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Prostate cancer is apparently the disease men don’t talk about. I’ll admit I’d barely thought about it myself until I reached the half century, at which point all and sundry told me I had to get checked. What men think of most when the subject of prostate cancer comes up is an internal examination that should be accompanied by a Carry On-style sliding whistle sound effect and a look of surprise on the patient’s face borrowed from Kenneth Williams.
But what if there was a way of greatly reducing the need for a very close encounter or, even more distressing, a painful biopsy? A new type of blood test is available which promises more accurate information about the likelihood of a patient having the disease and, alongside traditional care, means urologists can make more informed decisions about whether to take treatment to the next, often more alarming, stages.
The “problem” with the prostate is where it is and what it does. A small walnut-shaped gland (the walnut appears to be the official unit for measuring glands) that sits around the urethra, below the bladder and above the rectum, and produces the liquid for semen. As men age, the prostate usually gets bigger – the reasons for this remain a mystery, like why some men wear Crocs – sometimes causing men to urinate more often or with more difficulty. So not only is it in an awkward location, but it affects men’s toilet habits and the treatment can lead to erectile dysfunction.
That’s as well as the stress of having a serious, potentially life-threatening condition. After 50 the risk of prostate cancer begins to increase: there are around 55,000 new cases and 12,000 deaths in the UK each year. I had no idea whether I was at any risk or not, but I am now in the age range where men are warned to be mindful of the dangers, so the chance to get the most accurate combination of tests available was a welcome one. I had no history of prostate cancer in my family – heart disease had been the real problem for my antecedents, though that was as much the 40 cigarettes a day as anything hereditary.
The exact causes of prostate cancer are still unknown and the extent to which lifestyle affects it is contested, although obesity is now agreed as a contributory factor. The chances of developing it are doubled if you have a direct family history and black men are also twice as prone, whereas most Asian men are less likely to get it.
Sometimes there are red flags, such as needing to urinate more often or struggling to at all and most worrying, weight loss and blood in urine and semen. However, there are often no symptoms. Despite this the UK does not have a national screening programme for prostate cancer, and the onus is on men to request a test if they are concerned.
“The standard entry route before diagnosis is a PSA test referred by your doctor,” says Mathias Winkler, a consultant urologist at Imperial College. A GP may also recommend the infamously invasive examination heralded by the snap of rubber gloves, although this is much rarer these days.
Winkler adds: “The NHS advice is not to screen for prostate cancer because the health-economic benefits don’t warrant it [in other words, screening doesn’t save enough lives to justify the cost]. The PSA is a prostate health test rather than a prostate cancer screening test. It can suggest enlargement, infection and inflammation as well as cancer.
“PSA stands for prostate specific antigen. The downside is that the PSA test turns up very few cases of cancer and huge numbers of men are subjected to MRI scans and biopsies, as well as the worry that goes with that, and then it turns out they don’t have cancer.”
However, the new EpiSwitch prostate screening test (PSE), is designed to work with the PSA and together should provide a more accurate assessment of your condition.
It seemed eminently sensible to take both the PSA and PSE concurrently, on the assumption that to know was better than not to know. So I had two simple blood samples taken by the phlebotomist – the whole thing took a minute – and waited. After a week I got the PSA results back, which were well below the risk level. This is where the advantage of the PSE comes in, as much from a psychological and medical point of view. A couple of days after that the PSE results came back to me as “low likelihood”.
With that out of the way, now I can find something else to worry about. Apart from your own piece of mind, it’s a very pleasant feeling to tell your significant other that you’ve had two tests for something so scary and you got the results you wanted. Even if you don’t get the all clear, more accurate results can make a big difference to what happens next.
PSAs can produce both false positives and false negative results. This is where the new test comes into its own. A high PSA score contributes to the next stages of treatment – often an MRI scan and biopsy – but only a quarter of those with a high PSA level actually have cancer. Conversely, the test can miss cancer in 15 per cent men who have low PSA scores, which could mean the condition is left to develop untreated. The PSE on the other hand provides a more accurate picture of the likelihood of cancer.
“The PSE is a gatekeeping test. It can contradict a PSA positive [so there’s no need to worry] or it can contradict a PSA negative [so you do need a scan and more treatment after all]. In the validation study I’ve done it’s 94 per cent accurate for prostate cancer predictions,” says Winkler. “So the PSE can offer reassurance in a high risk situation.
“Medicaid in the United States has approved the PSE because they believe they can save billions of dollars on healthcare,” Winkler continues. In the UK the PSE is not covered by private health policies so you’ll need to order one directly from the provider. “The burden of proof for testing is much higher than the US and we haven’t reached that point yet for the NHS. Until then it will be used in the private sector [through the Goodbody Clinic]. I want to do more studies to prove the PSE is better than the PSA alone.”
Men should keep an eye out for red flags and always go to their GP if they have any concerns. Without screening, it’s very much the role of individuals to take the initiative for their own sake. King Charles has, in his own way, contributed to the increasing emphasis on the condition and the need for men to be diligent and honest with themselves. His undisclosed cancer was identified during a check up on the benign enlargement of his prostate. On top of the serious health implications, prostate cancer can be a huge psychological shock at any age, but in middle age it can appear at a moment when you don’t want to acknowledge the new, higher risks.
“Diagnosis often comes with other pressures: a family, working or running a business,” says Meg Burgess, a specialist nurse with Prostate Cancer UK. “It also might come at a time when you are looking forward positively to doing other things and changing your life and a diagnosis can really throw that.”
Winkler admits PSE is new and only partially validated. There are no safety issues as it’s just a blood test, but it’s not yet had the full “utility” study to assess its value to the NHS. Britain’s leading prostate cancer charity remains cautious. “PSE is still very early in this journey and requires significantly more work to prove that it is more accurate than the current pathway [PSA and MRI] and is cost effective,” says Dr Matthew Hobbs, the director of research at Prostate Cancer UK.
In the meantime scientists are looking at ways this type of test could help detect other cancers in the early stages. “We’ve done preliminary work on detecting breast cancer and we’re well along with a blood test that will be able to determine colon cancer or polyps, so that again will help avoid colonoscopies in many cases,” says Guiel, so there is optimism that this principle of using genetic markers is transferable to other conditions and could have similar benefits.
At the moment the PSE costs £905 so access depends on your circumstances. However, given the possibility of either being one of those people who doubt their negative PSA or want to be sure they really need a biopsy following a positive PSA, this new test provides what could be a life enhancing – even lifesaving – second opinion and potential peace of mind. So if you can afford it, that’s where the value lies. And not a rubber glove in sight.
The EpiSwitch prostate screening test (PSE) costs £905 via Goodbody Clinic and can be booked at over 140 clinics nationwide.
Source Agencies
