A recent TV drama depicted life in a great London teaching hospital in the early 20th century. Modern medicine, with improved drugs, safe anaesthesia, better surgery and more certain means of diagnosis, revolutionised the outcome for patients in the second half of the century, but the old-style hospital regime lasted until the 1970s.

The TV programme portrayed a system with rigidly hierarchical medical and surgical teams of doctors in which the consultants would probably have been at least 20 years in medicine before being appointed.

The wards were spotless with clean working lavatories, shining floors and sparkling bedside tables and windows. Doctors may not have been able to do so much to save patients’ lives but, once in a good hospital’s ward, whether dustmen or bankers, patients were fed, cleaned, talked to and cosseted.

Despite the lack of funds and the chaos that surrounds medical education now, patients’ chances of going home alive is better.

For the past 20 years, since I was middle-aged and long before I developed cancer of the prostate myself, I have been interested in the treatment of the condition in Britain compared with that in other Western countries. I recently encountered a 46-year-old solicitor from the West Country who for the past four years has been treated at the Middlesex Hospital, now part of University College Hospital, by my own oncologist, Dr Heather Payne.

The solicitor’s brother had had an early carcinoma of the prostate diagnosed and removed. This prompted the solicitor to have his PSA, a simple blood test that patients need to take annually after the age of 50. It was 37; the normal is under three.

The test showed that the tumour was highly malignant. The cancer had already spread from his prostate into the seminal vesicles. Many centres would have considered that he needed only palliative treatment to keep his cancer at bay for as long as possible, and that by now it was no longer capable of being effectively treated.

The solicitor was immediately treated with Zoladex hormone therapy to turn off his testosterone supply (prostatic cancers are initially hormone-dependent). After three months of Zoladex he was admitted to hospital for high-dose brachytherapy. This entailed three blasts of radioactive iridium through needles inserted into his prostate.

After the iridium brachytherapy a patient has conformal external beam radiotherapy before being prescribed Casodex, a hormone-controlling drug that doesn’t destroy the testosterone but prevents the body, other than the brain, from utilising it.

The solicitor once would have been written off but is now well. He is no longer taking Casodex and although he has had irradiation for only a moderately advanced cancer, his PSA is 0.2, well below normal levels. He is totally continent, has a good urinary stream, is not impotent, feels very fit and is working hard.

The malignancy of prostatic tumours is measured in three ways: by the nature of the cells, the extent of the tumour in the gland, and by the initial PSA. A normal PSA should be under 3. Any PSA over 10 puts it into at least an intermediate level of malignancy, as does the presence of the cancer in both lobes of the gland. The malignancy of the cells is accorded a Gleason score of up to 10. Scores of 2, 3 and 4 may mean a pussy cat lurking in the prostate, a relatively harmless type of prostatic cancer.

Those with a Gleason score of 5, 6 and 7 are in the intermediate group. A cheetah type of cancer may once have been tame, but could, if left, soon become aggressive. Most doctors agree that these intermediate cancers need active, vigorous treatment as soon as possible, but are not an emergency. The third group have a score of 8, 9, or 10. These cancers could be compared to wild and hungry tigers that must be disposed of immediately.

Recently Professor Stephen Langley and his colleagues from the Prostate Cancer Centre in Guildford announced their results of brachytherapy treatment with the insertion of radioactive iodine seeds — one of the first line therapies they offer for prostate cancer.

Until the last few years radiotherapy in the UK was only palliative. Its results didn’t have the aims of surgery to rid the patient of their cancer. The X-ray systems and machinery used were inadequate. Modern radiotherapy has revolutionised the situation and now gives men with prostatic cancer a reasonable chance of a cure or long-term survival.

The Guildford team, unlike Heather Payne’s team at UCH, don’t make a speciality of dealing with advanced cases. Guildford is, however, taking early, intermediate and advanced cases from all over Britain and the world.

Langley’s results are remarkable. Five years after treatment fewer than 1 per cent of patients have incontinence that needs a pad. Sixty-five to 75 per cent have retained their potency. Two out of 800 patients have even fathered children.

Prostatic treatment is improving. Robotic surgery is a viable alternative to open surgery, radiotherapy gives patients a chance and once untreatable cases are now effectively dealt with. Keyhole surgery, a procedure that needs considerable skill, is being performed. Chris Eden at Guildford is a master of this. At last chemotherapy is being used, but is still under-researched and under-utilised.