Urological cancer

16 October 2012

George Fowls is a Consultant Urological Surgeon in full time independent practice, after 15 years as an NHS consultant. In our live chat George answered your questions on everything from the risks of having a history of prostate cancer in the family, to signs, symptoms and treatments of all forms of urological cancer.

Here’s what he had to say:

390797 asked:I'll start the ball rolling - I understand that if men live long enough they will all develop some form of prostate tumour but is early onset hereditary?

George Fowls:Indeed, every man will develop prostate cancer if he lives long enough. The "causes" of prostate cancer are not fully understood but the risk of developing it is increased if 1 or more 1st degree relatives have the disease. Clearly therefore there is some genetic predisposition, especially or early development

390797 asked:1st degree being father, brothers?

George Fowls:Yes, also uncles & cousins.

390797 asked:So with maternal grandfather (60 at diagnosis) and paternal uncle x 2 (one diagnosed at 45 and one at 55) then I have an increased risk - is there any regular testing recommended and from what age?

George Fowls:Yes, statistically you have an increased risk. Testing, after full discussion & consent, is recommended in this situation from age 50 for whites & 40 for blacks

390797 asked:Many thanks for the clear response.

Fionad asked:Hi George - what lifestyle factors can contribute to prostate cancer? Do they differ in any way from other cancers?

George Fowlis:As the underlying cause of prostate cancer seems to be being male (presence of testosterone), no lifestyle factor has been clearly shown to contribute to its development. Increased/early sexual activity & vasectomy were suggested at some point but disproved eventually. Interestingly, eunuchs do not develop prostate cancer (lack of testosterone).

George Fowlis:The most controversial recent research into prostate cancer suggests that the majority of patients may not need any intervention, just careful follow up with PSA tests. This is known as active monitoring. Research is ongoing so watch this space....

AXA PPP healthcare:Thanks, can you explain what PSA tests are?

George Fowlis:While oncology is my sub-speciality, the majority of my urology patients have non-cancer diagnoses. In men, benign enlargement of the prostate is the commonest diagnosis; in women cystitis & incontinence. Patients with stones are also more common for reasons which are not entirely clear but may be related to more frequent travel to hot climates. All these conditions are now treated by endoscopic/keyhole surgery, meaning patients recover quicker.

A question from a blog reader:What’s the average age for men getting prostate cancer? Do I get a test through my GP?

George Fowlis:Autopsy studies have shown that prostate cancer develops as early as the 20s. However. Most patients are diagnosed after the age of 50. PSA testing cab be arranged via the GP

226940:Hi, what are the signs and symptoms of Prostate Cancer?

George Fowlis:Prostate cancer is generally asymptomatic, until it is advanced. Screening for early prostate cancer is not generally recommended. Men who are concerned can see their GP for a PSA test initially

A question from Twitter:What are the symptoms of bladder cancer?

George Fowlis:Blood, visible in the urine, is the main symptom of bladder cancer. However, all troublesome lower urinary symptoms should be investigated to rule out serious pathology

David asked:George - I have recently had a bladder infection and although the infection cleared after a couple of weeks, the symptoms lasted for around 3 months. I had all the expected tests and investigations such as a cystoscopy and urine and blood test, and everything was clear. Nobody could find any reason for these symptoms and they suddenly went. Why is this?

George Fowlis:A one off infection that cleared is hard to explain, especially as all the tests were clear. Persistence of symptoms might have been due to residual inflammation of the bladder.

Vonnie asked:What are the symptoms of prostate cancer? My husband had recently (3 months) had trouble dribbling after going for a wee, and also had a more pressing urge to wee that he has trouble holding in. His father had bowel cancer at 65, he is 55. He feels too embarrassed to see the doctor about it. Any suggestions? Many thanks

George Fowlis:The described symptoms are more suggestive of benign enlargement of the prostate, since early prostate cancer is virtually asymptomatic. He should see his GP and get referred to a urologist. The diagnosis can be easily made and treatment started

Vonnie:Thank you, I will try get him to go.

Billsgirl1 asked:My dad has a Gleason score of 6 and is on hormones, and in having 4 weeks of radiotherapy in the New Year. His consultant says that's still "treating with curative intent" and wants to do this instead of a prostectomy. Is this treatment really likely to cure him? Thanks.

George Fowlis:Radical radiotherapy is used with curative intent for early prostate cancer. This seems to be the position for your father, although clearly I do not have all the facts about his case

Billsgirl1:Thank you. I suppose we all keep thinking that his prostate might go wrong again if it's still there. He didn't want to do a prostatectomy because my dad is overweight/type2diabetic. Is there anywhere we can read about how likely it is to recur after treatment?

George Fowlis:There's lots of often conflicting information available. However, the available evidence is that radical prostatectomy and radical radiotherapy both have the same overall survival when used to treat early prostate cancer

Billsgirl1:And finally I know some men get breast cancer. Does prostate cancer happen in some women, especially if their dad had it?

George Fowlis:Women have a prostate "remnant" but prostate cancer in a woman is virtually unheard of and I have personally not come across a case in my 22 years of urological practice. There are certainly no reports of familial female prostate cancer.