AS I WRITE THIS my brother-in-law is undergoing a three-hour operation to remove his prostate. He was diagnosed with aggressive prostate cancer in early December. He’d had no symptoms but because he is over 50 his doctor, during his annual check-up tested his PSA levels. PSA stands for prostate-specific antigen which is a protein produced by the cells of the prostate gland – the level of these proteins is the benchmark test for prostate cancer diagnosis. Steve’s were high.

Doctors still don’t know what causes prostate cancer but the primary risk factor is age, and the older a man gets the more common it becomes. Even though the average age of diagnosis is 70, quite often there are no symptoms so it is advisable for men to check themselves out more often once they pass 50. The prostate gland lies at the base of the bladder. It produces the liquid part of semen and is about the size of a walnut. As it tends to increase in size with age, because the front of the prostate surrounds the urethra, any change in the size or shape of the prostate can narrow this tube, making it difficult to urinate.

Around 35,000 men in Britain are diagnosed with prostate cancer every year – and 10,000 men die from the disease, making it the most common cancer in men. Worldwide statistics show that one man is diagnosed every 2.6 minutes and the cancer kills another every 13 minutes. Frightening figures, yes, but the irony of it is that prostate cancer is completely curable if caught early, but if it remains undiagnosed and spreads to other parts of the body, namely the bones, the liver or the spinal cord, the five year survival rate of 98 per cent drops to just 30 per cent.

Professor Roger Kirby of the Prostate Centre in the UK believes that lives are lost simply because symptoms are ignored instead of dealt with. Many men are still deeply embarrassed about any problem that affects their libido or masculinity.

Difficulty or frequent urination, especially during the night, are among some of the symptoms as well as difficulty in starting and maintaining a steady stream of urine, blood in the urine and painful urination. Problems with achieving an erection or painful ejaculation are also signs.

As the doctors had diagnosed the disease in its very early stages, Steve was given the option of waiting until the summer before having the operation. The cancer was still contained within the gland and prostate cancers tend to grow slowly. He thought about it for a few weeks, and was sorely tempted as he had a heavy workload, but in the end he bowed to family pressure, namely the women in his life, who were horrified at the thought of postponing something so important because of work. He was advised to have a radical prostatectomy using robotic keyhole surgery because his cancer was particularly aggressive. Also, the precision of the surgeon-driven robot meant that there was far less chance of cutting the nerves that affect continence and sex drive. He was told that after the prostatectomy he may well have a problem with continence, but it gets better as the days pass.

He will be infertile, but in his case, he already has four children. Providing all goes well, he shouldn’t be in hospital for more than three to four days. Then, it’s home with his new best friend, the dreaded catheter, which will stay plugged in for a few days. After a six-week recovery period, and providing there are no post-op complications, Steve will be back at his law practice in the City.

Diagnosis of prostate cancer

A doctor will ask you about your symptoms and will examine you. He or she may also ask about your medical history and may do some of the following tests or will refer you to a urologist.

• A digital rectal examination (DRE) is an examination of your prostate. Your doctor will insert a lubricated, gloved finger into your rectum (the lower part of the large intestine, ending at the anus) and feel your prostate through the wall of your rectum. If there is prostate cancer, it may feel harder than usual, or knobbly.

• A prostate-specific antigen (PSA) blood test will test the amount of PSA in a sample of your blood. PSA is a protein which is made by both normal and cancerous prostate cells. A high PSA level doesn't always indicate cancer and can be caused by other prostate diseases.

• In a prostate biopsy, your surgeon will remove a small piece of tissue. The sample will be sent to a laboratory for examination to find out if it's cancer and if so, how fast it's growing.

• CT, MRI and bone scans can help your surgeon see how far the cancer has spread (if at all). A CT scan uses X-rays to make a three-dimensional picture of your body. An MRI scan uses magnets and radiowaves to produce images of the inside of your body.

Treatment of prostate cancer

Treatment for prostate cancer will depend on a number of factors, such as age and whether the cancer has spread, and if so, how far. There are various treatments available. Some can have serious side-effects so it's important to speak with your doctor who will advise you on the best treatment for you.

Active monitoring: sometimes, particularly for slow-growing tumours, no treatment is the best course of action. This is often called active monitoring or watchful waiting. Your condition will be monitored closely with routine check-ups. Your doctor may start treatment if your tests show that the cancer is growing or causing symptoms.

Surgery: surgery is a common treatment for prostate cancer. It's most suitable for otherwise healthy men (usually, those under 70) whose cancer hasn't spread beyond the prostate.

The most common technique is a radical prostatectomy. This is a major operation, which removes the whole of the prostate and some surrounding healthy tissue.

New surgical developments include keyhole surgery (a laparoscopic prostatectomy) where the prostate is removed through smaller incisions and robot-assisted surgery.

Radiotherapy: radiotherapy uses radiation to destroy cancer cells. Techniques for treating prostate cancer include conformal radiotherapy (CRT), high-resolution intensity modulated radiotherapy (IMRT) and brachytherapy.

Hormone therapy: hormone therapy blocks the action of the male sex hormone (testosterone) that helps cancer grow. This can slow the growth and spread of prostate tumours but won't kill the cancer cells.

Alternatively, surgical hormone therapy involves removing your testicles, which permanently gets rid of the main source of testosterone. This operation is called an orchidectomy.

Chemotherapy: if hormone treatment stops working (hormone refractory cancer) your doctor may recommend chemotherapy. Drugs are used to destroy cancer cells.

Cryotherapy: this is surgery to freeze the prostate with liquid gas and kill cancer cells. This treatment may be used if you have a recurrent or refractory prostate cancer.

Ultrasound: high intensity focused ultrasound (HIFU) is a treatment given using a machine that gives off high frequency sound waves. This heats up the targeted cancer cells and destroys them.