Date: 30 September 2007
Source: The Sunday Times
Jonathan Margolis

All men know they need to get their prostate checked, but that up close and personal encounter with the rubber glove – what’s it actually like?

I’ll tell you what it’s like. It’s like having a live, wriggling, muscular eel poking its head through your anus the wrong way, having a quick peer round your rectum, and then swiftly exiting with a pop you can feel, although thankfully not hear.

The word that flashed into my head the first time I had a digital rectal examination (DRE) was “indignity”. I wouldn’t use “unpleasant” to describe the sensations involved when a rubber-gloved medical finger is inserted where the sun don’t shine. It’s more like “surprise” or “novelty”, although not a nice surprise. In 50 years, nothing had ever entered me via my anus, or been up my bottom from south to north. So think in terms of discovering a new taste, but not a very pleasant one. And not in your mouth.

My anus and rectum had been something of a private place that I liked to keep to myself. But by the time I’d had my fifth DRE in a few weeks, for reasons I’ll explain in a moment, I could discuss football through it without missing a beat.

But you can and should forget about the sanctity of your anus when one leading urologist describes an “epidemic in waiting” of prostate cancer in Britain – and the dreaded DRE is the first and quickest way of discovering it.

There are 35,000 new cases of prostate cancer per annum in the UK, and it kills 10,000 British men a year, almost all of whom could be saved were they more aware of the disease and sought medical attention early, finger-up-the-bum and all. Diagnosis is set to get even more reliable with the announcement early this month of the first genetic test for the disease, to be used in conjunction with the traditional prostate examination.

Despite the risks, most men don’t even know what this troublesome, walnut-sized piece of offal is or does. The prostate gland’s main job is producing the liquid that, with a soupçon of this and a soupçon of that, becomes seminal fluid. The gland is prone to going wrong when you enter your late forties, all the more so if your father or brother had prostate problems, or if you are Afro-Caribbean or African-American. As many as half of all men suffer prostate problems of some kind. A load of the boring stuff that happens as you get older is prostate-related: the getting up to urinate frequently at night; the need to rush to the loo only to find there’s nothing much to pass; the feeling that your bladder hasn’t emptied properly; the charming dribbling of urine after you thought you had emptied the old tank. Most men don’t need to do much about it, as the problem is caused by a gentle but generally harmless enlargement of the prostate, known as benign prostatic hypertrophy, or BPH to its friends.

Prostate cancer, though, is a mean sucker, because it grows slowly over a couple of years, and often by the time any discernible symptoms appear (which range from erectile problems and soreness when ejaculating to lower-back pain and blood in the urine), it’s later than is ideal for diagnosis. This is not just by the dreaded finger – there are also blood and urine tests, an ultrasound-up-the-bum method and a technique called prostate massage, which sounds like something that you have done in certain places in Bangkok, but is actually serious medicine.

So the best way of nipping prostate cancer in the bud is by having annual checks from 50 onwards, or 45 if there’s a family history. Now here’s the problem. The reason I had five prostate checks in a row a couple of years ago is that I was researching a magazine article on the world’s ultimate health checks for men, so I had them all. In America and in the private sector over here, it’s seen as perfectly reasonable to have a prostate check even if you show no symptoms.

The NHS, however, tends to be haunted by the idea of the middle-class “worried well”, as British doctors (but not American) call them. The provision of prostate checks will, inevitably, vary according to what the NHS is like where you live, but you will almost certainly have a struggle getting an annual check if you aren’t actually experiencing anything abnormal in the undercarriage region. Once you are suspect, however, medical advice for prostate cancer in both private and public sectors is impressive. There’s a sense that doctors quite enjoy dealing with a condition strictly for blokes. Prostate specialists also have a manner highly attuned to men. For instance, Professor Roger Kirby, a leading urologist, prostate surgeon and a director of the Prostate Centre in London, is very much the kind of bloke a bloke can talk to. He is especially used to men’s squeamishness over those “Ooh, matron” moments with the rubber glove.

“The old finger up the bum is less of a ‘thing’ now than it was, I think,” Kirby says. “It only takes a second and it gives the urologist a lot of information. I think people would be a bit surprised if we didn’t do it. And it can be life-saving when you find something. What does sound weird, and is a bit of an odd thing to do, is the prostate massage, but if you push hard on the gland and can get the secretions from within it into the urethra, you can analyse for infection and cancer. It can even be therapeutic, because if the prostate is inflamed and infected, emptying out the ducts is a bit like lancing a boil. It hurts a bit, but if you ask, ‘Would you like a biopsy, or would you like a massage?’, people always go for the massage, thank you very much.”

The treatment for prostate cancer, he went on to explain, is usually complete removal of the gland. He is working on a less invasive version, done partly by robot, which he thinks will be the future of prostate surgery.

What are the effects of having it all out? “After entire gland removal, your continence is okay, and these days, things such as erectile dysfunction and impotence are unlikely, and only temporary if they do happen. But removal does take away the ability to ejaculate, which means you have dry orgasms. But they’re still orgasms.”

And what can men do about prevention? “There are some trials looking at vitamin E and selenium, and also some suggestion that the super-vegetables such as broccoli are preventative, but there’s no hard evidence. Stress might be a factor. I see lots of patients who work in the City and are stressed out. Although I can’t prove it, I suspect some of these severe, aggressive prostate cancers are stress-related. It’s certainly a factor, along with pollution, too many saturated fats and so on.”

The NHS Direct website also suggests that not eating meat can help; vegetarians, it says, are half as likely to get prostate cancer as meat-eaters.

Frequent ejaculation, whether with a partner or as a soloist, also seems to be good for keeping a healthy prostate. “There have been a few studies to suggest that it can be protective,” says Kirby. “It’s certainly better than bottling it all up.”

For more information, visit: Prostate Research Campaign UK, 020 8877 5840, www.prostate-research.org.uk; UK Prostate Link, www.prostate-link.org.uk; the Prostate Cancer Charity, 0800 074 8383, www.prostate-cancer.org.uk; NHS Direct, www.nhsdirect.nhs.uk.

Dr Roger Kirby and other experts can be contacted at the London Prostate Cancer Centre; 020 7631 1632, www.prostatecancertreatment.co.uk