The Manual: We answer questions raised by EastEnders’ prostate cancer storyline

Earlier this week (Monday 17 November) EastEnders’ Stan Carter revealed that he has advanced prostate cancer. And he's been keeping it secret from his family for a long time. We’ve been working closely with the show’s writers to advise on the detail and accuracy of the storyline. We really believe this story will make more men aware of the disease and we hope many will want to find out more. So here we address some of the questions Stan’s story may raise for anyone watching the show.

If you're diagnosed with prostate cancer is it very likely it will kill you?

Prostate cancer often grows slowly and has a low risk of spreading, so it may never cause you any problems or affect how long you live. Because of this, slow-growing prostate cancer might not need to be treated. You might be able to have your cancer monitored with regular check-ups instead. But some men will have cancer that is fast-growing and has a high risk of spreading. This is more likely to cause problems and needs treatment to stop it spreading outside the prostate. You can read more here about different stages of prostate cancer:

• Localised prostate cancer
• Locally advanced prostate cancer
• Advanced prostate cancer
  

Once you have advanced prostate cancer is chemotherapy the only treatment option?

If a man is diagnosed with advanced prostate cancer then he is usually given first line hormone treatment – hormone therapy in the form of a monthly injection. Hormone therapy can’t cure prostate cancer, but it may keep it under control for several months or years. But over time this may stop working so well.  

There are now several treatments available if first line hormone therapy is no longer working so well, including chemotherapy and other types of hormone therapy such as abiraterone and enzalutamide. There is lots of research under way looking at developing new treatments for men with advanced cancer and men can also get involved in clinical trials after discussing with their doctor. Read more about clinical trials here.

In the show Stan refuses chemotherapy.  Is that common because it
is so awful?

Everyone will make different choices about their treatment based on their own experience, situation and preferences. Every treatment has pros and cons and it’s up to each person to weigh up all the options with their doctor or nurse to make the right choice for them.

Like all treatments, chemotherapy can cause side effects. The side effects will affect each man differently, and you may not get all of them. Most of them are temporary and will gradually go away after you finish treatment. There are treatments available to help improve side effects, and things you can do yourself to help manage them.

Cora turns her back on Stan when she finds out he has prostate cancer.
Do a lot of men lose their relationships as a result of the disease?

Everyone’s relationship is different. Dealing with a serious illness such as prostate cancer can affect your emotions, relationships and wellbeing. Relationships may change, and these changes may be difficult to come to terms with. But some couples find that they become closer.

We’re working with Relate to offer counselling sessions to individuals, couples or family members affected by prostate cancer through our online chat service, Relationship Chat.

In the show Stan’s Tina tells him to cut down on the greasy food, coffee and alcohol. Can eating more healthily help combat cancer once you’ve been diagnosed?

There is some evidence that certain foods may slow down the growth of prostate cancer or reduce the risk of it returning after treatment. Some research also shows that physical activity can help to slow down the growth of prostate cancer, and help with some of the side effects of treatment. And being a healthy weight may help to reduce the risk of advanced prostate cancer and medical problems such as heart disease, diabetes and other cancers.

At the moment this evidence is limited and we need more research to show clearly how different foods may be able to help. However, by eating healthily and being physically active you can take more control of your health and do something to improve it. You can read more here.

In the show Stan seems to have kept his prostate cancer secret for a
long time. Do a lot of people find it hard to admit having cancer and telling family?

Everybody reacts to a diagnosis of cancer differently. Some people can find it difficult to come to terms with being diagnosed with cancer, or hold back from sharing with loved ones because they want to protect them. There are lots of support services available to help men and their families cope with diagnosis or going through treatment. You can find out more about the type of support available here:

• Coping with your diagnosis
• Living with prostate cancer
• Prostate cancer – the emotional impact
• Support for partners and family

What is the difference between first and second line hormone therapy?

Testosterone controls how the prostate gland grows and develops. Hormone therapy works by stopping the hormone testosterone from reaching prostate cancer cells. It treats the cancer, wherever it is in the body. Men might be offered hormone therapy as a first treatment – for example, if a man is diagnosed with advanced prostate cancer he is usually given hormone therapy. You might hear this called first line hormone therapy. Hormone therapy can’t cure prostate cancer, but it may keep the cancer under control for several months or years.

Over time, the cancer may stop responding to the hormone therapy. There are other types of hormone therapy, such as enzalutamide and abiraterone, available for these men, which may control the cancer. These are sometimes called second line hormone therapy.

Enzalutamide or abiraterone are not mentioned as alternatives to chemotherapy. Wouldn’t a man be offered these if he does not want chemotherapy?

Once the first line hormone treatment stops working the first option offered to a man may be chemotherapy. If the man does not want chemotherapy then his doctor may also look in to enzalutamide or abiraterone. However if the man’s wishes are not to have any more treatment then this is his choice. Every man should have the opportunity to discuss different treatment options with their doctor and come to an agreement about a way forward together.

I still have questions

If you have more questions about anything you’ve read here, our Specialist Nurses can help. And if you are worried about prostate cancer you should speak to your GP or our nurses.