Part 2 of Dr Thomas Stuttaford's online forum on the important topic of diagnosis and treatment of prostate cancer will be live after 1pm on June 18. To ask the doctor your question on this topic and to read other recent topics he has answered click here

Q1: I read with interest your humanitarian services in responding to questions from people who find themselves suffering from prostate problems. I am about 55 years old and all fingers point to people of that age bracket to be vulnerable to symptoms or actual victims of the problem.

Could you kindly tell me about the diagnosis and treatment of prostate/prostate cancer? The clinic at my place of work talk about benign prostate symptoms when I complained to them that I go urinating two to three times a night and that the flow is not as rapid as it ought to be.

I live and work in Ibadan, Nigeria where things are not easy medically and otherwise, and I believe your assistance can go a long way to stabilize my troubled emotion, since I hear it costs so much to venture an operation, which might not be permanent solution to some, after all. Many thanks. A. Williams

A1: There are two constantly repeated clichés about prostate disease that are misleading. The first is that far more men die with prostate cancer than from prostate cancer. This is not only misleading but dangerous. I suspect that it is quoted as often as it is in order to cut down on the numbers of men having regular tests so that their prostate cancers might be diagnosed at a stage when there is a better chance that they might be cured of it.

It is true that a large number of elderly men who have a post mortem for some other condition are found by chance to have malignant cells in their prostate glands but that these played no part in their death. It doesn't follow that a distinct cancerous tumour can be left in the prostate on the assumption that the patient will necessarily die from some other disease.

The mortality figures that show that over ten thousand men die every year in this country from prostate cancer demonstrates the absurdity of this argument. Every effort must be made not only to detect early prostate cancer, when the PSA is still low, but to have a biopsy of the malignancy so that the nature of its threat can be judged from the examination of the cells in the cancer and an estimate made of their likely level of malignancy.

Another aspect of this axiom, so beloved by government officials and laissez faire doctors who want to postpone action, that is dangerously misleading is the lack of understanding of the relationship between some of the deaths from other causes from patients with prostate cancer and its association with the cancer.

For complex reasons patients with a malignancy are more likely to suffer from thrombo-embolic problems including heart attacks and strokes. The likelihood of this happening varies according to the nature of the cancer but prostate cancer is about the second or third cancer that is most likely to cause this.

Many years ago I was told that one in four people with prostate cancer have a sudden death from strokes and heart attacks. I understand that, as the men with prostate cancer are often older, they would be more likely than younger people to suffer strokes and heart attacks and could be incidental. I also realise that the surgeon who told me this may have been exaggerating but it remains that many of my patients who have prostate cancer that is held in remission do die suddenly from these causes. Inevitably a non interventionist doctor will say "I told you so, men with prostate cancer die with it and not from it" but I don't believe it.

The second misleading oft repeated comment is that if a patient waits until he has symptoms from the cancer he will have waited too long and is already doomed. Sometimes this is true but often patients who have symptoms from the cancer have them early. The cancer is then not only treatable but can be cured. The time that cancer causes symptoms with bladder function depends to some extent as to where the cancer is in the gland and on the nature of the cells in the tumour.