At a certain age, most men begin to think about the possibility of prostate cancer and look for signs of possible symptoms. But, according to a review article by experts at University of Cambridge, by the time the urinary symptoms men are told to watch for show up, their cancer may have advanced, and this late presentation can result in incurable disease.
“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” researcher, Vincent Gnanapragasam, Professor of Urology at the University of Cambridge, said.
“This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage...We urgently need to recognize that the information currently given to the public risks giving men a false sense of security if they don’t have any urinary symptoms,”
National guidelines and media health campaigns continue to focus on urinary symptoms even though there is no scientific evidence of a clear link between urinary symptoms and prostate cancer.
An enlarged prostate can cause the urinary problems public health messages target, but prostate enlargement is rarely due to malignant prostate tumors. Quite the opposite.
While it is true that an enlarged prostate can cause the urinary problems public health messages target, enlargement is is rarely due to malignant prostate tumors. Quite the opposite. Research suggests that the prostate is smaller in cases of prostate cancer. In fact, according to a recent study, UK PROTECT, a lack of urinary symptoms may in fact be an indicator of a higher likelihood of cancer.
Not only do the guidelines give men a false sense of security, they mean men not experiencing urinary symptoms are less likely to get tested, losing the opportunity for early detection of a cancer that is more likely to be successfully treated.
PSA screening tests are one way that cancers are often detected at an early stage. Testing for prostate cancer involves a blood test that looks for a protein known as a prostate-specific antigen (PSA) that is made only by the prostate gland. The test is not always accurate. A PSA density test is better at predicting a positive biopsy.
Some argue that encouraging men to seek early testing risks overwhelming health services or could lead to men being treated for relatively benign disease.
The researchers acknowledge that changes in public health messages could potentially result in unnecessary investigations and treatment, but argue that there are ways to reduce the risk of this happening. Using algorithms to assess an individual’s personal risk with the possibility of referring a man with serious risk factors to a specialist who could then use an MRI scan could help rule out mild disease or negative findings, reducing the risks of an unnecessary biopsy.
“We need to emphasize that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages. Waiting out for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable” said Gnanapragasam. “Men shouldn’t be afraid to speak to their GP about getting tested, and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors.”
The study is published in BMC Medicine.