The Doctor’s Surgery Pros and cons of prostate surgery

These days, people – that is to say, politicians – have some difficulty in defining women, though not the same difficulty in recognising them.

How long will it be before difficulties attach to the definition of men? How about ‘people with prostates’? I make this as my contribution to intellectual clarity.

For most of their lives, men don’t think about their prostates, in the same way as no one thinks about their appendix until they get appendicitis.

But there comes a time of life when Englishmen’s first talk is not of the weather, but of the prostate, with such interesting (and important) questions as ‘How many times do you have to get up at night?’

Cancer of the prostate is a dreaded disease. At least three of my acquaintances have died of it, one at an age I now consider young. How should it be detected and, once detected, treated?

The PSA (Prostate Specific Antigen) test was long-used for detection.

Between 1999 and 2009, 82,429 men aged between 50 and 69 – that is to say, with a life expectancy of more than ten years – underwent the test in a very large trial of various kind of treatment.

Some 2,664 of them were found to have localised cancer, and 1,643 of them were entered into the trial: they were allocated at random to active monitoring of their condition, prostatectomy or radiotherapy.

They were followed up for a median length of time of 15 years. The investigators managed to follow up 98 per cent of those who entered the trial, which was a triumph of organisation in itself. The trial was carried out in Britain. We are good at clinical trials and coronations.

During the follow-up period, 356 patients died, but in only 47 of them was their death attributed to prostate cancer.

There was no significant difference in the rate of death between any of the three approaches, either in all-cause death or in death from prostate cancer.

Should you conclude from this that prostatectomy is either useless or harmful? It often has very unfortunate side effects such as urinary incontinence.

Alas, it is not quite so simple. Those who underwent prostatectomy had half the rate of metastasis of those who underwent active monitoring.

This did not affect the eventual death rate from prostate cancer, and most of the metastases were in the local lymph nodes – but what I would really have liked to know was whether they caused much suffering. It is not only death but suffering that one wishes to avoid.

Another problem was that a much higher proportion – 25 per cent versus 11 per cent – of patients who were actively monitored, rather than operated on or given radiotherapy, required androgen (male sex hormone) deprivation therapy, which is usually given by injection. This therapy has a list of side effects that competes with those of steroids for unpleasantness.

They include hot flushes, fatigue, erectile failure, testicular atrophy, cognitive decline, increased likelihood of diabetes and osteoporosis.

Since the many forms of human suffering, as of pleasure, are incommensurable, there is no indubitably correct answer to the conundrum as to what treatment is best – at least not until a method of treatment comes along that is vastly superior to any other. And in a disease that kills only about three per cent of the people who have it after 15 years, it will not be easy to prove that one treatment is vastly superior to another.

It is an old medical adage that many more men (as defined above) die with rather than of cancer of the prostate. About 80 per cent of men aged 80 have evidence of prostate cancer.

Though it is far from a sentence of death, still about 12,000 men a year die of it in this country alone.

The Oldie, 23–31 Great Titchfield Street, London, W1W 7PA letters@theoldie.co.uk

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Max Wall’s funny wasp

SIR: Thank you for running my piece on Max Wall (June issue). An error crept into the poem he recited at the Palladium:

‘There was a young man from Dundee

Who got stung on the neck by a wasp.’

In the Oldie piece, ‘wasp’ was changed to ‘bee’. ‘Wasp’ is funnier – perhaps a precursor of that Scottish master of whimsy Ivor Cutler.

Love, Kenneth Cranham, London N1

Suspender-belt failure

SIR: Surely Mary Killen (Spring issue) could not in the event of suspender failure have resorted to a 5p piece: decimalisation did not come until 1971, well after the arrival of tights.

In the forties and fifties, my mother always had with her – to respond to the inevitable ping of suspender malfunction – a reliable, ideally-sized and hard replacement, namely an aspirin. Yours,

Diana Finch, Felixstowe, Suffolk

Pritchett family fan club

SIR: How wonderful are the Pritchetts! I laughed out loud at Oliver’s ‘Dead funny’ (June issue) about the joy of accidents.

Having been a fan of his for years, I wrote to him once saying how much I enjoyed his Good King Wenceslas pieces which often turned up in December, and he was kind enough to reply. Likewise Matt, whose cartoons are an excellent start to the day and a brilliant accompaniment to his father’s writing. Many thanks to them both.

What a team!

Judy Davies, Tenby, Pembrokeshire

Bosses from Hell

SIR: I so enjoyed Oliver Pritchett’s witty and amusing look at our inability to keep a straight face when witnessing life’s banana-skin moments (‘Dead funny’, June issue).

However funny minor accidents can be, I could not help remembering my time working in the information-andguidance department of that often –but mostly unfairly – maligned public guardian the Health and Safety Executive.

One of my jobs was to record news releases describing workplace accidents. Many of these defied belief as they chronicled the unravelling of bizarre events leading to disastrous outcomes.

Others documented the result of workers’ scant regard for their own safety or their suffering at the hands of outrageous misfortune due to circumstances beyond their control.

The worst by far, though – and the ones that would make my blood boil – were reports of workers who suffered life-changing or even life-ending injuries at the hands of unscrupulous and shameless employers who put lives of their staff at risk simply in order to save time and therefore money. Health and safety gone mad? Tell me about it! Yours cautiously, Stephen Carr, Southport, Lancashire

Unhappy accident

SIR: Oliver Pritchett’s article in your June issue brought back memories of the time I arrived home to find my husband pinned to the floor by the grandfather clock. It had fallen on him when he was winding it.

Fortunately, he was unhurt physically – but oh how his dignity suffered, particularly when friends and family fell about laughing on hearing of the incident. He never did see the funny side of his accident.

Maureen Ferguson, Eastbourne, Sussex

Fat chance

SIR: There may well be a future article by the esteemed Dr Dalrymple (‘Ignore Wallis Simpson’s health tip’, June issue) advocating obesity but in the event that is not the case, I think it is vitally important to state the corollary of his thesis that losing weight in the elderly can increase the risk of early (late) death.

I have carried out extensive deskbased research and the good doctor’s thesis has gone a long way to support my contentions that a ten-per-cent increase in the weight of the over-70s could increase life expectancy by more than ten per cent. Extrapolation also shows that an increase in weight of 50 per cent could lead to a life expectancy of 150 or more.

I think we should be told.

David Pettit, Raglan, Usk

Julius Caesar’s steam train

SIR: ‘Our new king is a Shakespeare buff.’ How right Gyles Brandreth is in stating this (June issue) I found out

‘Now, during a memorable meeting with the future monarch in September 2006.

The occasion was the annual gettogether of the Prayer Book Society at an Oxford college. There was general excitement as the Prince of Wales as Royal Patron was paying us a visit by helicopter.

Much to our surprise, the Prince not only addressed us but did the rounds, meeting and exchanging words with all 60-odd members present.

As he approached, I thought he was bound to ask, ‘Why do you like the old Book of Common Prayer?’ and I frantically tried to come up with an answer. But no, the question when it came was ‘Did you study Shakespeare at school?’

With a sudden inspiration, I replied, ‘Yes, sir, and not only did I study him but also I taught Shakespeare.’

‘Oh, really – where was that?’

And that led on to a final exchange:

‘Are you still teaching?’

‘No, I gave it up and become one of Her Majesty’s Civil Servants.’

‘Oh, you poor chap!’

At which the Prince moved on to the Archdeacon of Berkshire.

I don’t know what he would have said had I related the incident that perhaps contributed to my premature exit from the teaching profession.

Scene: the School Hall. Thirty 14-year-old boys and one 24-year-old schoolmaster, all holding copies of Julius Caesar

Master (reading Act 1, Scene 2): Re-enter Julius Caesar and his Train.

Chorus of boys: Choo-choo-choochoo-choo…

Long may King Charles reign over us! Yours sincerely, John Dearing, Reading, Berkshire

Sterling moths

SIR: I read with interest the review of The Jewel Box (June issue) which celebrates the wonderful world of moths. It was a moment of irony to come across, a couple of pages later, an advert offering a service ‘guaranteeing the removal, destruction and prevention of moths’. Regards,

Verne Sanderson, Tenterden, Kent

Corned beef? Yum yum

SIR: By sheer chance, as I was enjoying a corned-beef salad in the sun this lunchtime, I turned the page of The Oldie (June issue) to be met with the headline ‘Where’s the corned beef?’

Corned beef has formed the staple diet of every yacht I have had the pleasure of skippering in high latitudes, especially when locally-caught, -shot or -snared meat has been scarce. Indeed, it also formed the fundamental ingredient of many meals in my youth while I was at sea in the ’40s and ’50s.

Yes, we called it ‘bully beef’ too, but more often it was referred to as ‘corned dog’ or, when in arctic Norway, as ‘dog in box’. I won’t horrify you with my ‘serving suggestions’ but they include masses of red wine, garlic and vindaloo – perfect when the cabin temperature is well below freezing.

Yours faithfully, Ewen Southby-Tailyour, Ermington, Devon

Making a hash of it

SIR: Trevor Groves’s article on corned beef (June issue) brought back not-sotreasured recollections of a year or so on National Service in the Suez Canal Zone in 1954. Our camp was on the shore of the Great Bitter Lake but, in other respects, very isolated – and we had no fresh meat; only corned beef, also known to us troops as corn dog.

I must say that our Army Catering Corps staff tried their best to make dishes to tempt jaded taste buds, but it must have been very difficult for them.

These days, I am not over-tempted by corned beef, although a simple hash has its merit.

Sincerely, David Holme, Accrington, Lancashire

Scotland the Brave

SIR: Regarding Tom Hodgkinson’s enquiry (Town Mouse, June issue) whether one can buy a property for £100,000: there are at least ten under £80,000 going in Wick, Caithness.

Please tell only those who can stand 70 mph+ winds, consider 10°C mild and can stand living with friendly, courteous neighbours who like a blether.

Stephen Cox, Wick, Caithness

Anti-cash conspiracy

SIR: I was delighted to see Julie Cruickshank’s Rant in the June issue. She is a woman after my own heart. I have been insisting on using cash everywhere I go, and like her I refuse to pay by card. There is a conspiracy to get rid of cash and we must fight to keep it.

‘There’s been another rant increase’

The card/banks make so much money from cards and will have complete control of the population if cash is removed. I thought that as cash is legal tender, companies cannot refuse it. I have found that if I say I have only cash so if they won’t accept it they must cancel my order, I find they do accept it.

I lecture all my friends and family to try to get them to use cash, as WHEN –not if – all the card machines fail because of a satellite crash (or interference from another country), the whole world will be in chaos and nobody, citizen or government, seems to see this.

Everyone, please WAKE UP and USE CASH. Boycott any business that says ‘Card only’. Bright blessings, Kate Jackson, Brixham, Devon

Cosy Iron Curtain

Sir, I write in defence of Hotel Moskva in Belgrade (David Halley, Letters, June issue). I have stayed there a number of times and never found it uncomfortable – certainly not the worst, by far.

There were hotels in Africa where taking a shower was risking electrocution and one in Bucharest where the stairs had no risers of the same height and the light switch was hidden behind a wardrobe, although the bed was comfortable. I am always puzzled as to why in most hotels it’s assumed you want to watch television only when you’re in bed.

Sincerely, Richard Barnes, Sellindge, Kent

Expert thong-writer

SIR: A thong does not dissect the buttocks (Mrs Bee’s letter, June issue). It bisects them. Cutting one’s buttocks into small pieces while wearing a thong is mind-boggling, to say the least. Geoffrey Robinson, Clifton, Bristol

While I was on a package tour of the Amalfi Coast in 2007, staying at a hotel in Sorrento, one of the fellow travellers stood out from the rest.

She wore a striking tweed jacket and, apart from being constantly shadowed by her diminutive female companion, very much kept her distance from everyone else.

It wasn’t until a week later, in the minibus taking us from the hotel back to the airport, that I spotted her luggage label: ‘C Payne’ – and the penny dropped.

Over the next few hours on the flight, I experienced a mixture of feelings, ranging between embarrassment and amusement.

My own companion, Gordon, was a charming elderly gentleman, somewhat old- fashioned, who in years past would have been considered gallant. I went cold as I recalled his words to Ms Payne as he’d helped her into the cable car in Capri with the words, said with a twinkle, ‘Trouble is, you need a man in your life!’

She retorted, ‘Oh, don’t worry, dearie, I’ve had plenty of those!’

I’d muttered something crass like ‘Good for you!’

The other cringeworthy recollection was Gordon helping Ms Payne, who was slightly unsteady and using a walkingstick, over the uneven cobbled paths of