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Why We Urgently Need To Start Screening For Prostate Cancer
Pressure is building on health service decision-makers to take action on prostate cancer screening. Prostate Cancer Research has launched a landmark report making a strong economic case for wide-scale testing.
The leading UK's charity for prostate cancer presented their findings at a celebrity-packed event at the House of Commons last month.
Wes Streeting, the Secretary of State for Health and Social Care, shared a platform with Conservative MP James Cleverly and Oscar-winning director Sir Steve McQueen and all three spoke passionately about their determination to improve early cancer detection.
Talking to an audience that included Gary Lineker, James Corden and Claudia Winkleman, Sir Steve told how he lost his father to the illness. In a powerful speech, he said his resulting vigilance and ability to fund his own health tests revealed that he too had developed the condition.
Among the high-profile figures was Nick Jones, the founder of the Soho House members club empire. Jones was diagnosed in 2022 and is a trustee of Prostate Cancer Research. His openness about his illness and its side effects has helped change the national conversation around the disease.
Soho House founder Nick Jones has been open about his prostate cancer diagnosis - Jamie Lorriman
Prostate cancer is the most common cancer in men in the UK, with approximately 55,000 new cases reported every year. Around 12,000 men die from prostate cancer annually compared to around 11,400 women killed by breast cancer.
Prostate Cancer Research says technology has moved on to the point where the cost-benefit justifications for a national programme of testing are beyond question. The Government, they say, needs to update its policy – fast.
The current position is anyone over 50 can ask for a PSA blood test. The NHS website says: "PSA tests are not routinely used to screen for prostate cancer, as results can be unreliable." But that position is being reconsidered. Alongside the evidence presented by Prostate Cancer Research, Sir Chris Hoy, 48, revealed that he was diagnosed with incurable prostate cancer last year. His case exposed the possible consequences of discovering the disease too late.
The new report from Prostate Cancer Research argues that screening technology is becoming cheaper and more effective while late-stage cancer treatments are becoming more costly. A five-year screening programme for high-risk groups 45-69 could result in a positive impact of £54 million, it says. The report points out that a 55-year-old man diagnosed at Stage 1 will cost society £0.9 million over a lifetime whereas the same man diagnosed at Stage 4 will cost closer to £2 million.
Oliver Kemp, the chief executive at Prostate Cancer Research, says: "The evidence is already there. With the tools we already have, screening would save a lot of lives. If you focus on really specific groups it saves you the £120,000 per person for late-stage treatment costs. We're allowing people to die and it's costing us money."
The charity is asking for a screening programme for high-risk groups aged 45-69 (black men and men with a family history of the disease) using currently available technology. They also want trials of new and already promising tests that can improve the accuracy of diagnosis and for that to lead to screening of the wider general population 50-69. These tests are currently both expensive and in need of large-scale data but could hugely impact the accuracy of screening if they were ramped up.
Even without more advanced tests, the arguments against prostate screening with current approaches and many of the fears about testing, are out of date, according to experts in the field.
Why we haven't had a national prostate screening programme to date?If a man were to ask for a prostate cancer test the standard first blood test would be to check for levels of PSA (prostate specific antigen) in the blood. For men aged 40-50, a test result over 2.5 nanograms of PSA per millilitre of blood requires further investigation. But the test is imperfect.
Nick James is a professor of prostate and bladder cancer research at the Institute of Cancer Research and the Royal Marsden Hospital in London. He explains: "Men without prostate cancer could have a raised PSA and some men with really nasty cancer won't have a raised PSA at all. PSA is a protein produced by prostate tissue and its normal function is to help liquefy semen. It's meant to be there."
Cancer cells cause PSA to rise. "If you have a cancer in your prostate the blood supplies grow haphazardly and they leak, so more PSA leaks into the blood supply."
However, small early cancers do not produce very much PSA and other factors such as ageing can raise PSA without indicating cancer at all.
In the past, a raised PSA would be followed up by an ultrasound which, Prof James says, is a poor way to locate the cancer within the prostate. These would then be followed up by a biopsy because so little information could be gleaned from the scan. Biopsies involve hollow needles being inserted into the gland. "In the past you had a transrectal biopsy, entering through the rectum, and that meant a risk of introducing faecal bugs into the prostate. There was a significant infection rate from that and a not insignificant death rate from sepsis."
Given the ambiguity of the result and the risks of follow-up testing, the decision not to offer screening was the correct one, Prof James says. However, the picture is very different now.
The MRI game-changerThe transformative innovation was the switch from ultrasound to MRI scans in conjunction with the initial PSA blood test. The MRI scan is non-invasive and has a high degree of accuracy. MRI goes a long way to compensate for the vagaries of the PSA.
Prof James also points out that even in isolation the PSA is no more or less imperfect than other comparable screening technologies. "Generally speaking, you have to screen about 300 men to stop one man dying from prostate cancer. That's about the same as mammography to stop one woman dying of breast cancer. It's rather less than bowel cancer screening. As a screening test it performs as well as breast cancer and better than bowel cancer."
MRI scans mean a big reduction in the number of needless treatments, "Once you put MRI in the mix you can identify with a high degree of probability areas in the prostate likely to contain the cancer and also whether it's a clinically significant cancer that you want to treat. If you look at the people in our clinic now with a high PSA, for half of them there's such a low risk of having anything that matters, we're not even going to biopsy them at all," says Prof James.
The much-feared biopsies are now safer. The vast majority are no longer undertaken via the rectum. The standard approach is now to go in via the perineum. Prof James says: "By doing biopsy through the perineum the risk of sepsis is massively reduced. It's about as painful as having a filling. People come in, have the biopsies and go home, it's usually a day procedure."
Kemp would like a new generation of blood and saliva tests developed to the point where they can be introduced between PSA and MRI. "We are asking the Government to roll out reflex tests (follow-up tests which use the biomarkers of cancer) and build up the evidence base. These tests have close to 90 per cent sensitivity. If you add in another filter you reduce over-treatment and over-diagnosis. We met one tester last week who has a product that is 99 per cent accurate."
Men are reluctant to request a PSA test but will go if invitedHe also says moving from offering tests to inviting men for tests will transform awareness and the numbers reached by the health system. "The number of black men (a high-risk group) who are aware they are more vulnerable to the disease has only risen from 24 per cent to 31 per cent over the last 10 years. We are not doing well at awareness."
Men can be reluctant to ask for a medical test but are very willing to answer an official invitation. "My grandfather never went to the doctor in 60 years but would have done so if he'd been told to. In our research, 80 per cent of black men told us they'd be willing to go for a test if invited." Eventually, however, Kemp would like to see all men over 50 invited for screening, once the new biomarker tests are in place.
The Government is listening. A spokesperson for the Department of Health and Social Care spokesperson says: "Prostate cancer patients are waiting too long for diagnosis and treatment, and we are determined to change that. The UK National Screening Committee is actively looking at all the evidence for prostate cancer screening programmes including targeted approaches for those at higher risk such as people with a family history."
The UK National Screening Committee examines all screening opportunities and makes recommendations to the Government. It is made up of experts and is currently chaired by Sir Mike Richards, a professor and practising physician for over 20 years, prior to taking up roles in industry bodies including serving as the Chief Inspector of Hospitals.
A body of evidence is mounting and those in charge of policy are being asked to make prostate cancer screening as much a part of life for men as breast cancer screening is for women. The Lancet Commission on Prostate Cancer published earlier this year predicted rising case numbers around the world. The clock is ticking on this crucial area of health policy.
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Men's Health: Signs To Get Prostate Cancer Screening
Prostate cancer is one of the most common cancers in men. According to the American Cancer Society (ACS), approximately one in eight men will be diagnosed with prostate cancer during their lifetime. Individual risk factors can vary based on age, race, and other variables. However, early detection is crucial, as it ensures effective treatment before the cancer advances and spreads to other organs. While prostate cancer is often asymptomatic, regular screening is essential. However, if symptoms do appear, prompt testing and medical attention are crucial for early diagnosis and better outcomes. Read to know all about the warning signs and when to get screened for prostate cancer.
Also Read: What Young Men Need To Know About Prostate Cancer Prevention: Tips To Reduce Risk
At What Age Should Men Get Themselves Screened For Prostate Cancer?"In general, high-risk individuals, such as those of African descent, those with a family history of prostate cancer or multiple cancers, those with Lynch syndrome, or those with known high-risk germline mutations like BRCA2, should begin annual Prostate-Specific Antigen (PSA) screenings for prostate cancer by the age of 45," says Dr Pratik Patil, Consultant - Oncology, Jupiter Hospital, Pune.
He added, "For males at average risk, screenings should begin no later than 50 years after a thorough discussion of the benefits and drawbacks of such testing. The testing should continue until the patients are 70-75 years old.
"Due to the substantial variability of PSA testing findings, it is advisable to collect two different specimens before undertaking additional investigations in individuals with abnormal PSA increases."
Warning Signs To Get A Prostate Cancer ScreeningEarly-stage prostate cancer is rarely symptomatic. However, when the condition progresses, the condition may cause certain symptoms, such as:
Screening for men at low to moderate risk may begin between the ages of 45. Men of low to moderate risk, aged 55-69, may be screened every 2-4 years.
Men 75 years or older with a PSA <3 ng/mL may have their rescreening interval extended or possibly stopped.
Also Read: Prostate Cancer Awareness Month: Expert Explains When, Why, And How Often Should You Be Screened?
Factors That Increase The Risk Of Prostate CancerSome of the most common risk factors for prostate cancer include:
In addition to identifying the signs, there are various tests that can help confirm prostate cancer. Screening tests can reveal whether you have symptoms of prostate cancer that necessitate additional testing. These include:
If you have high PSA levels, it might suggest malignancy. However, an elevated PSA level does not necessarily mean prostate cancer. PSA levels grow even if you have benign illnesses like Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, or prostatitis, a condition that causes inflammation or infection of the prostate gland.
ConclusionProstate cancer can be life-threatening, especially if detected late or left untreated. Early warning signs are crucial for timely detection, and screening tests play a key role in confirming the condition. Regular and timely screenings are essential for early diagnosis. Don't wait for pain or severe symptoms to appear; prioritise your prostate health and schedule regular check-ups for early intervention.
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New Test Can Detect Nearly All Prostate Cancers
By ROGER DOBSON, Daily Mail
Prostate cancer testing, currently renowned for inaccurate results, is set to improve with the development of a new test.
And as a result, it is hoped screening for all men over 50 will become much more viable.
Although prostate cancer kills around 10,000 men a year in Britain, with up to 400 men a week discovering they are sufferers, it has been impossible to undertake universal screening until now.
The major problem has been that the existing test not only misses up to a third of all cancers, but also produces a large number of false positives, with up to three out of four positive results turning out to be negative.
Many men who have tested positive to prostate cancer have had to go through distressing and costly biopsies unnecessarily, while the test has failed to pick up the illness in those who are actually suffering from it.
The original test measured the amount of prostatespecific antigen (PSA), a chemical made by the gland, in the blood. Higher than normal levels can be one clue that cancer has developed.
However, PSA levels increase with age and a high figure can be caused by other noncancerous conditions, including inflammation of the prostate, benign prostatic disease, and enlargement of the prostate.
A second problem is that some men with prostate cancer do not have high enough levels of PSA to raise the alarm.
'Our objective has been to design a better test that is more specific for cancer, and doesn't create false positives,' says David Corber, chief executive of Matritech, which developed the new test.
Known as NMP48, it works by detecting a protein in the blood which is found only in cancerous cells of the prostate. The test detects 96 per cent of cancers.
'The discovery of the NMP48 protein and the resulting test will significantly improve testing for prostate cancer.
Not only is it highly accurate, but it also does not create a positive result in a benign condition,' says Mr Corber.
The new test could be on the market shortly. 'We have a strategy that would allow us to be on the market in the UK and elsewhere as early as the beginning of next year,' he says.
'Our objective is to get the test out there as soon as possible because the earlier men are diagnosed, the better their chances of survival.'
The team which developed the test is already working on the idea of a DIY kit version that could be carried out quickly and simply at home.
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