One of the reasons why thousands of men each year are diagnosed only when the disease has spread is because, in the early stages, few have the known symptoms — including urinating more frequently, difficulty urinating, weak urinary flow or blood in the urine or semen.
Actor and comedian Stephen Fry revealed he had no signs of illness at all when he was diagnosed with prostate cancer in 2017. He later said: ‘I was pretty knocked back — I had no symptoms to indicate anything was wrong. Thankfully, it was caught early, making it more treatable.’
Raised levels of PSA can indicate the presence of prostate cancer cells. However, this can also be due to a range of other factors, such as a urinary infection, an enlarged prostate, vigorous exercise or having had sex within the previous 48 hours.
As a result, the PSA test has not been considered accurate enough to justify being used in a national prostate screening programme — such as that for breast and cervical cancer for women.
The UK National Screening Committee, which advises the Government on which diseases to routinely check for, has in the past ruled out using the PSA test for a nationwide screening programme because it says it is not reliable enough.
The worry was that if a national scheme went ahead, thousands of men with high PSA readings could end up enduring painful biopsies (where tiny samples of tissue are removed from the prostate to check for a tumour) when they didn’t actually have cancer at all, or had a tumour that was so slow-growing it was highly unlikely to kill them.
Some prostate tumours are aggressive and grow rapidly, while others progress so slowly that the patient almost always dies of something else before it ever gets to be a problem.
These two types are often colloquially referred to as ‘tigers’ and ‘pussycats’.
Under the Surrey and Sussex pilot scheme, men with raised PSA readings will only undergo a biopsy once they have also had an MRI scan (which generates detailed images of the prostate) to give vital clues as to whether it’s cancer, how big the cancer is and whether it appears to be at risk of spreading.
‘PSA is not a perfect test and it has had a bad press down the years,’ says Professor Langley.
‘But some large studies suggest it is about as effective as breast cancer screening in terms of picking up early cancers.’
The European study of screening for prostate cancer, a long-running investigation into the value of PSA testing, found that it reduced deaths by up to 22 per cent over an 11-year period, according to results published in The Lancet in 2014.
‘Men in our pilot project will have a biopsy only if the MRI scan results warrant it — we hope to distinguish not only that the raised PSA is due to cancer, but to separate the tigers from the pussycats at an early stage and, in the process, reduce the rate of unnecessary biopsies by up to 30 per cent,’ says Professor Langley.
‘One in eight men will get prostate cancer at some point in their lives. ’
Men taking part in the scheme will first be asked to submit a urine sample, to rule out an infection that might give a false high PSA reading.
If they then have raised PSA levels — above 3ng/ml — they will be referred straight to their local hospital, rather than have to go back to their GP for a referral for an MRI.
‘We are streamlining the pathway so these men get referred for prompt assessment within two weeks,’ says Dr Ed Bosonnet, primary care director for Medefer, a digital healthcare company which is taking part in the project. “We are dedicated to working with the NHS to reduce the cancer backlog and improve patient care, so we are delighted to be partnering with the Surrey and Sussex Cancer Alliance to shape and deliver this important service.”
The hope eventually is to provide men with both urine tests and PSA tests — using a finger-prick blood test similar to those used in diabetes — that they can do at home. The idea is they would then be able to log their readings on a website.
Dr Alex Norman, Medical Director at Surrey and Sussex Cancer Alliance, says: “This highly innovative, non-invasive approach will help us identify those most at risk for prostate cancer. And for those men that have not come forward this will make it really easy for them to have a test. We are taking the test to them. As with any illness, catching it early means it is more likely to be cured.”