Prostate news article, December 2007
| MEN ARE
STILL SECOND CLASS CITIZENS WHEN IT COMES TO CANCER -
AND ITS COSTING LIVES
The Government has ruled out a national prostate cancer screening programme, arguing the existing test is not accurate enough to justify mass checks.
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LAST week the Government ruled out, a national prostate cancer screening programme, arguing that the existing test is not accurate enough to justify mass checks.
This has angered Professor Roger Kirby, chairman of the charity Prostate UK and one of the country's leading experts on the disease, who accuses ministers of turning their backs on men's health. Every year in Britain, 10,000 men die from prostate cancer. That's the equivalent of a jumbo jet crashing every ten days. Imagine the outcry if that was really happening and the haste with which the Government would announce initiatives to stop the death toll. Contrast this with what happened last week, when ministers announced they were abandoning plans for a nationwide screening programme for prostate cancer. Frankly, I am alarmed and disappointed that this crucial area of men's health once again seems to have disappeared off the Government radar.
I look on with envy at my colleagues working in the field of breast cancer. Prostate cancer specialists can only dream of the same level of resources in research and testing. Let me state at the outset that I agree that the current test - the Prostate Specific Antigen (PSA) test - is far from perfect. First, it can sometimes give the wrong result. Some men with 'normal' PSA readings can turn out to have cancer. In addition, many men who have raised levels of PSA, and consequently suffer the anxiety of thinking they may have cancer, turn out to have another benign prostate disease that is treatable and not life-threatening. The test is also poor at identifying whether a man has a slow-growing, nonlife-threatening tumour, or a more aggressive one that is potentially fatal. In other words, it cannot tell the pussy cats from the tigers.
But that doesn't mean it is no use at all. On the contrary, I know from experience with my own patients that the PSA test can save lives. But to be really effective, it has to be used in the right way. The PSA value on its own doesn't give you the whole picture. The key factor is not the reading itself, but the degree of change since the last test and this is where it comes into its own. If a patient came to me and had a 'healthy' PSA value, I would call him back a year later for another test. That might seem a long time, but even aggressive prostate cancer develops relatively slowly. If his reading had increased, it would raise the alarm.
As there is increasing evidence that prostate cancer, like heart disease, is linked to diet and lifestyle, I think that monitoring PSA levels should be given the same priority by men as having their cholesterol and blood pressure checked. That's why I believe every man over 50 should be requesting an annual PSA check from his GP, so that any changes can be tracked closely. And if he has a close relative with prostate cancer, he should be tested from the age of 40. I have one at the same time as my other annual health checks.
The trouble is that the Government decision to abandon plans for a nationwide screening programme for prostate cancer will be misinterpreted by men. It will give them the perfect excuse to bury their heads in the sand. And, as a result, more men will die unnecessarily. GPs are supposed to advise patients on the pros and cons of the PSA test before agreeing to do it. But much of the literature they get from the Government is negative about its use, and discourages them from testing men. Many GPs won't even agree to a PSA test unless a man has other symptoms of prostate disease, either benign or cancerous, such as urgent or frequent need to urinate, or difficulty starting and stopping urine flow. It's not the cost of the test at less than £10 a time that has prompted the Government to scrap its screening plans. It's the cost of performing biopsies on thousands of men, and training surgeons to use modern, minimally invasive techniques, such as robotic surgery. What we are left with is this prevailing negativity about prostate cancer.
It was the same with breast cancer screening until women's lobby groups pushed hard for it to be introduced. British men, I'm afraid, just don't have the same attitude to their health. In America, it's a very different picture. Around 70 per cent of men know their PSA levels because they are encouraged to have regular checks. When I get a taxi in America and tell the driver what I do for a living, the first thing he'll tell me is his PSA score. Contrast this with Britain, where only about 3 per cent know their levels. Interestingly, prostate cancer deaths in America are falling. Here in Britain, the death rate has hardly changed in the past 20 years. The PSA test is not perfect: but for the time being, it's the best option we have and it's disgraceful that it's not being offered nationwide.