Prostate cancer patients across the UK are facing a “postcode lottery” of care, a charity has warned.
Prostate Cancer UK said the proportion of patients diagnosed with the disease when it is too advanced to treat varies significantly depending on where patients live. In Scotland, more than a third (35%) of men are only diagnosed when the disease is classed as stage 4 – which means the cancer has spread to another part of the body and is also known as metastatic cancer. This is compared to just 12.5% of men in London.
Prostate Cancer UK used various data sets to find out the proportion of patients diagnosed with metastatic prostate cancer – which in most cases is too advanced to cure.
The charity found the proportion of men diagnosed at stage 4 was:
- 35% in Scotland.
- 20.1% in the North East and Yorkshire.
- 20% in Northern Ireland.
- 19% in Wales
- 17.8% in the Midlands.
- 17.1% in the North West.
- 16.8% in the South West.
- 15.6% in the East.
- 14.7% in the South East.
- 12.5% in London.
The data suggests men from deprived areas are at higher risk of being diagnosed at a later stage of the disease, the charity added.
But what is prostate cancer, what is the PSA test and how can symptoms be checked at home?
Here’s what you need to know.
What is prostate cancer?
The prostate is a small gland in the pelvis. About the size of a satsuma, it's located between the penis and the bladder, and surrounds the urethra.
Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way.
The Prostate Cancer UK website explains that some prostate cancer grows too slowly to cause any problems or affect how long you live, but some prostate cancer “grows quickly and is more likely to spread,” which is more likely to cause problems and needs treatment to stop it spreading.
How can I check for prostate cancer?
The NHS explains that symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis, known as the urethra.
When this happens, you may notice things like:
- an increased need to pee
- straining while you pee
- a feeling that your bladder has not fully emptied
Although these symptoms should not be ignored, they do not necessarily mean you have prostate cancer.
The NHS website says: “It's more likely they're caused by something else, such as prostate enlargement.”
If prostate cancer breaks out of the prostate or spreads to other parts of the body it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- blood in the urine or semen
- unexplained weight loss
Although the above symptoms can all be caused by other health problems, it’s still a good idea to tell your GP about any symptoms you have.
What are the causes of prostate cancer?
The causes of prostate cancer are largely unknown, but certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older, with most cases developing in men aged 50 or older.
For reasons not yet understood, prostate cancer is also more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
How can I get tested for prostate cancer?
There's no single test for prostate cancer, but all the tests used to help diagnose the condition have benefits and risks that your doctor should discuss with you.
The most commonly used tests for prostate cancer are:
- blood tests
- a physical examination of your prostate (known as a digital rectal examination, or DRE)
- an MRI scan
- a biopsy
What is a PSA test?
The blood test, which is called a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer.
Men over 50 can ask for a PSA test from a GP, but men are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable.
This is because the PSA blood test is not specific to prostate cancer and your PSA level can also be raised by other, non-cancerous conditions.
Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not.
If you have a raised PSA level, you may be offered an MRI scan of the prostate to help doctors decide if you need further tests and treatment.
What is the online risk checker?
The charity Prostate Cancer UK has an online risk checker, which aims to check your risk of prostate cancer in 30 seconds. The check requires answering three questions and can be carried out on the charity’s website.
How is prostate cancer treated?
For many men with prostate cancer, treatment is not immediately necessary, and if the cancer is at an early stage and not causing symptoms, your doctor may suggest either "watchful waiting" or "active surveillance", explains the NHS.
Some cases of prostate cancer can be cured if treated in the early stages.
- surgically removing the prostate
- radiotherapy – either on its own or alongside hormone therapy
If the cancer cannot be cured then treatment is focused on prolonging life and relieving symptoms.
All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary symptoms, such as needing to use the toilet more urgently or more often.
For this reason, some men choose to delay treatment until there's a risk the cancer might spread.
Newer treatments, such as high-intensity focused ultrasound (HIFU) and cryotherapy, aim to reduce treatment side effects - including erectile dysfunction - and some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy.
What has Prostate Cancer UK said about ‘postcode lottery’?
Every year almost 10,000 men across the UK are diagnosed with stage 4 prostate cancer.
Laura Kerby, chief executive at Prostate Cancer UK, said: “This postcode lottery for cancer diagnosis simply isn’t fair, and the picture in Scotland is particularly shocking. Every man should get an equal chance of a cure, which is only possible if his cancer is caught early.
“Unfortunately, early prostate cancer usually doesn’t have any symptoms, which is why men need to be aware of their risk and should take our online risk checker to find out more. If you’re at higher risk – which includes all men over 50 – you’re entitled to a free PSA blood test from your GP. Because of their higher risk, we strongly recommend that black men and men with a family history of prostate cancer should speak to their GP from the age of 45.”
The charity has also raised concerns about fewer patients being diagnosed during the pandemic.
Ms Kerby added: “At one point in the pandemic, prostate cancer made up a third of all missing cancer cases, so it’s fantastic to see that we’re beginning to find and treat these men. However, there is still a long way to go to fully reverse the impact of the pandemic, and as these figures show our job isn’t done even then.
“That’s why we need a screening programme for prostate cancer, and we are committed to funding the research to make this a reality and save thousands of men’s lives.”