Meg Burgess, Prostate Cancer UK specialist nurse, discusses challenges and opportunities for early diagnosis of prostate cancer.
Prostate cancer is the most common cancer in men, affecting one in eight men in their lifetime. If it’s caught early, there’s a good chance it can be cured.
Sadly, too many men are still being diagnosed too late for curative treatment to be an option. This has been exacerbated by the impact of the Covid-19 pandemic and made worse by existing health inequalities.
Primary care professionals have an important role to play in raising awareness of prostate cancer and supporting conversations that lead to earlier diagnosis.
A dramatic drop in referrals
As part of Prostate Cancer UK’s specialist nurse team, I provide confidential support and information to men and their loved ones about prostate cancer. During the pandemic, we received a lot of calls from men who were concerned it had become much harder to speak to their GP about prostate cancer. This contributed to a massive drop in prostate cancer referrals. and we estimated that at least 14,000 men went undiagnosed during the first two years of the pandemic, potentially missing out on life-saving treatment.
To tackle this, Prostate Cancer UK launched a campaign with NHS England to help find these 14,000 men. The campaign promoted our 30-second online risk checker tool, which helps men understand their risk of prostate cancer and supports them to make an informed choice about the PSA test.
Health inequalities in prostate cancer
Although referrals are now rising following the pandemic, there is still huge variation in late diagnosis both regionally, and in relation to health inequalities.
A quarter of black men will get prostate cancer and they are twice as likely to die from the disease than other men. Men with a family history of prostate cancer are also two to four times more likely to be diagnosed.
Meanwhile, while those from areas of socio-economic deprivation are 29% more likely to be diagnosed with late-stage, incurable prostate cancer than those from the least deprived areas.
This is why at Prostate Cancer UK we strongly believe that clinicians should be taking a more proactive approach to discussing PSA testing with those men who are at highest risk of late diagnosis.
Busting the myths around PSA testing
The PSA blood test is often the first step to diagnosing prostate cancer, and all asymptomatic men have the right to a PSA test from the age of 50, as long as they have thought carefully about the implications.
We’ve known for some time now that testing more men reduces prostate cancer deaths, but there have always been concerns about how many men could face harms from unnecessary tests and treatments to achieve this. is clear that men should be supported to make an informed choice as to whether a PSA test is the right thing for them.
Since this guidance was established, the pathway to diagnose prostate cancer has changed. Diagnosis using multiparametric MRI (mpMRI) scans and a different type of biopsy makes the pathway significantly safer and more accurate. On average, 67% fewer men experienced harm during the diagnostic process.
Prostate Cancer UK believes that this may have tipped the balance in favour of screening, particularly for highest risk men, such as black men, and those with a family history of the disease. We are really pleased that the UK will be reviewing the evidence, and hope they will find that harm has been reduced enough to be ready to launch a screening programme for prostate cancer.
Until then, we will continue to support men to make an informed choice as to whether they want a PSA blood test.
Supporting early diagnosis through risk awareness
Early prostate cancer doesn’t usually have any symptoms, which means the only way to tackle late diagnosis is to raise awareness of who is at risk and encourage them to speak to their GP about it.
Primary care professionals play a vital role in facilitating these conversations and supporting early diagnosis. Sharing Prostate Cancer UK’s 30-second online risk checker can help men come to an informed decision about the PSA test and support them to have this discussion with their GP.
If you have any questions about prostate cancer, or want to signpost one of your patients to our service, you can call Prostate Cancer UK on 0800 074 8383 or find us online at prostatecanceruk.org
