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Health - HEALTH NEWS - Everything you need to know about prostate cancer screening

 


20/01/2017 @ 9:16 PM
by The_Guardian

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Prostate cancer kills as many men as women killed by breast cancer. But now new MRI techniques could help identify men at risk

Benjamin Zephaniah … ‘I’ve started to lose friends to the disease.’

Benjamin Zephaniah … ‘I’ve started to lose friends to the disease.’ Photograph: PR

Prostate cancer affects one in four African-Caribbean men in the UK, and kills one in 12 – double the rate of Caucasian men. But there is no UK-wide screening programme, and you will not be tested unless you ask for it. A new campaign aims to raise awareness and encourage more black men to get tested. Boxer David Haye is one of several high-profile men fronting Prostate Cancer UK’s Stronger Knowing More campaign with help from poet Benjamin Zephaniah, former sprinter Linford Christie and Labour MP Chuka Umunna. Overall, prostate cancer kills as many men as women killed by breast cancer. Both cancers become more common as we get older, although breast cancer has a higher public profile, perhaps because it is more likely to kill women at a relatively young age. Prostate cancer usually affects older men (though last year actor Ben Stiller talked publicly about his diagnosis at the age of 48).

Prostate cancer, already the commonest cancer in African-Caribbean men, is likely to be the most commonly diagnosed cancer overall in the UK by 2030. Zephaniah says: “Prostate cancer has always been a bit hush-hush. I’ve started to lose friends to the disease.” So why the silence? And why is there no national screening programme?

Roger Kirby, professor of urology at the University of London, says the problem with a screening programme is that prostate cancer is very unpredictable: “It can be rapidly growing and kill you, intermediate or slow growing and not cause you much harm. Screening picks up all three.” The PSA [prostate-specific antigen] blood test is cheap and easy, but isn’t selective, says Kirby. “You can’t differentiate benign (non-cancerous) prostate enlargement from cancer. And you can’t differentiate slow-growing from rapidly growing cancers.” Men often end up having further investigations, such as a biopsy, that can be painful, time-consuming and anxiety-inducing.

But a major new study has found that if men with a raised PSA have an MRI scan first, many unnecessary procedures could be avoided. The study estimates that adding the extra test could help 27% of men avoid an unnecessary biopsy and reduce the number of men who are “over-diagnosed” (diagnosed with a cancer that does not go on to cause any harm during their lifetime) by 5%. MRI scanning can help to identify which men with a raised PSA have life-threatening disease. Professor Mark Emberton at University College hospital, a prostate cancer specialist, says every man with an abnormally high PSA should have an MRI. If it’s normal, he does not need further investigation or treatment. But if an abnormal area is seen on the MRI, a guided biopsy is taken. In the days before widespread MRI, biopsies were very hit-and-miss. Kirby agrees that MRI-guided biopsies cause less damage and are more likely to yield results; the samples are analysed to find the severity of the cancer.

Kirby, who has been open about his own experience of prostate cancer, advises men to get an annual PSA blood test done by their GP after the age of 50. Emberton adds that men at high risk of prostate cancer, or with worrying symptoms, should be referred for MRI testing even if their PSA is normal. This will avoid missing the 15% of cases with a normal PSA. But official NHS policy is that PSA testing is “not accurate enough” to form the basis of a screening programme. The UK National Screening Committee (UK NSC) says: “A raised PSA level can mean a man has prostate cancer, although in some cases it may miss identifying a cancer risk. It can also falsely identify a possible risk of prostate cancer, or find a slow growing cancer. This may result in some men opting to have unnecessary treatments with side effects that can affect daily life.”

However, this policy doesn’t take into account the use of MRI and guided biopsy to fine-tune the result, and find the men harbouring aggressive disease. “We’ve been wrong on cancer screening for 40 years,” says Emberton. But changing the programme to include MRI requires clinical trials, and Kirby says that may take another 10-20 years. At the moment, official advice to UK GPs says: “The PSA test is available free to any well man aged 50 and over who requests it.” But “GPs should not proactively raise the issue of PSA testing with asymptomatic men”. And “GPs should use their clinical judgment to manage symptomatic men and those aged under 50 who are considered to have higher risk for prostate cancer”.

This woolly advice may account for the confusion that reigns among doctors and patients alike. Symptoms that may suggest prostate cancer include persistent burning, difficulty, frequent, uncontrolled or bloody urination in the absence of any infection. The main risk factor is age; 80% of all men diagnosed with prostate cancer are over 65 and it remains rare under the age of 50. African-Carribean men have a higher risk of getting fast-growing prostate cancer at a younger age, which is thought to be a result of genetic and environmental factors. Between 5% and 9% of cases occur in men with a strong family history of prostate, breast or ovarian cancer. The environmental factors are unclear but rates of prostate cancer are lower in less urbanised societies and rates rise when people move to a more westernised diet and lifestyle.

There may be two reasons why a GP doesn’t encourage a man to have the test; one is obsolete ideas about the accuracy of testing. Another is out-of-date ideas about the disadvantages of treatment; radical surgery that caused relatively high rates of impotence and incontinence is being superseded by less damaging options with fewer side effects. Treatment of localised prostate cancer which hasn’t spread can also be done by active surveillance (keeping an eye with regular checks), radiotherapy including the less destructive cyberknife, or robotic surgery to remove the prostate gland.

An exciting new treatment, Vascular-Targeted Photodynamic therapy (VTP), has been developed in Israel. This involves injecting a light-sensitive drug into the bloodstream and then activating it with a laser to destroy tumour tissue in the prostate – 49% of patients treated with VTP went into complete remission, compared with 13.5% in a control group. But further trials are needed and it may be several years until it is widely available. The landscape around prostate cancer is changing rapidly; more rapidly than many GPs may be aware of. The only way you will get tested is if you ask – and the price of keeping quiet may be the difference between an early, avoidable death and peace of mind.

Further information: Prostate Cancer UK’s specialist nurses are available to talk to in confidence on 0800 074 8383 or via instant messaging at prostatecanceruk.org

Source: The Guardian

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