Prostate Cancer Screening
Prostate cancer is common. Around 1 in 8 men will be diagnosed with prostate cancer in their lifetime and 40% of those occur in men under 65. 78% of men diagnosed will survive 10 or more years. It is the most common cancer in men with 52,000 cases in the UK each year with 12,000 deaths, that’s 33 men each day, just above the number of breast cancer deaths. Men with a first degree relative with prostate cancer are twice as likely to develop the disease.
Startling facts but there is still no prostate cancer screening program in the UK, unlike in other countries including France. The reason is that is current blood testing – the Prostate Specific Antigen or PSA – is not specific to prostate cancer and many men diagnosed with prostate cancer will have slow-growing disease with low mortality. The problem is assessing who they might be, who is at higher risk, what other tests can we do, and what treatments are available.
The Portobello Clinic has been screening men for prostate cancer for over 25 years and has extensive experience in how to interpret results and who to refer. This is normally done as part of a general yearly health screen but can be specifically requested. Most men diagnosed by us are asymptomatic or have common symptoms such as frequently passing urine or getting up at night. We start with the a digital rectal examination (finger up the bum) which is not as bad as it sounds, to assess the size of the prostate, whether both lobes are the same size, or if any obvious abnormalities are present such as a mass. This is followed by the PSA blood test which should be below 2.99 but can vary with age. The PSA can go up for other reasons such as inflammation or even sexual activity, so if borderline we might ask you to come back in a couple of weeks to be repeated. Then, if even borderline or there has been a significant change in the past year, we would refer for an MRI scan. This requires no radiation and just involves having contrast injected and passing through a high resolution MRI scanner.
The MRI scan result will then give us a guide as to how likely and where a tumour might be present. If there is any doubt we then refer to one of our highly experienced urologist colleagues who specialise in prostate cancer. They will likely do a biopsy, which involves a short general anaesthetic and samples taken from the prostate through the perineum (just behind the scrotum). This provides a tissue diagnosis and allows any cancer cells present to be graded using the Gleeson scoring system. The urologist can then assess how malignant the cancer is and how likely it is to spread. They may decide to just monitor it with regular PSAs and MRIs or might advise on more radical treatment such as removal of the prostate (prostatectomy – usually robotic these days) or radiotherapy.
We refer about two men each month to the urologists with a new diagnosis of prostate cancer in men with no significant symptoms, just on the basis of our PSA and MRI screening service. These men would not have been diagnosed otherwise and their cancer might have progressed in the following years. 99% of the men we have diagnosed are on the basis of the PSA; just two men in 25 years had a normal PSA and went on to be diagnosed with prostate cancer. We are therefore very cautious and keen to promote yearly screening with at least a PSA blood test in all men over 50 and an MRI scan if this is even borderline. It has proven successful over the years and has also reassured many men without prostate cancer, who were anxious about the possibility.
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