King Charles’ openness about his prostate issues will encourage men to get help

Three cheers for King Charles! Those are not words I thought would readily escape my lips – but the king’s preparedness to share his prostate with the nation is really rather wonderful.

In this respect, as in many others, the King’s a good egg. Not many monarchs have openly shared details of their medical ailments with their subjects!

I’m sure he’s hoping his declaration will encourage other men to seek help for their prostate symptoms. Symptoms such as having to get up several times a night to empty their bladder, a poor stream, dribbling, and an inability to empty the bladder completely. The prostate gland is an integral part of two of the body’s important systems. The first is the urinary tract where the prostate sits just under the exit from the bladder surrounding the tube (urethra) that carries urine through the penis to the outside.

The second is the reproductive system, because it lies close to the storage tanks for sperm, the seminal vesicles, so that on ejaculation sperm leaves the vesicles and exits through the urethra and the penis. Benign enlargement of the prostate is really quite common. Half of men will have some enlargement at ages 51 to 60; 70% will between the ages of 60 and 69; and 80% of men 70 plus will.
Contrary to what people think, benign enlargement of the prostate does not herald the possibility of cancer.

Why should the King be going into hospital? Possibly for tests like an ultrasound scan or a prostate biopsy, or for treatment, the commonest treatment being a TUR, or transurethral resection. This op is often done robotically or by passing a small tube with a light and camera up the penis to the prostate gland and treating it from the inside. The results of TUR are extremely good.
When I was a junior doctor, I served my time with a genitourinary surgeon and we did many prostate operations.

Little was known about the prostate gland in those days. And so our patients were generally very nervous – in fact, too nervous to ask questions. But I’m hopeful that, the King having disclosed his condition publicly, men won’t feel that reluctance to seek more knowledge about their own case.

In those days, I do remember patients saying, post-operatively, it felt like they were passing razor blades. However, with improved surgical techniques and much better post-operative pain relief, today’s patients won’t suffer that. There are now many tests for prostatic enlargement and for prostate cancer.

The commonest, which your GP can do for you, is the PSA which, unfortunately, is not that accurate. The PSA level can be raised by a simple infection. Today we have very sensitive and accurate tests for prostate cancer. The PSE, for instance, is 94% accurate, and then there’s the PCA3, which is the most sensitive of all.

Having said that, one can’t get away from the fact that prostate cancer is the commonest cancer among men. In this country about 52,000 men are diagnosed with prostate cancer each year, that’s 144 every day. And 12,000 men die of prostate cancer every year. The latest figures show that one in eight men will be diagnosed with prostate cancer in their lifetime. Let’s hope the King isn’t that one.