Why I’m pleased the number of men diagnosed with prostate cancer has gone UP

From a top cancer expert, a surprising verdict

SOME people reading about the latest cancer statistics might wonder why I am celebrating a sharp increase in the number of recorded cases of prostate cancer.

The figures show just under 50,000 men were diagnosed with the disease, a full 8,000 increase on the year before, which means it has replaced breast cancer (47,476) as the most common form of what we used to call ‘the big C’.

But actually that is not bad news. It is a tribute to men as diverse as Rod Stewart, Stephen Fry and BBC presenter Bill Turnbull who have spoken openly and articulately about their experiences. Men are no longer prepared to do what too many of their fathers did — die of shame rather than confront symptoms which once were considered embarrassing in parts of their body formerly regarded as unmentionable.

Worry

The new prostate awareness is due to brave individuals and groups, including the Mail’s End The Needless Prostate Deaths campaign, and means we are prepared to talk more openly about our discomforts and anxieties about what is going on ‘down there’.

It is hard to persuade young people that in our living memory, being diagnosed with any form of cancer was regarded almost as a mark of shame. Mercifully for us doctors, and indeed for patients, the world has changed.

But if you wonder why I am pleased by the latest cancer figures, I should explain there can be an important confusion between ‘getting’ cancer and being ‘diagnosed’ with it.

Prostate cancer diagnoses are increasing because we are living longer and are more likely to be tested. Previously, many men were diagnosed too late to save themselves.

The average age at which men get diagnosed with prostate cancer is now as late as 72, which means often they survive it but go on to die, on average 10 years later, of something else. The important point is that prostate cancer, like breast cancer, is a routinely survivable disease, as long as it is diagnosed early. So diagnosis is obviously the first step to treatment, and then, we hope, to remission.

The grim reality is that only three per cent of people diagnosed with pancreatic cancer today will be alive in five years. For prostate cancer the rate is over 50 per cent. So there is nothing to lose, and everything to gain, by responding to the first signs of trouble.

In 1979, Margaret Thatcher, then seeking a policy to appeal to female voters, pledged routine scanning for breast cancer as an election promise.

A generation or so later, breast cancer became almost a feminist political cause, and was taken up by Cherie Blair and Sarah Brown as Downing Street spouses.

Well-known women such as Kylie Minogue and Jade Goody became the faces of female cancers (Goody died from cervical cancer in 2009). Politicians did not want to be on the wrong side of the argument, so more money was poured into breast cancer screening, treatment and research.

All that is good and understandable, but it is dangerous when NHS spending priorities become a sort of political football between the genders. The consequence was that men’s ‘ below the belt’ cancers — testicular, bowel and prostate — tended to be overlooked.

Men came to worry more about their wives’ breasts than their own prostates. And of course you panic less about what you cannot see.

The Thatcher initiative and money subsequently thrown at routine screening did throw up undiagnosed breast cancers, but at an estimated cost of about £1 million per life saved.

On balance, that is not the best use of limited health spending, and we should be wary of allowing our politicians to enter into a competition to decide between Kylie Minogue and Stephen Fry.

When you have a finite NHS budget, you have to be wary of rolling out uncosted programmes. As an oncologist, I have severe reservations about the medical benefits of routine scanning, because screening large numbers of perfectly fit people clogs up the system and causes delays for those displaying actual symptoms.

These things are difficult to say when no political party wants to tackle the reforms the NHS urgently needs if it is to stagger on with an inevitably limited budget, without any insurance model, and an unquantifiable future demand from our ageing population.

When cancer specialists get together they often lament the hopelessness of men as patients. Statistics show men are far less likely to discuss their health concerns, or to get a doctor’s appointment unless badgered by their partners.

In many key respects, they are also wilfully ignorant about their own bodies. I still chuckle at research a quarter of a century ago in the British Medical Journal which showed that half of men believed they were at greater risk than women of prostate cancer.

Drastic

The same survey showed that only 11 per cent of men were capable of pointing to the rough location of their prostate on an anatomical diagram, fewer even than women respondents, at 16 per cent.

Mercifully, we have made progress since then, partly because of the celebrities who have spoken up and campaigns in this paper and elsewhere.

But I am also struck by the huge advances I have seen in men’s self-help groups.

In church halls and medical centres, men are getting together informally to support each other and discuss the sometimes life- changing consequences of the most drastic treatment of a prostatectomy (the partial or complete removal of the prostate), with the manageable but distressing side- effects of incontinence and impotence.

Women pioneered this sort of gathering decades ago in discussing breast and ovarian cancer, and it is heartening to see men finally catching up. So the news is generally very heartening about prostate cancer, though there is still much more to be done.

If you have private health insurance, you’ll typically have an annual physical, culminating in the dreaded moment when the doctor snaps on a latex glove and sticks a finger up your bottom to check the prostate is in good condition.

This is also what routinely happens in GPs’ surgeries in U.S. and Europe, but alas no longer here. In our rationed NHS with ten-minute appointments and too many doctors insisting they will discuss only one ailment per session, this health inequality will remain.

Aggressive

Nor are routine prostatespecific antigen (PSA) tests necessarily the right course of a socialised medical system, because it often indicates another condition and will not reveal how aggressive any potential cancer might be.

The real problem lies in delay between first symptoms and getting a test. A GP cannot routinely order an MRI for a patient without first referring him to a urologist, which can take months, while the cancer may or may not be advancing.

Sometimes the GP is also not looking for the problem, but acts as a gatekeeper pushing the patient up the system to the specialists. This is what happens when you have a bureaucratic health care system with a limited budget operating at full capacity.

But these concerns should not detract from the good news. Prostate cancer is now mostly a treatable and survivable condition, for which new proton and immunotherapy treatments act as a safety net for the most advanced cases.

If your bladder function changes radically, or you suffer a couple of urinary tract infections, these are clear signs to make a doctor’s appointment.

Diagnosis of prostate cancer is rising, but fewer men are dying of it. There is nothing to fear but your own indolence and squeamishness.

Gentlemen, take note.