March 2020 represents Prostate Cancer Awareness Month. On average, around 47,500 British men are diagnosed with prostate cancer each year, which is equivalent to 129 men every day. Prostate cancer causes the death of one man every 45 minutes and is responsible for more deaths than breast cancer; by 2030, it is forecast to be the most common cancer in the UK.
The symptoms of prostate cancer are quite limited, and can manifest in the form of difficulty urinating, a feeling that the bladder has not emptied, dribbling urine after finishing urinating, needing to urinate more often than usual, and a sudden need to urinate. However, many patients will not have symptoms and men over 50 years of age, or who have a family history of prostate cancer, are at higher risk of developing the disease over their lifetime.
The aim of the month-long campaign is not only to raise awareness amongst men of the particular signs and symptoms of prostate cancer, but also to highlight the significant risk to men of developing the disease so that they can be vigilant in visiting their GP when they show suspicious signs or symptoms.
Unlike breast cancer patients, those affected by prostate cancer cannot check themselves for likely signs of the illness, and there is no national screening programme to help detect the cancer in its early stages. The traditional technique for diagnosing prostate cancer is through a biopsy of the prostate, following a high prostate specific antigen (PSA) blood test score. However, this method is not completely accurate. If, for example, the area of the prostate biopsied is not an area affected by the cancer, then the biopsy will conclude that the prostate is not cancerous and a patient’s cancer may subsequently progress further without being treated. More recent techniques include MRI scans of the prostate, which studies show are almost 100% more accurate than the traditional biopsy. Diagnosis by way of MRI is now the standard method of diagnosing prostate cancer in the UK, although not all hospitals have access to the appropriate MRI scanning facilities.
Many patients who are diagnosed with prostate cancer do not require immediate treatment: this applies to those who have a slow growing cancer that does not cause symptoms and is not at risk of spreading to other parts of the body. Such patients are often advised against invasive treatment, such as surgical removal of the prostate, and are instead advised to ‘watch and wait’ to see if and how the cancer progresses. Those patients who are watching and waiting are monitored annually with blood tests to check the level of their PSA, which is an indicator for how aggressive their cancer is. Many patients will live their entire lives in this ‘watch and wait’ phase without any significant progression of the disease.
The risk, however, is that patients who are watching and waiting will attend their GP for an annual check-up one year after a normal PSA result to find that there has been a rise in their PSA level, indicating that their cancer may have progressed. Some of these patients’ cancers will have progressed significantly, and by the time it is detected it will be too late for treatment. Presently there is no way of detecting which patients are at higher risk of their cancer progressing and Gert Attard, of the UCL Cancer Institute, said that doctors “get it wrong half the time”. This must be incredibly worrying for patients living in a state of limbo during the ‘watch and wait’ phase between check-ups.
It has recently been reported that researchers have made a breakthrough in the way in which doctors can determine whether or not patients are at risk of developing more aggressive cancer in the future. A new blood test has been developed which is said to be able to tell whether a man is really at risk of aggressive prostate cancer and will identify those patients who require immediate treatment, which is preferable to advising all patients to ‘watch and wait’. This could be an important step towards implementing a national screening programme for men, which would be similar to the NHS breast cancer detection programme. It would allow doctors to identify which of their patients ought to be recommended for active treatment and which can be advised to ‘watch and wait’, as well as reducing the risk of a cancer progressing between yearly appointments.
Arran Macleod, a member of the clinical negligence team at Penningtons Manches Cooper, said: “We act for many patients who have suffered a delay in diagnosis of their aggressive prostate cancer. This can be incredibly distressing and upsetting for them, as many are concerned about how their life expectancy will have been affected by delays in their care. Sometimes the effects can be tragic, with significant shortening of their lives.
We are encouraged to read about the recent breakthrough blood test, which we hope will form the basis for a national screening programme for prostate cancer in the UK and help reduce the missed opportunities to diagnose and treat patients with aggressive forms of prostate cancer.”
If you, a friend or family member has any concerns over the diagnosis or management of prostate cancer, please do get in touch as a member of the team would be happy to discuss your options with you.
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