more children.

Alastair refused the offer of a prosthesis to replace his lost testicle. But he still had to cope with the psychological effects of having had testicular cancer.

"At the end of the day it does not make you any less of a man to have had testicular cancer," he says.

"You are still very much the man you were. If anything you have proved it by doing the right thing."

Alastair's regular check-ups dwindled from weekly to monthly, to six months to a year - until finally he was given the all-clear five years ago.

"I never thought I would get the all-clear," Alastair says. "After the visits had gone on for five years the doctor turned round and said, It is not coming back,' which was an extraordinary relief."

The feeling he had been kicked in the groin after his holiday was the only physical pain Alastair experienced to suggest something was wrong.

He says men need to get into habit of testing their testicles regularly or getting their partners to do it for them. "It is a practice we should all be doing.

"You can feel extremely fit and healthy which is why it is important to check for lumps. By the time you start to feel sick from testicular cancer you can be on your way out and it may be too late to do anything about it."

Men should see their doctor if they have any of these symptoms:

A lump in either testicle.

Enlargement of a testicle.

A feeling of heaviness in the scrotum.

A dull ache in the abdomen or groin.

A sudden collection of fluid in the scrotum.

Advice and information:

Contact Everyman, the campaign set up by The Institute of Cancer Research to raise awareness of male cancers - particularly testicular and prostate cancer - and to fund research within The Everyman Centre, the UK's first dedicated male cancer research centre. Log on to www.icr.ac.uk/everyman or call 0800 7319468.

To contact The Prostate Cancer Charity, log on to www.prostate-cancer.org.uk call the helpline on 0845 300 8383 or the textphone on 0845 300 8484. It does not make you any less of a man to have had testicular cancer