Prostate Cancer: a rising problem

This year for the first time deaths from prostate cancer have exceeded deaths from breast cancer: and yet it feels as if much less attention is paid to it. There is no national screening programme as there is for breast cancer, much less public fundraising for research and no one could blame men for feeling a little neglected. Why is this so?

Prostate Cancer: a rising problem

Prostate cancer is problematic for several reasons. In all men, the prostate gland grows very gradually larger with age as hormone balances change. Because the prostate gland is doughnut shaped, encircling the urinary pipework, an enlarging prostate gland causes a weaker urinary stream and a need to pass urine more frequently day and night. So these symptoms are almost universal as men age. 

If a cancer is developing in the prostate gland, as it grows, it causes almost exactly the same symptoms so very often a serious problem is not suspected. 

Next problem is that there is not a reliable test for prostate cancer. Every prostate gland makes a substance called PSA ( prostate-specific antigen) so every man’s blood contains some of this and it can be measured in a blood test. There is a normal range as with all tests and this varies a bit with age: but a one-off reading, unless it is very high, is not very helpful.

For example, the normal range for a man of 73 is 0-6.50: so Mr A might have a reading of 2.0 and Mr B 6.0: both are “ normal”. Without knowing what those levels were last year and will be next year we have not established anything with that test. If on the other hand the test is repeated annually then we might find out that Mr B’s level remains 6.0 the following year ( so he has a largish but stable prostate almost certainly NOT a cancer) whereas Mr A has a reading of 6.0 a year later. His reading has trebled in a year and this suggests something is wrong, something is growing quite quickly and more tests are needed.

Even then, 3 out of 4 cases of a rising PSA will turn out NOT to have cancer.

So PSA even when undertaken every year is not a complete solution to screening for prostate cancer. It is just the best we have at present.

And next problem: if cancer is diagnosed, the treatment options are not straightforward and not without significant side effects. The course of the disease can be very slow and no action at all might be the best course. Conversely, it can be an aggressive cancer and side effects may be the price of life-saving surgery.

All in all, it's a tricky business. At Private GP Services, we treat you as an individual: we discuss the merits of screening with the available tests and inform you of the realistic reliability of them. Please make an appointment if you would like to discuss this further.


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