Health is always an issue and more so as the years roll by. The following few pages are dedicated to some common health issues experienced by senior golfers – if you have any comments, advice or questions please get in touch – share your experience with others who might be concerned about these issues.

Prostate problems
	Prostate cancer is now the most common cancer in men in many western countries. However, most prostate tumours are slow-growing and may not need treatment. Others grow quickly and eventually spread to the bones, where they can cause severe pain. Currently there are 30,000 new cases a year in the UK; 215,000 in the USA; 20,000 in Canada and 12,000 new cases a year in Australia.

The main symptoms are:  difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs.  However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement.  Men with any of these symptoms should consult their doctor. Prostate Cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 75. Men from families with a history of prostate cancer are at higher risk than normal.

Some evidence suggests that a low-fat diet can reduce the risk of prostate cancer.  Other studies have suggested that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussel sprouts) and selenium can also reduce your risk.  However, apart from selenium (see below), these findings have not been confirmed. Although there is no known way of preventing prostate cancer, studies have shown that men who took 200 microgrammes of selenium each day substantially reduced their risk of prostate cancer.

If prostate cancer is diagnosed early, it can be treated very successfully.  However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and take themselves to their doctor. A number of different tests are used, but none of them is conclusive on its own. Rectal examination - by inserting a gloved finger into the back passage your doctor can actually feel the prostate gland, to find out whether it is larger than it should be. Even if it is enlarged, this does not mean that it is cancerous. PSA blood test - if the level of Prostate Specific Antigen (PSA) in your blood is too high, this suggests that there is a prostate cancer, but there are several other conditions which cause an increase in blood PSA levels. Ultrasound - a small probe is inserted into the back passage and used to do an ultrasound scan, showing the exact size of the prostate. Biopsy - this involves taking a tiny sample of tissue from the prostate. A probe is inserted into the back passage and a small needle jabbed into the prostate itself. X-rays - an x-ray can reveal whether there is any cancer which has spread to the bones near the prostate.

In half or more of patients the cancer is detected at an early stage and treatment is successful for nine out of ten of these cases. The other half of the patients are not diagnosed until the cancer is advanced and has spread. Treatment can give these patients several extra years of life and stop the pain of the disease, but cannot normally cure them. Sometimes prostate cancers are so slow growing that no treatment is needed. However, when treatment is necessary, there are three main types used: Surgery - in an operation called a prostatectomy, the whole prostate gland is removed. Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This will help destroy the original tumour and also reduces the pain caused by tumour cells which have spread to the bones. Brachytherapy - this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the prostate tumour, killing it from the inside. This is at least as effective as the other treatments and sometimes more so. There are also usually fewer side-effects with brachytherapy. Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour and sometimes shrink it. However, after about five years, most prostate cancers go on to develop the ability to grow without androgens and the hormone therapy stops working.   There are normally no side-effects from surgery, although there is a risk of impotence as an after-effect.  Radiotherapy causes general side-effects such as tiredness, diarrhoea and nausea. These will all go away after the treatment has finished. The only long- term effect is impotence, which happens in about half of patients having long-term radiotherapy. Almost all patients receiving hormone therapy experience impotence while the treatment is being taken. Hot flushes, tiredness and weight gain are also common, but will cease when the treatment stops.

The good news is prostate cancer need not be a death sentence. Early diagnosis is so important and there is a great deal all men can do to safeguard their health.