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Writing on the Department of Health and Social Care’s Twitter feed earlier this month, Government officials suggested that all men over the age of 50 – and black men over 45 – should speak to their GP about their risk of prostate cancer.

After all, one in eight men develop the disease at some point in their lives and it kills 12,000 a year.

Without a national screening programme to pick up the disease early, 9,000 men a year are diagnosed once it has already spread, making it the second most common cause of death from cancer in men after lung cancer.

The advice seemed designed to encourage the most at-risk men to see their GP for the only test available to spot signs of the disease: a blood test known as a PSA test. ‘One in eight men will get prostate cancer,’ the post said. ‘Men at higher risk are aged over 50, those with a family history of the disease, and black men over 45. If that’s you, speak to your GP.’

And yet the advice has been met with alarm from senior GPs and even the Government’s advisers. Their main gripe, backed by an article in GP magazine Pulse, was that GPs would be overwhelmed if millions of men turned up at surgeries looking for a prostate check, along with concerns that PSA tests were unreliable and led to false positives.

Professor Alf Collins, NHS England’s clinical director for personalised care, wrote: ‘Is this right @DHSCgovuk? General practice on its knees yet you suggest all men over 50 might want to contact their GP re their prostate cancer risk…’

SURVIVORS: Writer Stephen Fry (pictured) and other celebrities filmed for a charity campaign

SURVIVORS: Writer Stephen Fry (pictured) and other celebrities filmed for a charity campaign

Boxer Johnny Nelson (pictured) had a prostate cancer scare in 2020

Boxer Johnny Nelson (pictured) had a prostate cancer scare in 2020

Actor Jim Broadbent (pictured) who also suffered from prostate cancer joined the campaign

Actor Jim Broadbent (pictured) who also suffered from prostate cancer joined the campaign

And Professor Azeem Majeed, head of the department of primary care and public health at Imperial College London, told The Mail on Sunday that encouraging all men to come forward could ‘put a lot of pressure on the NHS and potentially end up causing harm to quite a lot of people’.

Mail on Sunday health reporter Jo MacFarlane

Mail on Sunday health reporter Jo MacFarlane

Many suggested the advice amounted to ‘an unofficial screening programme’ and that the National Screening Committee – which analyses the evidence for screening – had rejected the rollout of PSA tests in 2020 because they are not reliable enough.

The test threw up too many false positives, meaning that men were referred for invasive, risky and ultimately unnecessary diagnostic procedures. The risk of screening – inviting large numbers of otherwise healthy men without symptoms to have a test n the hope of picking up early stage disease – outweighed the benefits.

But is this view now outdated? That is what specialists working in prostate cancer, including the charity Prostate Cancer UK, say.

They point out that new methods have made diagnosis significantly safer and more accurate.

These developments led the European Commission to recommend screening programmes in EU member states last year. The UK has lagged behind. But now, they say, we may be on the cusp of a similar programme ourselves.

Dr Matthew Hobbs, director of research at Prostate Cancer UK, says: ‘For years the message generally was that the risk of PSA screening outweighed the benefit, which is why GPs push back against it. But this is no longer the case.’

PSA – or prostate specific antigen – is a protein released by the prostate, the small gland behind the bladder that helps men make semen. Raised levels could indicate prostate cancer. But levels also rise naturally with age, and a higher reading – usually above three – can be associated with urinary tract infections, vigorous exercise, certain medication and recent sexual activity.

It’s partly because of the unreliability of PSA tests on their own that GPs do not proactively offer them to men at risk. Instead, the guidance states they can give a test only if men ask for it. But Dr Hobbs says this should change. ‘GPs should be allowed to be more proactive and offer PSA tests if someone is high-risk,’ he says.

Until recently, men with a raised PSA were routinely referred for a biopsy, an invasive procedure that involved inserting a needle via the rectum to take tissue samples from the prostate to check for cancer cells. This was not risk-free: about one in 1,000 men biopsied in this way develop infections that can lead to deadly sepsis. And, historically, in 75 per cent of these referrals, no cancer was found. Today, men with a raised PSA are given a new type of MRI scan, called mpMRI, which provides a detailed image of the prostate. It can rule out cancer and help doctors decide which men need a biopsy, which means fewer take place.

Prostate Cancer UK charity campaign urging men to check their risk for the disease

Prostate Cancer UK charity campaign urging men to check their risk for the disease

Professor Alf Collins, NHS England's clinical director for personalised care, wrote: 'Is this right @DHSCgovuk? General practice on its knees yet you suggest all men over 50 might want to contact their GP re their prostate cancer risk…'

Professor Alf Collins, NHS England’s clinical director for personalised care, wrote: ‘Is this right @DHSCgovuk? General practice on its knees yet you suggest all men over 50 might want to contact their GP re their prostate cancer risk…’

Professor Azeem Majeed (pictured), head of the department of primary care and public health at Imperial College London, said that encouraging all men to come forward could 'put a lot of pressure on the NHS and potentially end up causing harm to quite a lot of people'

Professor Azeem Majeed (pictured), head of the department of primary care and public health at Imperial College London, said that encouraging all men to come forward could ‘put a lot of pressure on the NHS and potentially end up causing harm to quite a lot of people’

‘The evidence suggests this new-style of MRI can reduce the number of biopsies by about one quarter,’ says Cancer Research UK’s Naser Turabi. ‘Access to it has improved a lot over the last five years and is largely implemented across England.’

If there is a concern, it’s that those scans rely on specialist uro-radiologists, who work at major cancer centres, to interpret them.

‘If uro-radiologists aren’t available, the scan will be analysed by a generalist radiologist who may not be able to say definitively that there isn’t a cancer there,’ he adds. ‘So men may end up being referred for biopsy anyway.’

However, biopsies have also changed. In most cases, the technique used now involves the needle being inserted via the perineum – the thin layer of skin between the genitals and back passage. This reduces infections to just five in every 10,000 cases.

Dr Hobbs says: ‘MRIs have reduced the number of unnecessary biopsies, which is one of the key harms that prostate cancer screening causes. And if you do need a biopsy, it will also be more accurate because it can be guided based on the scan. We’ve definitely moved in the right direction.’

However, even backers of prostate screening admit there are still questions that need to be better answered before it’s rolled out. The main concern is over-diagnosis – when the cancer detected is so slow-growing that it would never have caused the patient a problem during their lifetime, but gets treated aggressively all the same.

‘The temptation is for men to want to treat it,’ says Prof Majeed. ‘That might involve drugs, surgery, radiotherapy and chemo, and they have potential complications, including sexual dysfunction, bladder and bowel problems.’ Historically, for every man whose life-threatening prostate cancer was detected following a PSA test, 12 more men were diagnosed with a cancer that would never have caused them problems in their lifetimes.

Some experts believe it’s likely that fewer people would be over-diagnosed with prostate cancer thanks to the accuracy of new diagnostics, but the evidence is not yet available.

And whether it reduces deaths is also still unknown. ‘In America, they have a much more proactive asymptomatic screening approach, and a much higher incidence of prostate cancer – simply because they’re looking for it – but they don’t have lower mortality,’ says Mr Turabi.

However, Professor Nick James, a urological cancer expert at the Royal Marsden NHS Foundation Trust says: ‘A bigger proportion of those having treatment these days have significant cancers and will benefit. The others we’re mainly monitoring with MRI scans and repeat PSA tests, not with biopsies.

Prof James adds: ‘Critics of screening say it will diagnose a lot of prostate cancer that wouldn’t have killed you if it hadn’t been picked up but has to be treated. That’s what the big screening trials show – but those were 20 years ago. Of the men coming into our clinic with a raised PSA, only half now go on to have a biopsy. I think the data now supports PSA screening that incorporates MRI.’

Several initiatives have set up public screening centres. One NHS initiative is offering men an MRI scan, in a van parked at West Ham Utd’s football ground in London’s Olympic Park.

One in eight men develop prostate cancer at some point in their lives and it kills 12,000 a year (stock photo)

One in eight men develop prostate cancer at some point in their lives and it kills 12,000 a year (stock photo)

Another, called Man Van, was developed by Prof James and is run by the Royal Marsden NHS Foundation Trust in conjunction with the Institute for Cancer Research (ICR).

It targets black men, and those from deprived areas, who are least likely to request a PSA test from a GP but may be more at risk of the disease. So far, between two and three per cent had prostate cancer.

Prof James says: ‘Black men are twice as likely to get it but that risk increases hugely once you factor in deprivation. It’s genetic, not environmental. But their risk of late diagnosis is absolutely modifiable.’ Samuel Nelson, 63, from Romford, Essex, knows this only too well. He was diagnosed with prostate cancer aged 57, after asking his GP for PSA tests as his father and two uncles died of the disease.

‘My father was a proud man and ignored his symptoms until it was too late,’ he says. ‘He was worried about treatment causing sexual dysfunction. But I have six children and nine grandchildren and I want to see them grow up – I choose life.’

Teacher Mr Nelson, originally from Jamaica, was diagnosed in 2017. He opted to have his prostate removed and is now cancer-free. His four brothers also have regular tests.

‘Without these tests I wouldn’t be alive today,’ he says. ‘Black men must come forward and ask their GP for a PSA test if they are concerned.’

Some researchers are looking at polygenic risk scores for prostate cancer – where combinations of genes may indicate an increased risk of disease. Professor Ros Eeles, an expert in cancer genetics at the ICR, says: ‘I think it’s likely that in five years men will be able to access a genetic test to indicate their risk of prostate cancer when they hit a certain age.’

In the meantime, men who are worried and have symptoms – which include a frequent need to pee, including at night, blood in the urine and difficulty starting to pee – should see a GP.

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This post first appeared on Daily mail