A recent study by researchers at University College London compared the traditional method of screening for prostate cancer, the PSA blood test, with a ten-minute MRI scan, to see if imaging was possibly a better tool.
303 men, without any symptoms of prostate cancer, aged between 50 – 75 were recruited, undergoing both tests.
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The researchers identified 48 with prostate cancer, of whom 25 were diagnosed with “significant” cancer after further tests, including biopsy.
However, half of those with an MRI indicating cancer had a PSA below the level that would raise concern.
Had they only had this simple blood test, this would have resulted in what is termed a false negative, and they would have been reassured when in fact disease was present.
This is potentially very exciting news for the most common of male cancers.
The issues around prostate cancer remain complex. As a result, a screening programme does not exist currently in the UK.
The above study may suggest that by the time the PSA has risen to a level of concern, the disease has already advanced which will reduce treatment options and survival.
Every year ten thousand men in the UK are diagnosed too late with prostate cancer.
At the same time, it is estimated that between 25-50 percent of men in the UK are over diagnosed with a disease which can almost be seen as a part of natural ageing, and which they would have died with, and not from. Again, this figure is around ten thousand men.
Abnormal cells in the prostate are seen in fifty percent of men at age 50 and eighty percent of men at age 80.
The PSA or Prostate Specific Antigen blood test has been around since the early nineties. It and a rectal examination remain the first line in identifying potential prostate cancers.
Since this time rates of diagnoses of prostate cancer have doubled. This may be in part due to greater awareness of the disease, thanks to certain high-profile figures with the condition sharing their personal stories.
However, as demonstrated above, the PSA test is not one hundred percent sensitive nor specific for prostate cancer. It can be normal in the presence of early prostate cancer.
Similarly, it may be raised for forty-eight hours after sexual intercourse or vigorous exercise. It can remain elevated for up to six weeks following a urinary tract infection (UTI).
Various strategies for targeted screening have been proposed. These include identifying those high risk and offering them PSA testing.
Risk factors for prostate cancer include a family history of the disease, this usually being a first degree relative who developed prostate cancer before the age of 60.
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Black African men are four times more likely to suffer from prostate cancer.
Men identified as having the BRCA gene, or with a first degree relative with breast or ovarian cancer are also at increased risk.
Currently you can request a PSA test from the age of 50, but those at high risk can ask for it at a younger age.
At the present time we are some years away from MRI being first line screening, and significant thought would have to go into whether this was offered to all, or just those at high risk.
Consideration would also need to be given to those men who are identified with low-risk tumours who then must live with the burden of a diagnosis which is unlikely to have caused them any problems otherwise.
One of the biggest issues surrounding prostate cancer is reticence to come forward and be tested. Statistically, those from ethnic minorities with a higher risk remain reluctant to seek help, black men being five times less likely be screened.
Similarly, many with symptoms of prostate issues often seek false self-reassurance in the belief that it is just part of getting old.
Red flags for prostate cancer, yet which may also reflect benign enlargement of the prostate include: hesitancy, so you struggle to start urinating; your flow is poorer than it used to be; you get dribbling at the end. Getting up several times in the night to pass water is also a symptom that should not be ignored.
On a final note, the PSA test is only half of initial screening. It is not as reliable as this and a rectal examination.
Several are reluctant to undergo this, yet it may detect an abnormal feeling gland, even if the PSA level is normal.