Posted: 14/01/2022
On average, around 50,000 men in the UK are diagnosed with prostate cancer each year, resulting in the death of approximately 12,000 men annually. Prostate cancer 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 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.
Unlike, for example, breast cancer, there is no screening test that can indicate whether or not prostate cancer is present. A blood test to check for prostate specific antigen (PSA), which may indicate the presence of prostate cancer, is offered to men over 50 years of age. However, PSA testing has not been adopted as a method of screening patients for prostate cancer for many reasons, including the fact that PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result). Additionally, 1 in 7 patients have prostate cancer but have a normal PSA level. Relying only on an elevated PSA level would result in many patients’ cancer being missed.
The other important point to make is that not all prostate cancers cause harm. Prostate cancer can be slow growing, and many patients will live with the cancer without needing any treatment for the rest of their lives and so, even if prostate cancer is present, there is currently no general screening method to determine if the patient will or will not need treatment. This often results in many patients undergoing invasive procedures, only to be told that they don’t ultimately need treatment and their doctors are happy to ‘watch and wait’.
In order to identify a method for screening patients who have prostate cancer, as well as determining which patients require treatment, a screening program, similar to the mammogram for breast cancer, is needed. NHS England has stated that this has been notoriously tricky, but an expert from the Institute of Cancer Research, Professor Rosalind Eeles, has recently said that medical advances in understanding who has been born at greater risk, blood tests, and scanning the body mean that within the next five years it could be possible to screen for the presence of prostate cancer.
This is important, because if it becomes possible to screen men to determine who has cancer and which patients require more urgent treatment than others, doctors can better prioritise their waiting lists so that the most at risk patients receive treatment first. Similarly, patients who have early and slow growing cancers can avoid the need for treatment, either indefinitely, or until their cancers advance to the point that it is required.
Professor Peter Johnson, the national clinical director for cancer at NHS England, has also warned that the pandemic has likely meant that thousands of men who need treatment have not been diagnosed.
Penningtons Manches Cooper acts for many patients who have suffered a delay in diagnosis of their prostate cancer. Sometimes the delay occurs because GPs do not act upon an elevated PSA blood test; sometimes it occurs because hospital doctors overlook clinical signs and symptoms of the disease. Ultimately, however, it seems that the lack of a screening programme for detecting prostate cancer in the UK is contributing to delays in patients’ diagnoses.
Arran Macleod, a senior associate in the clinical negligence team at Penningtons Manches Cooper, said, “A delayed diagnosis can be incredibly distressing and upsetting and many of our clients are concerned about how their life expectancy will have been affected. The result can be tragic, with significant shortening of their lives, and we sometimes act for the surviving family of a patient who has sadly passed away because of their cancer.
“We are encouraged to read that there continue to be developments in pioneering a screening programme that could be adopted for prostate cancer in the UK and help reduce the missed opportunities to diagnose and treat patients with aggressive forms of prostate cancer, and look forward to hearing about developments in the future.
“As regards to the comments of Professor Peter Johnson, we share these concerns. We hear anecdotally of patients being unable to access their GPs during the pandemic which could mean that many patients with symptoms that could indicate prostate cancer, may have not been diagnosed. From our experience of working on these types of cases, we know that the earlier the diagnosis and treatment the better, so we would encourage anybody who has concerns that their symptoms might indicate prostate cancer to contact their GP as soon as possible.”
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