Dead patients don’t vote, and uninformed families don’t complain. The result of early diagnosis and treatment is very good, but the result of a later diagnosis of cancer of the prostate, especially in younger men is poor. 25% of needle biopsies on cancer prostate patients are negative, so a more accurate diagnostic algorhythms is to be welcomed. Unfortunately, due to fragmentation and lack of choice, informed citizens may need to go privately. If you are unfortunate enough to be in a “worst” area you may have five times the risk of death from this disease. although hopefully some 9 years later things are better. There are no approved screening tests for Ca Prostate, but serial PSA tests are reasonable.
Obviously in Private Medical Care there is an incentive to screen (perverse?), and the Mayo Clinic gives good advice. Prostate cancer screening: Should you get a PSA test? The AUA (American Urological Association) recommends that beginning at age 55, men engage in shared decision-making with their doctors about whether to undergo PSA screening. The AUA doesn’t recommend routine PSA screening for men over age 70, or for any man with less than a 10- to 15-year life expectancy.
Recently some question has been raised on the use of hormonal therapies and a link with dementia, which emphasises the need for early curative treatment options.
In New Zealand the Health Navigator as a decision making aid:
The pros and cons of screening for prostate cancer should be discussed with your doctor to help guide you in deciding if it is the right course of action. Routine screening for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Experts have been unable to agree that prostate cancer screening helps patients. Use this decision aid to help you and your decide whether or not you will have a prostate specific antigen (PSA) test.
The Times on 1st January 2018 reported (not on line) “Prostate scan lottery”: (Previously Chris Smyth had reported that One in ten men is refused prostate cancer test – June 13th 2017)
“Seven out of 1o men are missing out on the latest technology that detects prostate cancer. Prostate Cancer UK says that the availability of enhanced MRI scanning is patchy, with only 30% of men having access to the tests. More than 150,000 men a year have needle biopsies triggered by a high PSA blood test. A third have the disease diagnosed and 11,000 men die each year.
Prostate Cancer UK: mpMRI: The new test with the potential to save thousands of men’s lives
Adrian Monti for the Mailonline 27th June 2017: The scientist who helped create a new prostate cancer scan (that’s now saved his life, too)
Nursing in Practice 17th June 2009: Postcode Lottery on Prostate Cancer – Campaigners have revealed official figures which indicate that men in some parts of England are almost five times as likely to die from prostate cancer as those in other areas.
Olivia Lurche in the Express reports: Prostate cancer treatment: New hope for patients suffering symptoms of DEADLY disease – PATIENTS with suspected prostate cancer should have an initial MRI scan to improve detection of aggressive forms of the disease in a bid to save lives.
Experts said the the scans could reduce the number of men undergoing unnecessary biopsies for prostate cancer.
A report, published in British medical journal The Lancet, estimates an MRI could help 27 per cent of men avoid an unwarranted biopsy, during which a small sample of tissue is removed from the body for examination.
Adding an early MRI scan could also reduce the number of men who are diagnosed with a cancer that later proves harmless by 5 per cent, researchers found.
Angela Culhane, chief executive for Prostate Cancer UK, praised the findings as a ‘huge leap forward’ for the ‘notoriously imperfect’ diagnostic processes currently used.
“The results from the (trial) make it clear that giving men with raised PSA an mpMRI scan before a biopsy can help increase the number of aggressive cancers detected whilst reducing the number of unnecessary biopsies for men.”
“This is the biggest leap forward in prostate cancer diagnosis in decades with the potential to save many lives.”
They found a specific form of scanning MRI scan can provide detailed information about the cancer, such as how well-connected to the bloodstream it is. Experts said this could in turn help distinguish between aggressive and harmless types of cancer.
As part of the study more than 570 men with suspected prostate cancer – those found to have elevated levels of the prostate-specific antigen (PSA) protein in their blood or other symptoms – were given an MRI scan followed by two types of biopsy.
Researchers found the MRI scan correctly identified 93 per cent of aggressive cancers, while most commonly used biopsy type only diagnosed about half.
Dr Hashim Ahmed, of the University College London Hospitals NHS Foundation Trust (UCLH), said the current biopsy test could be inaccurate because tissue samples were selected at random.
“This means it cannot confirm whether a cancer is aggressive or not and can miss aggressive cancers that are actually there,” he said.
”Because of this, some men with no cancer or harmless cancers are sometimes given the wrong diagnosis and are then treated even though this offers no survival benefit and can often cause side effects.”
“On top of these errors in diagnosis, the current biopsy test can cause side effects such as bleeding, pain and serious infections.”
The organisation was already working with clinical experts and professional bodies to investigate how a rollout of the MRI scan method may unfold, she said.
The Medical Research Council said an approximate 100,000 men every year in the UK undergo a type of biopsy – with about 66 per cent found to have no cancer or no life-threatening cancer.
The study was conducted by researchers from a range of institutions, including University College London, and funded by bodies including the UK Department of Health.
One PSA is not a screening test. Serial PSAs are a good indicator but they have not been sanctioned..