A delicate operation - Intelligent Life - The Economist

THE SCENERY WAS like nothing they had ever seen before. Last March, 47 cyclists had negotiated a 27km climb to the Puyehue Pass on the border of Chile and Argentina, passing forests and mountains, hot springs and glacial melt-water. At the summit one of them noticed a circling Andean vulture, and they joked that it might be a grim omen. Others noticed that one of their most experienced riders was looking distinctly grey. Roger Kirby, a 62-year-old professor of urology, was taking part to raise money for the Urology Foundation. He had been on similar rides in Malawi and Madagascar and prided himself on his ability to keep up with younger riders, but now he felt severely breathless. His father had died of a stroke following heart failure at the age of 49, and ever since he had been wary of the weight of genetics. So he resolved to have a cardiac check and some blood tests as soon as he returned to England.<br /><br><br /><br>The heart exam showed a little calcifying in the arteries, something fairly typical in men of his age, and the blood tests showed another common male attribute: a raised level of prostate-specific antigen (PSA). PSA produces the liquefying component of semen, and may ease the passage of male sperm within the uterus. It is a vital protein for conception, but when it enters the bloodstream in increasing amounts it may also indicate the growth of prostate cancer.<br /><br><br /><br>Roger Kirby had monitored his PSA level for more than a decade. At 50, it stood at 0.5, which was negligible. But it had risen gradually over the years, to 1.5 and then 3.3, which he regarded as a light flashing on the dashboard. Two weeks after getting back from South America, he took a second PSA test, and found it had gone down a little, which reassured him. Six months later, in September, he had another test and his PSA was 4.3, the highest it had ever been, so he underwent a high-resolution localised MRI scan. <br /><br><br /><br>The news wasn't good. There was a definite lesion on the right side, which his radiologist thought could be one of two things: prostatitis, an inflammation treatable with antibiotics, or a tumour. And so a biopsy was ordered, involving a local anaesthetic and a rectal probe, and the removal of 12 samples from the suspicious area.<br /><br><br /><br>The following day Kirby received a phone call from his pathologist. "Are you sitting down?" He was. "I'm afraid that three of the biopsies show Gleason 7." The Gleason scale is a grading system particular to prostate cancer, made up of two scores, each defining the advancement of a tumour and the risk of spread to other organs, with 10 as the worst prognosis. A combined score of 4 or 5 would prompt concern, and perhaps a policy of watchful waiting. But with a score of 7, Professor Kirby had a decision to make.<br /><br><br /><br>He looks boyish for his age, with a full mop of greying hair and a slightly Bunterish face, and he is not averse to wearing a rugby shirt in his leisure time. He likes to think of himself as a rather stoical, stiff-upper-lip type of Brit. But in the case of his illness his stoicism had both cause and irony: Kirby is one of the leading prostate surgeons in the world.<br /><br><br /><br>Prostate cancer—its prevalence and diagnosis, its virulence and treatment—has not been short of publicity recently, and Kirby is one of the reasons why. The fact that the disease is now regarded as both common and a common topic of conversation is partly thanks to Kirby's proselytising and fund-raising. He has written more than 200 research papers on the prostate and several books, including one called "The Prostate: Small Gland Big Problem". He estimates that he has removed more than 2,500 prostates since the mid-1980s.<br /><br><br /><br>As well as being Mr Prostate UK, Kirby has one other claim to fame: he was briefly Mr Viagra UK. As Viagra was being developed at the old Pfizer laboratories in Kent, Kirby conducted many of its safety trials (particularly on cardiovascular patients) from his base at St George's Hospital in Tooting, south London. When Viagra was announced to an excited media in 1998, Kirby was on hand as an expert, dismissing claims that it would lead to the world's adult male population spending the rest of their lives walking around like tent poles.<br /><br><br /><br>More ...<br /><br><br /><br><a href="http://moreintelligentlife.com/content/ideas/simon-garfield/prof-roger-kirby?page=full&utm_source=Daily+Newsletter&utm_campaign=266acda8e6-Newsletter&utm_medium=email">http://moreintelligentlife.com/content/ideas/simon-garfield/prof-roger-kirby?page=full&utm_source=Daily+Newsletter&utm_campaign=266acda8e6-Newsletter&utm_medium=email</a>

A delicate operation - Intelligent Life - The Economist

THE SCENERY WAS like nothing they had ever seen before. Last March, 47 cyclists had negotiated a 27km climb to the Puyehue Pass on the borde...

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