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A year
ago, I was diagnosed with prostate cancer. Thanks to my specialist
knowledge, I was able to react quickly when I suspected I had the
disease and had at my disposal the best diagnostic tools needed.
Unfortunately,
most of the 40,000 men diagnosed with prostate cancer in Britain each
year can’t bank on such inside expertise. Instead, they face a rather
more arbitrary approach to diagnosis.
What usually happens is that
either driven by symptoms such as rushing to the loo, or thanks to a
general check-up, they are given a PSA test – this is the blood test
that measures levels of the protein prostate specific antigen, which is a
marker for the disease.
Most of the 40,000 men diagnosed with prostate cancer in Britain each year can’t bank on inside expertise
There is no national screening programme for
prostate cancer, and it’s unlikely one will start any time soon,
particularly after a study published in The Lancet earlier this month.
The
European Randomised study of Screening for Prostate Cancer involved
162,000 men aged 50 to 74 and concluded that while screening could save
around 2,300 lives in Britain annually, two out of five men told they
had cancer would be ‘over-diagnosed’.
In other words, they’d undergo
investigations such as biopsies as well as treatment such as
radiotherapy or surgery when it wasn’t really necessary – a third of
prostate cancers picked up are so microscopic they won’t ever spread or
cause any problems.And, believe me, having a biopsy – which involves
inserting a thin needle through the rectum to remove a tissue sample –
is not a procedure most men would undergo lightly.
Biopsies can also
trigger side-effects such as difficulty passing urine for a short time,
as well as blood or semen in the urine.
What could rule out such
‘over-diagnosis’ would be to tackle screening this way: let every man
over 50 ask for an annual PSA test.
Anyone with a raised level should
then demand a detailed 3 Tesla MRI scan, a form of magnetic imaging
that can identify the presence and extent of the cancer.
Biopsies
miss one tumour in two, while a high-quality MRI scan can rule out
tumours that don’t require urgent treatment in 95 per cent of men with
prostate cancer.
After keyhole surgery Roger had incontinence for about a week (posed by model)
If an MRI shows a biopsy is needed, it will also
pinpoint where in the prostate this should be carried out. That way, the
damage to normal tissues during subsequent treatment can be minimised.
Doing
this, we could eradicate the scattergun approach with biopsies that
causes so much anguish as a result of side-effects, physical discomfort
and expense.
This is exactly the approach I took when I suspected I
had prostate cancer. I’ve monitored my PSA count for years on an annual
basis (I’m 63).
In spring 2012, my reading was 3.4 – nudging towards
above normal, which is four for a man of my age. I’m a keen cyclist,
but a few months later, on a fundraising cycle in Patagonia, I felt
breathless and tired and thought I’d better have tests to check my
cholesterol and blood pressure.
I also did a PSA test; it was raised
again, but I put it down to the long days on the bike. To be sure, I had
it retested a couple of months later. By then, the level was 4.4.
Because
it was rising, I decided to have an MRI. I don’t think I was even
shocked when a shadow showed up on it. I had a biopsy the next day,
which confirmed it was prostate cancer. The severity of prostate cancer
is recorded as a Gleason score – between two and six is a low-grade
prostate cancer. Mine was a seven.
However, it was neatly contained within the prostate and I was treated successfully with keyhole surgery to remove the gland.
I
had incontinence for about a week and there was some impact on sexual
function for a few months, though Viagra helped. I’m glad to report all
is well there now, too.
Trials are taking place to establish whether
PSA tests followed by an MRI scan and then a biopsy are the best ways of
identifying the kinds of prostate cancer that require surgery and
radiotherapy. Trials take years. My hunch is that they’ll support rather
than deny this approach.
Meanwhile, since 10,000 men a year are
dying from prostate cancer, my advice to men over 50, especially those
with risk factors such as a family history, is have a PSA test.
And
don’t be distracted by a GP who says results are unreliable, as many do.
A PSA over more than four in the over-60s and over 2.5 in the over-50s
is a good enough indicator that further investigation is needed.
The
only reason PSA fluctuates is if you’ve had sex or been cycling up to
24 hours before, as this can put pressure on the prostate. Any recent
infection may also raise PSA.
Until MRI scanning is routinely
introduced, men have to take responsibility and ask for an MRI before a
biopsy. As for me, 18 months on, I’m fighting fit. My PSA is negligible
and this week I did a 100-mile bike ride.
Professor Roger Kirby is
director of the Prostate Centre, London. To speak to a specialist
nurse, call Prostate Cancer UK on 0800 074 8383, free from landlines.
Interview by ANGELA EPSTEIN
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