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Prostate cancer cases risk being detected too late due to a "misleading" focus on urinary problems as a symptom, according to a new study.
Men with early, curable stages of prostate cancer are missing opportunities to have it detected because national guidelines and health campaigns focus on urinary symptoms - despite a lack of scientific evidence, say Cambridge University scientists.
Prostate cancer is the most common type of cancer in men. More than 52,000 men are diagnosed with prostate cancer each year and there are more than 12,000 deaths, according to Cancer Research UK.
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More than three-quarters of men diagnosed with the disease survive for over 10 years (78 percent), but that proportion has barely changed over the past decade in the UK, scientists say, largely because the disease is detected at a relatively late stage.
In England, nearly half of all prostate cancers are picked up at stage three of four, stage four being the latest stage.
However, despite no evidence of a link between urinary symptoms and prostate cancer, national guidelines, health advice and public health campaigns continue to promote the link.
In a review, published in the journal BMC Medicine, the Cambridge team argues that not only is it unhelpful, but it may even deter men from coming forward for early testing and detection of potentially treatable cancer.
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Professor Vincent Gnanapragasam, an Honorary Consultant Urologist at Addenbrooke’s Hospital, Cambridge, said: “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.
“This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”
He said prostate enlargement can cause urinary problems often included in public health messaging, but evidence suggests that it is rarely due to malignant prostate tumors.
Instead, research suggests that the prostate is smaller in cases of prostate cancer. © Provided by talker (Ground Picture via Shutterstock)
A recent study, the UK Protect trial, even went as far as to say that a lack of urinary symptoms may in fact be an indicator of a higher likelihood of cancer.
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Screening programs are one way that cancers are often detected at an early stage, but in the case of prostate cancer, some argue that such programs risk "overwhelming" health services and lead to men being treated for relatively benign diseases.
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; however, it is not always accurate.
PSA density is "significantly more accurate" than PSA alone in predicting a positive biopsy and is used in everyday clinical practice, says the research team.
They point to evidence that there is a "misconception" that prostate cancer is always symptomatic: a previous study found that 86 percent of the public associated prostate cancer with symptoms, but only one percent were aware that it could be asymptomatic.
Professor Gnanapragasam said: “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.
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“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.
“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 such as being of black or mixed black ethnicity.”
The researchers say they are not advocating for an immediate screening program, and acknowledge that changes in messaging could mean more men approaching their GPs for a PSA test, potentially resulting in unnecessary investigations and treatment.
However, they argue that there are ways to reduce the risk of this happening - including the use of algorithms to assess a person’s risk and whether they need to be referred to a specialist, and for those who are referred, MRI scans could help rule out mild disease or negative findings, reducing the risks of an unnecessary biopsy.
Professor Gnanapragasam added.“We’re calling on organizations such as the NHS, as well as patient charities and the media, to review the current public messaging.
“If men were aware that just because they have no symptoms doesn’t necessarily mean they are cancer free, then more might take up offers for tests.
"This could mean more tumors identified at an earlier stage and reduce the numbers of men experiencing late presentation with incurable disease.”
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