What is prostate cancer and how is it diagnosed in the UK? | Prostate cancer

What is prostate cancer, what are its symptoms, and who are the groups most at risk?

Prostate cancer It develops in the prostate gland.

that it The second most common Cancer in the UK, second only to breast cancer, with around 55,300 new diagnoses and 12,200 deaths each year. It is the most common cancer in males. Nearly 80% of men diagnosed with this disease live for at least 10 years.

It often does not show any symptoms in its early stages. But changes in men’s urination habits — for example, the need to urinate frequently, including during the night — can indicate its presence, as can erectile dysfunction.

It mainly affects men over the age of 50. But there are three groups of men who are most at risk: black men; Those with a family history of prostate cancer, or breast or ovarian cancer in their female relatives; And men who carry the BRCA1 or BRCA2 gene variants.

Black men are more likely to contract it as well as die from it. A quarter of black men will be diagnosed with prostate cancer in their lifetime, compared to one in eight in the general male population.

Black men in England are also more likely to develop late-stage prostate cancer than their white counterparts. Socioeconomic circumstances and genetics are believed to be contributing factors to a significantly increased risk.

How is prostate cancer detected?

All men over the age of 50 can request a PSA test to check if they have prostate cancer. These men, and those in higher-risk groups, can talk to their GP about the pros and cons of having the test.

GPs no longer need to assess a man’s prostate via a rectal examination. Historically, men considered to be at higher risk were offered a biopsy, in which a needle is inserted into their prostate.

The PSA test checks the level of prostate-specific antigen (PSA) in the blood. Other conditions can cause a high PSA level, including prostate enlargement and prostatitis, not just prostate cancer.

Unlike smear tests for cervical cancer and mammograms for breast cancer, the PSA test is not a test in itself for prostate cancer. It is useful, but not final.

Although any man can ask his GP for a test, and GPs will usually refer anyone over 50 who requests a PSA test, routine PSA testing is not offered in the NHS. This is because universal PSA testing can lead to overdiagnosis of prostate cancer and lead to men undergoing unnecessary biopsies and surgical treatment, including surgical removal of the prostate.

For example, some studies have shown that Black men may have higher PSA levels than their white counterpartsThe use of PSA testing in men who do not suffer from prostate symptoms does not reduce the number of deaths from prostate cancer.

Why doesn’t the NHS screen men for prostate cancer?

The UK routinely screens people for breast, bowel and cervical cancer, but not prostate cancer, although it is common.

Detecting it is not as simple as it is for other cancers, due to the historical weaknesses of PSA testing – the potential for false positives and false negatives – and the historical lack of alternative screening methods.

The UK’s National Screening Committee (NSC), independent experts who advise ministers, is due to decide on Thursday whether the NHS should start screening all men, or those in some or all of the three highest-risk groups, for the disease.

She has come under intense pressure in recent months to rethink her position on screening. She spent months collecting and analyzing evidence.

Charities such as Prostate Cancer UK and Prostate Cancer Research say the NSC should at least approve targeted screening for men in the three highest risk groups. They say doing so would detect more cases and thus save more lives.

Lithuania (2006), Kazakhstan (2013), and Sweden (2020) have already introduced screening for many or all male citizens who are at least 50 years old.

What are the arguments for and against targeted prostate cancer screening?

Prostate cancer research insists that recent advances in diagnostic testing mean screening can be carried out with far fewer risks than those involved with a PSA test.

Men can be safely screened using a prostate-specific antigen test, followed by a pre-biopsy MRI scan – “which rules out cancer in a large proportion of cases” – and then, if necessary, a transperineal biopsy, thus sparing many of them the hassle and risks of a traditional biopsy.

“The primary safety objection to screening is essentially designed out of the system,” she says.

Prostate Cancer UK agrees. “We believe the evidence suggests that screening high-risk men is safe and more beneficial than the harms that could come from a screening program,” says Chiara Di Biasi, the organization’s director of health services, equity and improvement.

The charity says: “MRI prior to biopsy improves the detection of clinically significant prostate cancer and reduces the risk of diagnosing cancers that do not require treatment. We hope the committee agrees and we await the result urgently.”

However, others, notably Cancer Research UK, argue that there is still too much “conflicting evidence” about screening to even justify a targeted programme. “The evidence is still not very clear regarding targeted screening,” says Nasser Al-Turabi of CRUK.

What might a prostate cancer screening program look like?

the The TRANSFORM prostate cancer screening trial may provide the answer. The £42m trial is the largest and most ambitious prostate cancer screening trial in 20 years.

Its purpose is to discover the most effective and least harmful ways to screen the UK adult male population for the disease in its early stages. Three hundred thousand men will be recruited for the trial.

It is led by Prostate Cancer UK and is due to report in 2027. The NSC has agreed to look again at prostate cancer screening in light of the TRANSFORM findings. The National Institute for Health and Care Research covers £16m of the £42m cost.

The study will also look at how current testing methods, including PSA blood tests, genetic spit tests and MRI scans, can be used more effectively when screening for the disease.

Dr Sam Merrill, from the Center for Primary Care and Health Services Research at the University of Manchester, said: “Better evidence using modern methods of prostate cancer screening that incorporate the latest tests, including prostate MRI and genetic testing, is urgently needed to find better ways of detecting prostate cancer rather than relying on PSA alone.”