Men must be champions of prostate breakthrough

If you want to see the inner child in any man, suggest he goes to the doctor. Some will sulk, others will strop and most will find a reason to leave the room. They'll go to hospital with an injury, preferably in a mud-spattered sporting strip. I have seen so many footballers and rugby players limping through A&E departments wearing boots with studs that I wonder whether they've messed up doing DIY at home and changed before driving to hospital. Men may submit to an X-ray and plaster cast as a result of the scrum or the ski slope, but they will mooch moodily around the house for months denying more worrying symptoms.

Anything internal is required to heal of its own accord. Anything below the waistline won't even be discussed. It's one of the reasons that 10,000 men in the UK die every year from prostate cancer.

Prostate cancer is now the most common cancer in men, with more than 30,000 cases diagnosed every year. By the time a man is in his fifties he has a one-in-three chance of having cancer cells in his prostate. By the time he reaches 80 he will be an exception if he doesn't have a small area of prostate cancer.

By the time women have reached their middle years they have been through childbirth and the menopause, leaving them unblushing. Not so men. When they find themselves rushing to the loo several times a night or when their back aches and their pelvis feels creaky, they decide it's simply the onset of old age. The more symptoms persist, the less likely they'll acknowledge them, losing the possibility of early diagnosis and its increased chance of a cure.

I don't blame them. An internet search reveals prostate cancer's diagnostic examination as uncomfortable, involving a rubber glove and lubricant. A biopsy might follow and if cancer is diagnosed there are several possible treatments.

The first one is active surveillance. Since the cancer is often very slow moving some men can live with it for years without ill effect. But identifying which men fall into that category requires medical expertise. There is hormone treatment that reduces testosterone levels: not something the average man welcomes. That leaves radiotherapy and surgery. Both of these carry the risk of incontinence and impotence.

It's enough to make the natural ostrich stick his head further in the sand.

There is, however, another treatment that is almost a secret in the UK and is likely to remain so. It's called High-Intensity Focused Ultrasound (HIFU) and is non-invasive, comparatively cheap, has fewer side effects than other treatments and can be delivered in one hospital visit. Unlike surgery or radiotherapy, it can be repeated if necessary. The European Journal of Urology has reported on an eight-year study from France and Germany, showing that it is effective. It concluded that HIFU is an ideal treatment option for men with localised prostate cancer and should be part of a doctor's armoury when treating the disease.

Hallelujah, you might think. It won't be the right option for every man but it could nip cancer in the bud for many of the 32,000 a year who receive a prostate cancer diagnosis. Furthermore, if men can be assured that there is a one-off, non-invasive treatment with a good chance of leaving them cured, continent and with a sex life they might go to the doctor quicker.

Europe is delighted with the breakthrough. But, perversely, the National Institute for Health and Clinical Excellence in England (Nice) is reportedly about to change its guidance on HIFU to make it all-but-impossible to access on the NHS. A draft guideline issued over the summer said the therapy was not recommended for men with localised or locally advanced prostate cancer other than in controlled clinical trials. Scotland will adopt the same backward guidelines.

Why? What has made Nice go back on its decision three years ago to offer HIFU on the NHS? It says it's about value for money, not affordability. It is shocking. But when it comes to their health, men are a pushover. They don't wield political clout on health issues like women do. On the evidence so far they'd rather die than make a fuss.

John Crow is an exception to that rule. The 64-year-old ex-RAF man is the first patient in the UK to have had HIFU twice after developing prostate cancer aged 58. He had radiation and hormone treatment but the cancer persisted. He wasn't offered HIFU but found out about it through the internet and was accepted for it as a private patient at University College Hospital, London. He said: "I applied to the NHS and was turned down so I found out the cost of hormone treatment and I found out the cost of radiation and I re-presented my case. When I demonstrated that HIFU is more cost effective, they paid up."

John had his first treatment 18 months ago but recently a check revealed a tiny bit of cancer remained so the treatment was repeated two weeks ago under general anaesthetic. He said: "I had a cup of tea half an hour later and I was up and about the same day. I won't minimise it. There was discomfort but no pain. I have a catheter but that comes out in a few days. I haven't had to take hormones for the past 18 months, which has been welcome because they destroy the libido and gave me hot flushes. HIFU is a very precise treatment so there's much less chance of it causing incontinence or impotence. I had cancer for some time before I discovered it. There's a diagnosis every 20 minutes in this country and a death every hour. Men are just silly if they ignore symptoms. They need to listen to people like me because it could save their life."

In fact, men need to do more than listen. They need to fight Nice (Scotland follows its guidance on prostate treatment). HIFU treatment costs £13,000 compared with £3000 for radiotherapy and £5000 for surgery. The machine that delivers it costs £300,000. It might sound expensive but there are no overnight hospital costs and a short recuperative period. Most importantly, as eight years of observation in France and Germany now shows, nine out of 10 men treated were free of cancer after treatment and five years later eight out of 10 were still well. How do you price results like that?

If all cancers could be treated with such relative inconvenience we would welcome it as the dawning of a new age. HIFU needs to be trumpeted as a breakthrough and its efficiency advertised so that men are coaxed out of their anxieties and into treatment. To ration it, to deny it to most prostate cancer patients is not only perverse, it's wicked.

If you have any queries about prostate cancer call the Prostate Cancer Charity's confidential helpline, 0800 074 8383, staffed by specialist nurses from 10am to 4pm Monday to Friday and Wednesday from 7-9pm or visit www.prostate-cancer.org.uk.