‘Too many men are dying from prostate cancer needlessly – earlier detection can save lives'

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a day ago

David James is director of patient projects and influencing at Prostate Cancer Research, a leading British charity advancing prostate cancer treatment
Prostate cancer is the most common cancer currently affecting men in the UK. Last year, more than 55,000 men were diagnosed in England (where we have the most recent data). It's also the second most common cause of death by cancer, with more than 12,000 men in the UK dying from the disease every year. Sadly, projections suggest this figure will only increase during the next 15 years.
My motivation for getting involved in this area is actually three-fold. At a very young age, my mother died of brain cancer. I saw the impact of that being caught late and the implications for my life and our family's life. I have an uncle who developed prostate cancer (he's fine now) and also my father was recently diagnosed, quite early, so it's being monitored.
Currently, we have the Informed Choice system, which, technically, is the Prostate Cancer Risk Management Programme. What that means is, if you have no symptoms, but are over the age of 50, you can request a PSA blood test from your GP (this measures a substance that occurs naturally in the prostate – a high score can be an indicator of cancer but can also be unrelated). Younger men should be able request a test if they are in a high-risk category, too. You are supposed to be given the test once you have been counselled about the pros and cons.
The problem with this approach is really the guidance, which is pretty poorly understood both by members of the public and clinicians. The guidance leads to huge inequalities in the system. There are examples of men being turned away time and time again, sometimes men with cancer that could have been caught early.
Why are men not getting tested?
I was speaking to a man in his late 40s the other day. His name is Mark, he has three kids and has been diagnosed at an advanced stage. He'd been trying to get a test and was turned away. This is because of the confusion around these guidelines. Although he was under 50, he was in a high-risk group because he has a family history of the disease.
If members of your family have had prostate cancer, you are high risk. If you are black you are about twice as likely to have the illness. There are also certain gene mutations that increase risk. We have polled GPs, and many don't know about the higher-risk categories, so there is an inconsistency in the way the guidelines are being implemented.
Doctors are supposed to counsel patients about potential harms and benefits of different treatments and the limitations of the PSA blood test. Like any other health problem, it should be up to the individual to make an informed choice – that's what the system is designed for. But a GP may not be up to date with the latest diagnostic and treatment techniques or have some historical objection to screening.
If a man has plucked up the courage to ask his GP for a test and is told to go away, that undermines their attempts to be proactive about their health. Prostate cancer in its early stages is usually symptomless. If we don't want to see people dying from late-stage disease, the key is to catch it before symptoms appear.
People who are more affluent and health-educated will actively seek out the test and be persistent until they get it because they know their rights (or they have already tested positive privately). Men from areas of socio-economic deprivation are 29 per cent more likely to be diagnosed with late-stage, incurable prostate cancer.
Being invited for a test as part of a screening programme is quite different to going along and asking for one yourself. We've spoken to a lot of people. I think receiving an official letter from the NHS, or your doctor saying this is a risk we want to keep an eye on will make you feel emboldened to go. Having something official drop through your letterbox takes away the fear of needlessly troubling a busy GP, for example.
Since 2019, UK guidance has been that if a patient has a raised PSA level, then he should go for an MRI scan. And that MRI scan has been a massive game changer, because the MRI is really good at filtering out people who don't have the illness. This avoids sending patients for unnecessary biopsies.
No test is perfect, though. No test is accurate at picking up everyone who has the disease, but it is certainly better than not doing anything and we think the evidence shows significant reduction in harm and the benefits of screening.
Next-generation testing
There has been a fear of over-treatment as screening exposes people with low-risk cancers. We now see that more than 90 per cent of those people are going onto active surveillance, where they are being given a follow-up PSA and MRI every six to 12 months. If you have a slow-growing cancer, you could well live out your life healthily with no problematic symptoms and die in your sleep of old age. But if it does start to grow and become problematic, then you're in the system. We can catch it early and treat it before it spreads and becomes incurable.
Our research showed that screening people in high-risk groups is cost-effective. Treating advanced cancer is 10 times more costly than treating it at stage one. We're calling for a targeted prostate cancer screening programme for high-risk groups.
The NHS cost of a PSA test is around £33, so we could implement this fairly quickly and start catching prostate cancer earlier in these groups – then, for the general population of men over 50, let's invest in some real-world evidence gathering. We should carry out pilots on the next generation of tests. When we're confident the new tests are effective, we can roll out universal testing to all men over 50. Too many men are dying from a disease needlessly when we know that testing and earlier detection can save lives.
The NHS is working with the target of catching 75 per cent of all cancers early. At the moment, only about half of prostate cancers are diagnosed at stages one and two. So, if the NHS is to meet its target, given how significant prostate cancer is, that target is going to be impossible to reach unless we break the back of late diagnosis.
The decision is being reviewed by the Government's screening committee right now and they are due to report back this year. This is something that's also being looked at in Europe and the US.
The world is watching us right now. I'm really hopeful the UK can be a leader.
As told to Phil Hilton
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