Prostate cancer cases detected too late due to misleading focus on urinary problems, say University of Cambridge experts
University of Cambridge experts say early, curable cases of prostate cancer are being missed because national guidelines and media health campaigns focus on urinary symptoms, despite a lack of scientific evidence.
The researchers argue this is not only unhelpful, but may deter men from coming forward for early testing and detection of a potentially treatable cancer.
More than 52,000 men are diagnosed each year in the UK with prostate cancer, which causes more than 12,000 deaths.
While 78 per cent of men diagnosed with it survive for more than 10 years, the proportion has barely changed in a decade, typically because it is often detected at a relatively late stage.
Nearly half of prostate cancers in England are picked up at stage three - with stage four being the latest stage.
“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” said Vincent Gnanapragasam, professor of urology at the University of Cambridge and an honorary consultant urologist at Addenbrooke’s Hospital in Cambridge.
“This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”
While prostate enlargement can cause the urinary problems featured in public health messaging, the evidence suggests this is rarely due to malignant prostate tumours.
The prostate is actually smaller in cases of prostate cancer, research suggests. In fact, one recent study, called the UK PROTECT trial, even suggested a lack of urinary symptoms could be an indicator of a higher likelihood of cancer.
While screening can be used to detect disease at an early stage, some argue that such a programme in prostate cancer risks overwhelming health services and will lead to men being treated for relatively benign disease.
And while a blood test for prostate cancer is in use - one which looks for a protein known as a prostate-specific antigen (PSA) only created by the prostate gland - it is not always accurate.
Evidence shows PSA density is significantly more accurate than PSA alone in predicting a positive biopsy, and this is therefore used in everyday clinical practice.
There is a misconception that prostate cancer is always symptomatic, with an earllier study finding 86 per cent of the public associated prostate cancer with symptoms, but only one per cent are aware that it could be asymptomatic.
Prof Gnanapragasam said: “We urgently need to recognise that the information currently given to the public risks giving men a false sense of security if they don’t have any urinary symptoms.
“We need to emphasise that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages. Waiting out for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable.
“Men shouldn’t be afraid to speak to their GP about getting tested, and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors such as being of black or mixed black ethnicity.”
The researchers are not advocating for an immediate screening programme.
And they acknowledge that changing the public health messages could mean more men approaching their GPs for a PSA test, which could lead to unnecessary investigations and treatment.
But they say there are ways to reduce the risk of this, including the use of algorithms to assess an individual’s risk and whether they need to be referred to a specialist.
For those who are subsequently referred, MRI scans can help rule out ‘indolent’ - mild - disease or negative findings, which will cut the risk of unnecessary biopsies.
Prof Gnanapragasam concluded: “We’re calling on organisations such as the NHS, as well as patient charities and the media, to review the current public messaging.
“If men were aware that just because they have no symptoms doesn’t necessarily mean they are cancer free, then more might take up offers for tests.
“This could mean more tumours identified at an earlier stage and reduce the numbers of men experiencing late presentation with incurable disease.”
The study is published in BMC Medicine.