From telegraph.co.uk
By Dr Yae-eun Suh
From how long treatment takes to what radiotherapy means for your sex life, one expert dispels the common misconceptions held by patients
When men are diagnosed with prostate cancer, they’re often frightened by the unknown. But I’ve found that one of the biggest obstacles isn’t always the disease itself – it’s the misconceptions people bring with them into the consulting room.
I’ve spent more than a decade as a consultant treating prostate cancer patients, after years of specialist training and a PhD focused on radiotherapy, and working out why some cancers resist treatment. It’s a field I love working in because, unlike some cancers, the outcomes can be incredibly positive: we cure a lot of patients, and even when we can’t cure, we can frequently extend and improve quality of life.
Prostate cancer is now the most commonly diagnosed cancer in men in the UK, and yet a new study by GenesisCare shows there are still significant gaps in understanding, with 92 per cent of patients admitting they don’t fully understand their options for treatment when they’re diagnosed.
Awareness has undoubtedly improved. Patients regularly tell me they booked a PSA test after having heard about people like Sir Chris Hoy, Stephen Fry or David Cameron talking publicly about their prostate cancer. Not long ago, many men felt it was simply too private to discuss. Even now, I’ll ask patients whether their father had prostate cancer and they’ll reply: “I think so, but we never really talked about it.”
The good news is that treatments have advanced dramatically in recent years. Yet many of the myths I hear today are the same ones I heard when I first started practising.
These are the most common misconceptions.
Myth 1: Prostate cancer treatment takes months and turns your life upside down
Many men still believe that radiotherapy involves endless hospital visits and months of disruption.
When I became a consultant, the standard course of radiotherapy lasted seven and a half weeks. Patients often tell me they can’t imagine committing to four weeks of treatment, and I remind them that not very long ago we were asking men to attend for nearly two months. Looking back now, it feels extraordinary, especially with the news that more targeted radiation beam therapies will now be offered on the NHS, which can cut treatments from 20 sessions down to only five, delivered over two weeks.
This exciting development, called stereotactic body radiotherapy (SABR), is more convenient for patients, will ease capacity challenges in radiotherapy departments, and opens up the potential to commission novel technologies such as the MR Linac. This technology allows us to see the prostate while we are treating it, making adjustments in real time and protecting healthy tissue with extraordinary precision. MR Linac treatment is well tolerated and similar to having an MRI scan for 45 minutes.
The result is shorter treatment schedules without worse side effects, and far less disruption to daily life. Many of my patients continue working throughout treatment. They exercise, look after their families and maintain their normal routines.
What I tell patients is this: prostate cancer is now part of your life, but it shouldn’t take over your entire life. That’s increasingly achievable.
In fact, we’re already exploring whether treatment could eventually be reduced further, with trials currently investigating whether two treatments could be as effective as five. Unimaginable when I first started practising.
Myth 2: Having your prostate removed means the cancer won’t come back
This is probably the single most common misconception I encounter.
Many men come into clinic convinced that surgery is the “stronger” option because the cancer is physically removed. There’s a sense that if you remove the prostate entirely, known as radical prostatectomy, the problem is gone forever. I understand that surgery feels definitive – as I sometimes joke with patients, surgeons are very good at selling surgery! – but it isn’t quite that simple.
After a successful prostatectomy, the PSA blood test should fall to an undetectable level because there is no prostate tissue left producing PSA. However, microscopic cancer cells can sometimes remain behind. This may happen because the cancer was very close to the edge of the prostate or because tiny amounts of disease had already escaped beyond what could be seen during surgery.
Studies show that between 16 and 46 per cent of men who undergo radical prostatectomy will develop evidence that the cancer has returned.
One of the hardest conversations I have is with patients who genuinely believed surgery meant they would never need treatment again. Discovering that radiotherapy may be required afterwards can come as a huge shock; it’s crucial for men to speak to both a surgeon and an oncologist when they are diagnosed with prostate cancer to understand what may happen if the cancer returns.
The reassuring news is that recurrence does not mean all is lost. Modern radiotherapy techniques are highly effective, with large trials showing PSA control rates of around 96 per cent at five years for men treated with SABR.
Myth 3: Radiotherapy will ruin your sex life
Many assume surgery is automatically better for preserving sexual function. In reality, the evidence generally points in the opposite direction.
When I discuss treatment options with patients, I always ask what matters most to them. If preserving sexual function is a priority, that’s a very important part of the conversation.
Erections depend on delicate neurovascular bundles that run alongside the prostate. During surgery, even when nerve-sparing techniques are used, those structures can be affected.
Radiotherapy works differently. It uses targeted radiation to destroy cancer cells while avoiding as much healthy tissue as possible.
No treatment is completely free of sexual side effects, and many men already have some degree of erectile dysfunction before they’re diagnosed (commonly this can be why they originally went to the GP, which complicates the picture). But multiple trials have consistently shown that radiotherapy generally preserves sexual function better than surgery.
What I find reassuring is that sexual function after radiotherapy often follows a pattern. It may dip initially, reaching its lowest point around six months after treatment, but many men then experience recovery.
The conversation also needs to be broader than erections alone. Some men tell me they miss ejaculation after treatment, while others say orgasms feel different after treatment. It’s not always weaker – I have had patients say that orgasms are more intense following radiotherapy.
If problems do arise, there are far more options available than many people realise, from medication and vacuum devices through to specialist treatments and penile implants. Too many men assume they simply have to live with sexual difficulties after prostate cancer treatment. That’s rarely true.
Myth 4: Only women get hot flushes
Many people associate them exclusively with menopause, but hot flushes are actually one of the most common side effects of hormone therapy for prostate cancer.
Hormone therapy works by suppressing testosterone, which prostate cancers depend on for growth. It can be extremely effective, but it comes with significant side effects. One of the misconceptions I hear is: “Am I going to turn into a woman?”
The answer is no. But lowering testosterone does have consequences, including hot flushes, tiredness, weight gain, loss of muscle strength, reduced libido and erectile dysfunction. Some become more emotional. Others notice changes in concentration or memory. Some find themselves crying at films they would never previously have cried at.
What concerns me is that many patients underestimate the impact hormone therapy can have on their day-to-day lives. Research suggests that more than a third of men who have experienced hormone therapy would consider declining further treatment if it meant having to go through it again.
The good news is that hormone therapy isn’t always necessary.
One of the biggest advances in recent years is that many men with early localised prostate cancer can now receive highly effective radiotherapy without hormone treatment at all.
When hormone therapy is needed, I encourage patients to think about exercise as a powerful part of their treatment, not as an optional extra because there’s such strong evidence it helps. Regular cardiovascular and resistance exercise can help counter many side effects, preserve muscle strength, improve bone health and may even improve treatment outcomes.
Myth 5: If my treatment works, I’ll never need to think about prostate cancer again
Most men with localised prostate cancer do extremely well. Of course I hope treatment works, but patients deserve honesty.
Prostate cancer can return years after apparently successful treatment. Looking at all stages of localised prostate cancer, between 20 and 50 per cent of survivors will experience recurrence within a decade of their first treatment.
I don’t tell patients this to frighten them, but the opposite. Understanding the potential for recurrence means understanding the importance of follow-up appointments, PSA monitoring and knowing what options remain available if the cancer comes back.
This is an area where education is still catching up with medical advances. Even clinicians outside specialist centres may not always be aware of the newest treatment approaches.
The field is evolving rapidly, particularly around re-irradiation (having radiotherapy to an area that has previously been treated) and advanced radiotherapy techniques. The reality is that prostate cancer care is changing faster than ever before. Treatments are becoming shorter, more precise and more personalised.
The biggest myth of all may be that a prostate cancer diagnosis automatically means your life is about to be put on hold. For many men today, that’s simply no longer true.
Dr Yae-eun Suh is a consultant clinical oncologist at GenesisCare UK and The Royal Marsden. She specialises in radiotherapy and systemic treatments for prostate cancer and also has a PhD from King’s College London in Radiotherapy.
As told to Susanna Galton
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