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The latest breakthroughs that could help Andrew Lloyd Webber beat prostate cancer | Mail Online
By Thea Jourdan
Last updated at 11:44 AM on 28th October 2009

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Composer Andrew Lloyd Webber, 61, who has just been diagnosed with prostate cancer 'in its very early stages' is fortunate to have caught the disease in good time.

He is now receiving treatment and expects to be 'fully back at work before the end of the year'.
Not all men, however, have time on their side.

Around 35,000 men are diagnosed with prostate cancer in the UK every year and more than 10,000 a year die from the disease, which affects the small doughnut-shaped gland that produces seminal fluid and fits around the urethra.


Choices: Andrew Lloyd Webber, pictured and his daughter Imogen, has cancer


Early treatment can be crucial.
Up to 98 per cent of men who are diagnosed when the cancer is still contained within the gland itself will live for more than five years.
But the five-year survival rate drops significantly - to 30 per cent - if the cancer has spread to other parts of the body.
Unfortunately, funding for research has long been a problem.
'It receives a tenth of the money of breast cancer even though roughly as many men die of prostate cancer each year as women die of breast cancer,' says Professor Roger Kirby, chairman of Prostate UK and director of the Prostate Centre, London.
'One reason for the lack of attention given to prostate cancer has been that men are reticent to talk about their health.
'The other issue has been that prostate cancer has been regarded as an old man's cancer and there has been a feeling that old men have to die of something.'
But, thankfully, treatments are improving and there is a wide range to choose from. While this is good news, it can also be bewildering.
Here, with the help of top experts, including Dr Tom Stuttaford, vice president of the Prostate Research Campaign UK and Professor Kirby, we look at the options for men facing a diagnosis of prostate cancer.
Cancer that hasn’t spread beyond the prostate


ACTIVE SURVEILLANCE
WHAT IS IT? Typically, active surveillance means having a PSA test, which looks for raised levels of special markers in the blood called prostate specific antigens, done every three months for two years, then every six months.
Patients will also undergo regular Digital Rectal Examinations (DREs), when the doctor feels the prostate with his finger to check whether it is changing.
'This is only an option for older men whose life expectancy is not assumed to be more than ten years. Patients should have a tumour with a low Gleason score (under 5). The Gleason scoremeasures the aggressiveness of the cancer from a tissue sample,' says Dr Stuttaford.

PROS: 'For many men with prostate cancer, the disease may only progress slowly and will not cause any symptoms. In other words, some men with prostate cancer don't need immediate treatment,' says Dr Stuttaford.
CONS: 'Patients may feel anxious that their cancer is not being tackled head on. The surveillance may also miss cancers that suddenly become more aggressive.'
PHOTODYNAMIC THERAPY
WHAT IS IT? Patients take a special light sensitive drug which is active only when a laser is shone onto it.

Cancer cells absorb the drug, and are destroyed by a laser on a flexible tube inserted into the rectum. It has been in trial phase since 2002, but it still only available on a limited basis through the NHS.

PROS: It is a non-invasive treatment which targets cancer cells very specifically and does not require removal of the whole prostate.

This reduces side-effects, such as erectile dysfunction and incontinence. The procedure can take as little as half-anhour.

Another benefit is that any healthy tissue that is affected grows back normally without scarring.

CONS: It isn't widely available and there are no large-scale follow-up trials for the prostate. 'Because the whole prostate is not removed, there is a chance that the cancer will return,' says Dr Stuttaford.
RADICAL PROSTATECTOMY
WHAT IS IT? This is a very common operation, to remove the entire prostate gland. It can be done either by using open surgery or keyhole methods.

Open surgery, when a small incision is made at the bottom of the tummy, is more common.

PROS: Radical prostatectomy produces good results, with more than a 90 per cent chance of enjoying a further ten years of high- quality life after the surgery and many are 'cured'.

CONS: Men may suffer lifelong problems with incontinence and getting or keeping an erection. Minimally invasive RP (keyhole surgery) has similar side-effects, but there is less scarring and hospital stays are shorter.
ROBOTIC RADICAL PROSTATECTOMY
WHAT IS IT? Gold standard surgical removal of the entire prostate using keyhole methods.
A robot helps to guide the surgeon and control his or her movements.
This is the treatment of choice for relatively young men who have very early stage cancer and don't want to affect their libido and potency.
It is almost certainly the treatment Lord Lloyd-Webber has opted to have.
PROS: Robotic surgery is increasingly being used because it has two advantages: the operation is more precise and can spare key nerves behind the prostate which control continence and erectile function.
'By filling the abdominal cavity with carbon dioxide, we raise the pressure inside the tummy to create a tent like space in which to work. This means the pressure inside the tent is greater than the blood pressure itself, so bleeding is kept to a minimum,' explains Professor Kirby, who has carried out 600 robotic radical prostatectomies.
The best surgeons are now getting over 70 per cent potency retention in men under the age of 70. This is far better than potency rates for standard radical prostatectomies, when around 60 per cent of patients will be left impotent after the operation.
CONS: There are only 18 robots in NHS hospitals in the UK, although more are planned, so the procedure is not widely available.
Private patients have to pay up to £10,000 for the operation.
COMPUTERISED CONTROLLED EXTERNAL BEAM RADIOTHERAPY
WHAT IS IT? EBRT is the most common treatment in the UK for men with localised prostate cancer and destroys cancer cells with highly focused X-rays.
PROS: EBRT can be given on an outpatient basis, so no need for a hospital stay. Computerised EBRT is highly accurate and can give patients a similar outcome to radical prostatectomy.
CONS: Patients may experience a sensation of burning when urinating for a short while after the procedure. Some may also have erection problems.
COMPUTERISED BRACHYTHERAPY
WHAT IS IT? There are two types, highdose rate, and low-dose rate, but both involve placing sources of radiation within the body, inside or near the tumour in the prostate.
In low-dose brachytherapy, radioactive pellets or seeds are placed directly inside the tumour.
They give off low doses of radiation for weeks or months.
High-dose involves inserting tiny tubes into the prostate under general anaesthetic, again using computers to guide the doctors.
The patient is given a measured dose of radiation which is then removed after a few minutes.
PROS: Short hospital stays - 24 hours is normal - and quick recovery times. Damage to the urethra, bladder and rectum is minimised. Widely available.
CONS: Brachytherapy is not suitable for men who have enlarged prostates. Men may also experience inflammation in that area and the neck of the bladder may be narrowed.
HIFU (HIGH INTENSITY FOCUSED ULTRASOUND)
WHAT IS IT? Relatively new treatment that destroys cancer cells by heating them with ultrasound energy (high frequency sound waves).
The ultrasound waves are focused on the prostate via a probe that is inserted into the rectum.
Healthy tissue nearby is protected using a balloon that is filled with cooling water.
PROS: May be as effective as surgery or radiotherapy for localised prostate cancer.

CONS: Some urologists believe that its advantages have been overestimated. Longer term follow ups and more studies are needed. Not widely available.

CRYOTHERAPY
WHAT IS IT? A treatment to destroy cancer cells by freezing them.
Special probes called cryoprobes are inserted through the perineum (the area between the anus and the scrotum) into the prostate.
Argon gas is pumped through the probes to freeze the prostate tissue that is cancerous.

PROS: May be as effective as surgery or radiotherapy for localised prostate cancer and could help retain a man's potency.
CONS: This treatment is still not widely available and you may have to pay for private healthcare which can cost thousands of pounds.
Might not destroy all the cancer in the area so a man may have to return for regular treatment.
'Long-term results are still unknown. It might well be that patients have to decide whether they are prepared to forgo curative treatment in order to retain their potency,' says Dr Stuttaford.
Cancer that has spread beyond the prostate


CONFORMAL RADIOTHERAPY (COMPUTERISED CONTROLLED RADICAL RADIOTHERAPY)
WHAT IS IT? A type of external radiotherapy when metal blocks are placed in the beam of the X-rays, making them bend and conform more precisely to the shape of the prostate. Regular radiotherapy uses a more ' scattered' beam so is less precise and can affect normal tissue.
PROS: The treatment is more accurate than normal radiotherapy and means healthy cells are less affected.
This should produce fewer side-effects. Intensity-modulated radiotherapy (IMRT) is a newer type of conformal radiotherapy that can deliver different doses of radiation. Widely available.
CONS: Can miss treating some cancer cells. It should always be followed up by hormonal treatment.
MEDICAL HORMONE THERAPY
WHAT IS IT? The aim of hormone therapy is to remove testosterone from the body so that prostate cancer cells, which need the hormone to survive, shrivel and die.

This causes the tumour to shrink. Medical hormone therapy can be given by injections or with daily pills (both are equally effective).
The injections are chemical castration and stop the production of testosterone in the testes.

The daily pill cleverly blocks testosterone receptors in most of the body, so does not act on other tissues and organs.

Testosterone is still produced, although its effect is drastically reduced.

PROS: When used in conjunction with radiotherapy, cancer cells in the tumour become more sensitive to radiation treatment.

CONS: Will not cure cancer, but can keep it at bay for years. The price to be paid is that men will develop female distribution of hair, fat and some breast development, as well as becoming impotent.

When starting treatment, they may experience hot flushes and sweating. With injections, sexual desire is lost. With the pills, it is normally retained.
Advanced cancer


SURGICAL HORMONE THERAPY
WHAT IS IT? The surgical removal of one or both of the testicles which are responsible for producing the male hormone testosterone.

The operation can be done using a general or local anaesthetic and will not normally need a stay in hospital.

PROS: Very effective at controlling the cancer for a variable length of time in nine out of ten men. A single treatment can remove the need to take tablets or have injections.

CONS: This operation can be upsetting for men who will be impotent and lose sexual desire. Prostate cancer cells can regrow, causing the tumour to return .
RADIOACTIVE THERAPY
WHAT IS IT? Radioactive material is passed through the entire body.

The radioisotope Strontium 89, which targets secondary tumours in the bone, is injected into a vein in the arm and absorbed by bones affected by cancer.
'The boney tumour shrinks and small ones in the bone may disappear completely,' says Dr Stuttaford.
This can usually be done at one outpatient procedure.
An exciting new form of radiation treatment, using the radio isotope Radium 223 (Alpharadin), is now being trialled internationally, including at the Royal Marsden Hospital in London, which will spare the patients some of the disadvantages of the Strontium 89, which may effect the bone marrow.
PROS: This is used to ease symptoms and reduce bone pain.
CONS: Strontium 89 can destroy bone marrow, treatment is 'one time only' and a cycle cannot usually be repeated.
Radium 223 may turn out to be a better alternative because it can be repeated.
Patients may find their immune systems are depressed for both treatments.
CHEMOTHERAPY
WHAT IS IT? A treatment to kill cancer cells using drugs which are given as tablets, injections or via a drip.
Usually given in hospital and is given in cycles followed by periods of rest and recovery.

PROS: This treatment can help to relieve symptoms as well as improve quality of life.

CONS: Healthy cells that characteristically grow quickly, such as hair and blood cells, and cells in the gut, can be damaged.
There many possible side-effects including nausea, fatigue, bruising or bleeding and hair loss.
Expensive (£5,000 a course) so not offered by all PCTs.
TURP
WHAT IS IT? This is usually performed to improve urine flow in patients with benign prostate disease, but if a cancer tumour is growing enough to cause problems with urination, your doctor may recommend you have a TURP, too.
Involves cutting away tissue in the enlarged prostate gland that is putting pressure on the urethra.
PROS: You can remain awake during the operation, so there is less risk of side-effects which come with any general anaesthetic.
CONS: It doesn't cure the cancer, just eases the discomfort.
You may need to stay in hospital for a few days afterwards. It stops ejaculation, although men can still have sex after a TURP procedure.

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