By Mr Luke Stroman, Consultant Urological Surgeon, The Urology Partnership
Prostate cancer has been increasingly in the media recently, particularly with the news of the diagnosis of Sir Chris Hoy, who has been bravely sharing his story. Like many men diagnosed with the disease, Sir Chris did not have any urinary symptoms. This is one of the main challenges facing patients and urologists who are aiming for early diagnosis and cure. We know that one in eight men will be diagnosed with prostate cancer in their lifetime but this raises to one in four if black or African-Caribbean origin of or if the man’s father or brother has been diagnosed with the disease. Other risk factors include increasing age and genetic factors such as the BRCA2 gene, which can be related to breast, ovarian and pancreatic cancers.
Testing for prostate cancer is usually done through a blood test called prostate specific antigen (PSA), a protein produced by the prostate gland, which can be done through your GP. The National Institute for Health and Care Excellence (NICE) allows PSA testing be performed on all men 50 and older who request a PSA test. Given the higher risk to certain groups, a Prostate Cancer UK consensus concluded that black men and men with a family history of prostate cancer aged 45 years and over should have a proactive discussion about prostate cancer and PSA testing with their GP.
While the majority of men who are diagnosed with prostate cancer do not have any symptoms of the disease, symptoms can include difficulty in urination and poor urinary flow. Prostate cancer is not the only cause of these symptoms, which can also be caused by benign (non-cancerous) prostatic growth causing urinary tract obstruction. Features of more advanced prostate cancer include weight loss, new lower back pain and blood in the urine and men with these symptoms should seek medical advice.
Currently prostate cancer screening in the UK is a contentious topic and a routine screening programme is not in place. The reason for this is that a large UK based study showed that PSA was not sensitive or specific enough to justify screening all men and would lead to too many false positive and negative PSA tests. However, this is a space for research and there are trials ongoing looking at using MRI or genetic testing for prostate cancer screening and we would expect that this might change practice in years to come.
If you are found to have a raised PSA then you will likely be referred to a urologist for a MRI scan of your prostate which will look for any abnormalities or potential prostate cancer tumours. If there are any suspicious areas then biopsy will be performed which will give an accurate diagnosis and tell us how aggressive the prostate cancer is likely to behave.
Prostate cancer is a broad term, encompassing some cancers that men can live with and monitor lifelong, some that require urgent treatment to cure and some, such as in the case of Sir Chris Hoy, that metastasise and escape the prostate. There are treatments available to all prostate cancers and the correct treatment will depend on the individual and the disease.
Would I encourage a man to get a PSA blood test? Yes, particularly if they are in a high risk group. I believe that all men with a family history or in a high risk group should have a blood test from the age of 45 and would be prudent to have this monitored. Men who develop changes in their urinary symptoms over the age of 50 would also be prudent to have this investigated.
Sir Chris Hoy’s courage and positivity in announcing his diagnosis has been inspiring for us all who treat men with prostate cancer as well as for prostate cancer sufferers and survivors. The hope is that this has positive impact on prostate cancer research, earlier PSA checks and in turn saving the lives of many men.
For more information, visit: PSA: https://theurologypartnership.co.uk/treatments/raised-psa/ and Luke Stroman: https://theurologypartnership.co.uk/specialist/mr-luke-stroman/
