Prostate cancer screening ‘fails to save lives’
As BBC presenter Bill Turnbull shares his prostate cancer diagnsosis, Guy Kelly asks why we know so little about the ‘silent killer’
SCREENING for prostate cancer does not save lives and may do more harm than good, a study has concluded.
The largest ever trial of PSA tests – which all men over 50 can obtain on request from their GP – found that the screening made no difference to death rates. Inviting symptomless men for the one-off blood test detected some tumours that were unlikely to be harmful, while missing others that were fatal, researchers warned.
The study, funded by Cancer Research UK, follows a long debate about whether the NHS should introduce routine screening using the tests.
Prof Richard Martin, the lead author and a Cancer Research UK scientist at the University of Bristol, said: “Our large study has shed light on a highly debated issue. We found offering a single PSA test to men with no symptoms of prostate cancer does not save lives after an average follow up of 10 years.
“The results highlight the multitude of issues the PSA test raises – causing unnecessary anxiety and treatment by diagnosing prostate cancer in men who would never have been affected by it and failing to detect dangerous prostate cancers.”
While some forms of prostate cancer are aggressive, most do not cause any symptoms. But it is not possible to distinguish between the two types using the test for PSA – which stands for prostate-specific antigen, a protein produced by the gland. The trial included 400,000 men aged 50-69. The findings were published in the Journal of the American Medical Association.
In cases of prostate cancer, it seems almost an inevitability. After the crushing diagnosis, the regret: realising you could, and probably should, have had yourself checked earlier. Yesterday, the veteran broadcaster Bill Turnbull revealed he is engaged in an unwinnable battle with the disease. Since his November diagnosis the cancer, he said, has spread to the bone in his legs, hips, pelvis and ribs, becoming inoperable.
The 62-year-old’s announcement that he is one of the 40,000 new cases of prostate cancer – which recently overtook breast cancer to become the UK’S third deadliest form of the disease, behind lung and bowel – to be diagnosed every year came with a familiar note of frustration. According to his former BBC Breakfast co-host, Sian Williams, who interviewed him for Radio Times, he had been proud of not visiting a doctor for four years – an all-too-common badge of honour for men – having had the all-clear from prostate cancer checks at the ages of 40 and 50.
“Well, it’s stupid, really. I’m cross with myself,” said Turnbull. “Maybe if I’d got it earlier and stopped it at the prostate, I’d be in a much better state.”
It is an age-old issue, that of men feeling too stubborn; too proud, busy or embarrassed, to consider “belowthe-belt” health – or simply being unaware of their own bodies. As a consequence, they neither take themselves to the doctors for a check-up nor notice potential symptoms.
It’s an attitude that has never been so dangerous: a man dies of prostate cancer every 45 minutes in the UK, making it the most common form of cancer in men, affecting one in eight at some point in their lifetime. At this rate, it is set to become the most commonly diagnosed cancer by 2030.
“If you’d asked me before I was diagnosed, I wouldn’t have been able to tell you what a prostate does, and most of my friends probably still can’t,” admits Tony Collier, a 60-year-old accountant from Altrincham, who was diagnosed with terminal prostate cancer, which had spread to his pelvis, last May when he investigated what he believed was a persistent groin strain during ultra-marathon training. “Men are pretty useless, aren’t they? It’s a macho thing, and we need to break that taboo” – not helped, he adds, by some of the “entirely emasculating” side-effects such as a loss of libido, no erections, fatigue and hot flushes.
Collier admits that, until his diagnosis, he was unaware of what prostate cancer actually was. Despite its potency, 54per cent of men don’t know where the prostate gland is on the body, according to Prostate Cancer UK, while 17per cent are unaware they have one, and an almighty 92per cent don’t know its function. To shed some light: it is a gland the size and shape of a walnut, and only men have it. It sits underneath the bladder and surrounding the urethra, can become swollen, and has one main role: producing semen, the fluid that carries sperm through the urethra.
According to the charity’s deputy director of research, Dr Matthew Hobbs, identifying the illness can prove challenging – unlike breast or testicular cancer, there is no quick “self-check” that men can undertake in the shower. Nor, in a lot of cases, are there any symptoms.
Turnbull noticed his “pee pattern” had changed (one of the few potential outwards signs of cancer), but understandably put that down to getting older. “It isn’t completely straightforward,” says Dr Hobbs. “It requires a bit of a conversation, and that’s one of the problems we have: we don’t know a lot.”
Lloyd Pinder, an insurance broker from Yorkshire, was one of those who found he had the “silent killer” without any symptoms. Two years ago, aged 44, fit and healthy, he had deemed prostate cancer “an older man’s disease” unlikely to affect him.
“You do your research on Google and what does it say: frequent visits to the toilet, aching bones… that wasn’t me. A potential link to breast cancer on your mother’s side, that wasn’t me either. It wasn’t hereditary, I’m not black [there is an increased likelihood of prostate cancer in black men] and no one in my family had suffered from it. I didn’t think there was anything to worry about,” Pinder, a father of two young daughters, says.
What he did have, however, was blood in his semen, which was cause enough to send him to his doctor. He’d previously seen a locum GP, who’d checked his prostate and declared him healthy, yet a process of elimination meant he was ultimately diagnosed with the disease months down the line.
“I was told that doctor must have had ‘short fingers’, which shows there are still people out there misdiagnosing, which is worrying,” he says of his illness, which is terminal.
“You don’t feel like you’re going to die, that’s the weird thing,” Pinder, who is attempting to treat his illness with a testosterone suppressant taken four times a day, explains.
Last October, Prostate Cancer UK stated that 72,513 pieces of research had been published on prostate cancer since 1999, while 146,000 had been published on breast cancer – no wonder, perhaps, that understanding of the disease remains so limited. Indeed successful awareness campaigns such as the “pink ribbon” symbol, supported by celebrities from Liz Hurley to Millie Mackintosh, have helped fund major research breakthroughs in breast cancer over the past two decades; it is now hoped that, with the likes of Turnbull, Stephen Fry (who revealed his own diagnosis, caught early enough for successful treatment, with a Youtube vlog last month) and former Rolling Stone, Bill Wyman, speaking out, that awareness will be heightened.
Yet a major stumbling block remains: just how little is known about how best to identify the disease.
‘I want to be the first person who can say a terminal diagnosis is not terminal’
Just today, the PSA (Prostatespecific antigen) test – the screening test for prostate cancer that men over 50 on the NHS can currently ask their GP for – has been shown to be far less effective than believed. The largest ever prostate cancer trial, conducted over 10 years by Cancer Research Uk-funded scientists, compared 189,386 men who were invited to have a one-off PSA test (in which a blood sample is taken) with 219,439 men who were not invited for screening; a decade later, the percentage of men from both groups dying from prostate cancer remained the same.
“We know the PSA test isn’t perfect, and that means it can’t be used as a straight screening tool, so it means we need better tests,” Dr Hobbs concedes. “Our immediate message to men is to speak to your GP, understand what the cancer is, what it can do, and what can be done, because there often won’t be any symptoms and the all-clear does not mean an all-clear for life.” Alongside radiotherapy and chemotherapy, immunotherapy, laser therapy, and a robotically assisted prostatectomy are being explored as areas for research that may yield hope for sufferers.
For Pinder, whose “life expectancy could be a few years or it could be more”, he can only hope that a new treatment will extend the years he has left. “But I believe in a positive attitude,” he says. “I want to be the first person who can say a terminal diagnosis is not terminal.”