What’s the point in having a prostate?

Speaker: Professor Anthony Mundy PhD (Hon), FRCP, FRCS, FRACS (Hon), FACS (Hon)

Professor Mundy will ask the question “What’s the point of having a prostate?”. It could be said, almost sarcastically, that one point is to give men a source of distress, disruption and sometimes death due to the potential for prostate cancer.

Every year in the UK, more than 63,000 men are diagnosed with this malignancy. It is the most common cancer in men in the UK, accounting for approximately 30% of all new male cancers annually and for more than 12,000 deaths a year. Despite these worrying numbers, it is reassuring that for 95% of men of 70 years and above, the 10-year risk of death directly attributed to prostate cancer is less than 1%.

The routinely available screening test for prostate cancer is the prostate-specific antigen (PSA) and it has been proposed that the PSA should be offered as a routine screening test for men over 50. But the PSA is not entirely reliable, creating the risk of over diagnosis and then the potential for over treatment. The UK National Screening Committee has reviewed the evidence and, in November 2025, decided against offering regular PSA screening for all men (although there were exceptions), citing evidence that ‘harms outweigh the benefits’.

Prostate cancer treatment options are surgery, radiotherapy, chemotherapy and hormone treatment and all have their potential risks. The most common harms associated with radical surgical treatment (prostatectomy) are urinary incontinence and erectile dysfunction. Tony Mundy has a wealth of experience in performing remedial surgery for those with persistent urinary incontinence and no doubt he will discuss this unwanted consequence of prostatectomy, for which the potential might increase when mass PSA screening leads to a false positive diagnosis and potentially unnecessary treatment, including surgery. This and other complications of treatment are even more concerning when 40-50% of those cases diagnosed with certainty will be slow growing and require only regular monitoring and sometimes hormone therapy.

Notwithstanding the Screening Committee’s decision which is still subject to a consultation period, there is widespread concern that, without a reliable and full screening programme, large numbers of men will miss out on early diagnosis of prostate cancer. Thankfully, alternative screening programmes are being evaluated to determine the safest, most accurate and most cost-effective way to screen men for this all too common cancer.

To learn more on this important subject please join us at The Athenaeum and hear the views of our vastly experienced speaker, Professor Tony Mundy, and on other aspects of prostatic function and disease, mostly from a surgical perspective.

Dr Russell Cowan