Prof Prabhakar Rajan: We need to improve GP recording of risk factors and continue open conversations about PSA testing
Prof Prabhakar Rajan: We need to improve GP recording of risk factors and continue open conversations about PSA testing – Jeff Gilbert.
Of all the health conditions facing men as they get older, there is no doubt that prostate cancer is the most widely discussed, emotive and challenging. It is also fairly controversial, given the UK National Screening Committee’s recent recommendation to limit screening to a few thousand men with a gene that puts them at higher risk of prostate cancer, though the Health Secretary has expanded a screening trial to black men, who run twice the risk of developing it.
As a London-based consultant urologist and robotic surgeon at University College London Hospitals (UCLH) and Barts Health, I specialise in researching prostate cancer and treating men with the disease, so have been on the frontline of combating this increasingly common condition.
My experience is not limited to the professional. My father was diagnosed with the disease 13 years ago and was successfully treated, so I know how important it is to get the message out to men about a cancer that sees more than 56,000 new cases diagnosed annually in this country, and will affect at least one in eight men during their lifetime.
Thanks to some high-profile personalities who have spoken about their own diagnosis, such as cyclist Sir Chris Hoy with his recent documentary, Cancer, Courage and Me, film director Sir Steve McQueen with his short film Embarrassed, and most recently Jeremy Clarkson in his Amazon Prime documentary Clarkson’s Farm, more men than ever are requesting a PSA test. The test measures the levels of a prostate-specific antigen in your blood, a protein made by cells within the prostate gland.
A raised PSA level can serve as a biological signal for the presence of a tumour. However, high levels of PSA don’t automatically mean a bad cancer. This is one of the reasons why I think it is so important for men to have a better understanding of this disease and why it is so important for us to discuss it.
I have lots of patients, and their knowledge and understanding of prostate cancer – the causes, the symptoms, the treatments available, the survival rates – varies wildly. For example, if you have a family member with prostate cancer, you are at an increased risk of developing the disease. Rather than a one in eight risk, you are looking at around one in four risk. One in four is also the risk factor for black men.
So here are a few things for all men, their partners and their families to know when it comes to prostate cancer.
Don’t be afraid to ask your GP for a PSA test
Raising awareness is vital for people to understand their risk, and men need to be able to have an open and honest conversation with their doctor about the PSA test. Currently, any man aged over 50 years can request a test whether or not they have symptoms. This is important because prostate cancer is often symptom-free until it has escaped the prostate, at which point it is harder to treat. Red flags of advanced prostate cancer include pain around the back, pelvis or in the hips, any surprising weight loss, any blood in your urine or semen, as well as problems getting or maintaining an erection.
Problems with urination are also common as men get older, but you should also speak to your GP if you develop difficulty urinating or feel as though your bladder isn’t empty when you finish. Having a weak flow when you urinate, feeling the urge to go to the toilet more than usual – especially if you suddenly feel desperate to go – and leaking, either before urinating or after emptying your bladder all require investigation.
Having one or any of these symptoms doesn’t necessarily mean you have prostate cancer, nor does an absence of symptoms mean you do not have cancer. Talk to your GP or urologist about it. And don’t worry – they don’t need to stick their finger up your backside to check.
There are ways to improve the health of your prostate, like drinking green tea
You can lower your risk of prostate cancer by staying physically active and maintaining a healthy weight. Eat a Mediterranean-style diet rich in vegetables, especially tomatoes and broccoli, as well as fruit, wholegrains, and fish.
Limit red meat and excess dairy. Don’t smoke and limit your alcohol intake. Get enough vitamin D from sunlight, food or supplements. Some foods also appear to directly protect the prostate, including green tea, soy foods, turmeric and pomegranate.
Diagnosis doesn’t mean you are going to die or suffer life-changing problems
As soon as patients hear the word cancer, it can be shocking and many fear the worst. But prostate cancer can be treated successfully, especially if it is caught early. And as doctors, we are more sympathetic to post-treatment outcomes.
It used to be simple. As doctors we believed we had to cure all cancers. The view was that cancer is bad, therefore we need to cure you and deal with the consequences afterwards. But patients have to live with the consequences of our work. And while we think that we’re doing a wonderful thing by offering 99 per cent cure rates, if that means a man becomes either impotent or incontinent, that’s a significant impact on the quality of life.
Prof Rajan
Prof Rajan says the risk of permanent damage from prostate cancer surgery is far lower than it used to be, thanks to advances in technology – Hattie Ellis.
We understand that saving a life is simply not enough if people feel their new life is not worth living. Incontinence and impotence are both possible side effects from prostate cancer surgery, but the latest advances in robotic surgery mean that the risk of permanent damage is far less than it used to be.
Surgery may not be the best solution
Over the years, there have been controversies around the way in which patients with prostate cancer may have been overtreated. In the past, surgeons operated on patients with low-risk cancer that we now know was never going to spread, but we have moved away from that.
We are able to offer different treatments, such as active surveillance (where slow-growing cancer is closely monitored, rather than risk immediate treatment), focal therapy (to freeze the cancerous area, heat it with ultrasound, or burst it with electricity), and radiotherapy (using high-energy focused rays similar to X-rays to kill cancer cells).
By tailoring the treatment to the individual patient – factoring in criteria such as age, overall health and the aggressiveness of their cancer – the outcome is much more likely to be a positive one.
Technology is helping transform prostate cancer care
Something we have pioneered at UCLH is that every single patient who comes to us will have a tailored plan that tells us exactly how we should be doing their surgery, thanks to the technological advances in magnetic resonance imaging (MRI) used for the initial diagnosis.
In each case, there is a meeting where expert radiologists and surgeons will sit together and have a conversation about how best to undertake the patient’s surgery based on the position of each tumour on an MRI scan and the grade (or aggressiveness) of the disease on the biopsy. These plans guide the decisions to safely preserve delicate nerves affecting continence and erections, offering patients a better quality of life after their operation.
Lack of a prostate cancer screening strategy is part of a bigger conversation
Rather than simply pushing through a blanket PSA test which isn’t accurate enough, what we really need is a screening strategy that reliably identifies those with aggressive prostate cancer at any early curable stage. This is why the National Screening Committee did not recommend blanket screening for all men. They did, however, suggest that PSA screening might benefit men with inherited mutations (or spelling errors) in the BRCA genes (also linked to breast and ovarian cancers). But they did not recommend screening for black men or those with a family member with prostate cancer, despite these groups being at increased risk.
A challenge we face is that neither BRCA mutations nor family history is well recorded in GP records. Many people simply don’t know if they are a gene carrier or have relatives who have suffered from prostate or other cancers. The bottom line is that if we were to roll out a screening programme tomorrow in the UK through the NHS, we’re not really ready to identify everyone at the highest risk, and we do not have full confidence in the PSA test.
But we need to start doing something about it now. This is where the UK’s TRANSFORM and IMProVE screening trials come in. Both are comparing different types of MRI scans alongside PSA, as well as genetic tests, to find out which is the best screening strategy. But the results won’t be available for several years, so in the meantime, we need to improve GP recording of risk factors, ensure men are aware of their individual risk, and continue having an open conversation about PSA testing.
Source: Yahoo Health
