First, the bad news from two recent studies. Prostate Cancer (PCa) remains the commonest cancer in UK men with 47,000 new registrations each year and it is the second commonest cause of cancer deaths at 11,000 each year. Despite this a new survey conducted by the charity Prostate Cancer UK confirms that British men remain amazingly ignorant of this potential threat. It showed that of 1,900 men questioned, 17% had never even heard of the prostate, 54% didn’t know where it was and 92% didn’t know what it did! Couple this to a generally negative view of PCa screening held by many GPs and it helps explain why our death rate from PCa is poor compared with similar western countries.
A second worrying statistic from a new Northwestern Medicine study in the USA reports a national 72% rise in new cases presenting with advanced, incurable, metastatic PCa from 2004-13 with the largest increase in 55-69 year olds. This is exactly the age group for whom there is an international consensus that Prostate Specific Antigen (PSA) screening should be targeted.
Over the past decade in the USA there has been a substantial reduction in the number of men screened and the number of new cases has declined. Though this alarming trend may not be solely down to lack of screening, it is clearly a major contributory factor.
The good news is that the latest screening trial results from Europe are showing that if you are in an organised PCa screening programme using the blood test PSA from your 50s onwards, you can cut your risk of death from PCa by 40-50%. Furthermore, if you do have an abnormal PSA, increasing use of MRI scanning before invasive prostate biopsies greatly improves our ability to decide whether a biopsy is necessary and if it is, greatly improves the accuracy of the procedure. This leads on to an avoidance of unnecessary treatment for many harmless cancers and ensures better identification for early curative treatment for the dangerous ones.
There is more good news for men diagnosed with PCa. Many such patients ask what they themselves can do to help combat the cancer. There is some evidence to suggest certain diets may help but nothing else till now. A research team from Atlanta, Georgia, led by Dr Ying Wang has shown that in 10,000 men with PCa that had apparently not spread elsewhere at the time of diagnosis, exercise reduced subsequent PCa mortality. Those doing more than 17 hours exercise per week before their diagnosis reduced their chance of death from PCa by 30%. Also, very encouragingly, a 34% reduction occurred in men who only started to exercise after their PCa had been diagnosed! Walking was the main type of exercise but the maximum benefit was seen in men with a varied exercise regime such as gym work and swimming.
All this information continues to point to the need for UK men to become much more aware much earlier about what can go wrong in the future. It also means our GPs, upon whom PCa screening depends, need to be supplied with up to date evidence from trials and best clinical practice so that they can provide sound counselling and allow their patients to make informed decisions for their future health.
NB: If you have a family history of PCa or breast cancer on your mother’s side OR if you are a black African or African Caribbean man, you may have a much higher risk of PCa and need to discuss being in a screening programme.