What sort of treatment is available to treat prostate cancer?

Chris Hiley:If a man is diagnosed with localised prostate cancer -where it only affects the gland - he will be offered several options which can be quite confusing - the man is always after the best treatment after all. This is one of the uncertainties of prostate cancer - there are a range of treatments.

The first is surgery - where the prostate is removed - or a course of radiotherapy - which can last up to five or six weeks meaning visits to hospital each day. There is another treatment called brachytherapy - where radioactive seeds are inserted directly into the prostate gland.

And there is another one which isn't really a treatment and must sound completely mad to many people, which is active monitoring. Here the man's health is monitored by looking for markers in the blood - the PSA level - and changes in symptoms and sometimes by taking more samples from the prostate. The reason for this option is that for a lot of men, prostate cancer is an extremely slow growing cancer which may never cause significant problems or be life threatening. By actively monitoring you can actually avoid the effects of treating the disease because the treatment itself isn't without problems - impotence and incontinence being the effects which cause the greatest amount of worry. By having active monitoring you can actually delay doing the treatment for some years especially for older men, you may never have to treat because he may die peacefully and comfortably from other natural causes.

And some men will be diagnosed with an advanced prostate cancer - where it is outside the gland and may have spread elsewhere in the body there is no treatment that can offer a cure, but there are various hormone therapies - injections tablets or both - which starve the cancer of male hormones which otherwise help it grow . This doesn't work indefinitely and most hormone therapies have side effects of impotence to varying degrees.

Can you screen for prostate cancer?

Chris Hiley:We don't have a screening programmed for prostate cancer at the moment. Nowhere does, except Luxemburg, I believe. This is not because people are not bothered about men's health and prostate cancer. Screening is only ever going to be good as the technology which is available to use. What we have at the moment is biological markers - the PSA which I mentioned earlier. This was brought into use from about the middle of the 1980s onwards. Its not bad - but it isn't brilliant.

Everybody has been casting around for the evidence that PSA does in fact reduce mortality rates but it is very difficult to see if it does make that difference. The other problem with prostate cancer is that if a man has an aggressive cancer he needs treatment at an early stage. But a lot of the cancers are slow growing and aren't aggressive and may not need treating. It may be that some men who have been diagnosed with cancer are less likely to want to leave it alone so go for treatment and we may in fact impair their quality of life if they were screened.

The PSA test can only indicate that there may be a problem with the prostate - there are other problems which can effect the PSA level.

The Prostate Cancer Charity doesn't support the introduction of a screening programme with the technology that is available at the moment, but we would certainly be keen if something was developed which would tell us a) which men have prostate cancer and exclude the men who do not have the illness and b) can let us know about the difference between those suffering from the aggressive cancers and the men who have a very slow growing cancer.

The NHS and the government have made a big push on the treatment of breast cancer. Have they done enough to when it comes to prostate cancer?

Chris Hiley:Well certainly the services should be comparable. That's what we work towards. There's not a lot of mileage in constantly pointing out what hasn't happened in the past. We have this problem to sort out from now. We don't know why specialist nurses as common as they are for breast cancer. But that's something we are addressing ourselves, by developing our own programme of specialist nurses for men with prostate cancer. Hopefully the NHS will take them over when it is proven that they do make a major difference to these men's lives with prostate cancer.

The other side of the coin is to attract the amount of money going into cancer research. In the past breast cancer has been relatively well funded, and prostate cancer has been very much the poor relation. This is beginning to change slightly, but of course we are making no claim at all that we want the money that goes into breast cancer. We don't want a bigger slice, we want a bigger pie. And we've got a lot of ground to make up as this area has been chronically under-funded in the past.

Do you think men are in general less health conscious than women?

Chris Hiley:There is huge evidence that life expectancy of men is easily six or seven years less than that of women. There is something perhaps in the perception that it is slightly wimpish to go off to the GP. It may be the way the service is delivered. Some experiments have proved useful in attracting more men to surgeries - such as holding them in a pub or a barber shop, or somewhere like that.

Other examples include companies offering their employees the chance to have their blood pressure checked. You'd certainly pick out one or two who wouldn't normally have bothered and turn out to have a treatable problem. Its just making things easier for them.

Women's experience of going to the doctor is much more straight forward. They are more used to seeing GPs because women have cervical cancer screening or because they accompany their children - so its something to do with familiarity as well.

What are the rates of survival compared to the EU or America?

Chris Hiley:Well survival rates are actually problematic. The survival rates in America look brilliant - but they are more likely to screen there and so are more likely to find the cancer much earlier. Those men could still be dying at the same time but because you've identified them much earlier in their life they appear to be alive for a lot longer.

We're getting into that now and you can pick it up in UK figures, where our survival rates are improving but its actually more likely to be a measure of how much more PSA testing is in place. In actual fact the America's mortality rates are not that dissimilar to ours.

What would you like to see the government do on this? What should be their priority?

Chris Hiley:The first thing is still to pump more money into research. We are getting more and we want more and more. We also want more men to know about PSA tests. At the moment, the policy is that men who don't have symptoms but come across the test can then go to their GP and get information and proceed if they want. All sorts of information has to be exchanged because it's a complicated issue.

What I'd like the Department of Health to do is think about encouraging all men to know about the PSA test - and the attendant uncertainties. They are worried that there'll be a scramble for the test, but its not clear to me that they will all inundate the NHS and say we want to be screened now. Whatever happens it's a complicated communication problem - it is simply not going to be easy. At the moment we're rationing of the information and I don't like that. After all, information is power.

Should there be more of a media campaign to raise awareness?

Chris Hiley:I've got sort of a 'yes, but' answer to that. Certainly the press is very much more aware of prostate cancer as an issue than they were a year ago and we hope that we have contributed to that. So I'm not implying that the media haven't been doing a good job. They have.

However, there are all sorts of problems that work against us and don't help the media as well. The profile of breast cancer is very high. Both men and women have an interest in breasts - everyone likes them, more or less. The prostate, by contrast, has literally no profile - there is no external evidence that it exists. And if anyone does know anything about the prostate, in their minds it is probably bound up with being associated with problems for elderly men. And older men, according to society at large, are not sexy.

This is something we have to work against. All of us have never had a better chance of becoming older people, or having parents who survive into old age and we want the best for them don't we? so we have to get away from the culture of youth which is always producing images of younger people. There are more men and women over the age of 60 than there are under 16.

Some might say that any extra money coming your way would come from another good cause. How would you answer this?

Chris Hiley:Well we're always in the position of playing catch-up. Cancer has a huge public profile but the thing that's most likely to kill you in this country is either heart disease or stroke so it's a balance we're always trying very hard to strike.

Most people know it's all to do with equity. I think there are things that are more easy to raise money for like children's issues or donkeys - I'm not against that, its up to the voluntary organizations to get their message across in different ways. But it's also up to policy makers.

It's a difficult balance to strike but I think that most of the time, most of the general public understand complicated issues and pick the ones that are the most important to them, which is the huge strength of the voluntary sector. We are a conduit that allows people to put their money where their conscience, interests and priorities direct them - something which is impossible with taxes.