Will Hide was 52 when he found out he had been diagnosed with prostate cancer. A travel writer who had seen his sources of work dry up during the early stages of the pandemic in spring 2020, Hide volunteered to take part in a University College London Hospitals (UCLH) clinical trial, in which all participants received an MRI scan of their prostate.
“My decision to volunteer in the UCLH trial was driven largely by a desire to do my bit for science as well as the fact that I had nothing much better to do,” says Hide. “At 52, I’d been having an annual check for prostate cancer – PSA [prostate specific antigen] blood tests – for the past five years or so, and my most recent one in December 2019 had shown nothing irregular, so I wasn’t worried at all.”
But a few months later, Hide received a surprise phone call. To his shock he was informed that the MRI had picked up signs of a tumour. “I can’t remember the exact words, just something like: ‘It’s about 6mm long; 90 per cent of it looks slow-growing but 10 per cent isn’t,’ ” he says.
Hide was one of the estimated 48,500 new cases of prostate cancer in the UK every year, a disease that has an annual death toll of 11,700 – more than those from breast cancer. But while mammograms are routinely available on the NHS for all women aged between 50 and 70, there is no such screening programme for prostate cancer.
Last week, former Scotland rugby star Kenny Logan revealed he had also been diagnosed with prostate cancer in February at the age of 50. Logan had been urged by his wife Gabby to do a PSA test which showed elevated levels, leading his doctor to recommend further investigation. “It was a huge shock,” Logan said, speaking on BBC Breakfast, revealing that he underwent surgery to have his prostate removed, but was “95 per cent” back to normal.
Both Hide and Logan were among the lucky ones. Because their disease had been picked up at an early stage, they were able to undergo surgery to have the whole of their prostate removed. This means they have a far greater chance of being cured compared with those for whom the disease has spread to other organs.
There are many different types of prostate cancer. Around 30 per cent of these cancers are indolent, meaning they would cause little or no problem if left untreated, while many are curable with radiotherapy or surgery.
However, as Johann de Bono, professor of experimental cancer medicine at the Institute of Cancer Research in London explains, around one in four cases of prostate cancer is very aggressive and spreads extremely quickly, making it far more difficult to treat, especially if it is diagnosed at a later stage. This was the case for Bill Turnbull, the much-loved BBC Breakfast presenter who died earlier this month at the age of 66, and who was only diagnosed after the disease had spread to his legs, hips, pelvis and ribs, in 2017.
Much research has been devoted to identifying the subgroups of men who are most likely to be at risk of aggressive prostate cancer and could benefit most from screening. While age is the biggest risk factor – the majority of cases are over 50 – a combination of genetics, ethnicity and lifestyle factors, such as eating a high-fat diet, are also thought to contribute to the risk.
“Genetic changes underlie at least part of the risk of prostate cancer,” says Nick James, consultant clinical oncologist at the Royal Marsden NHS Foundation Trust. “Men of African or African-Caribbean ancestry have roughly twice the risk of white men. Men with a strong family history of prostate cancer at an early age – under 65 – or breast or ovarian cancer in female relatives are also at a higher risk.”
The charity Prostate Cancer Research says key warning signs include difficulty or pain in passing urine, having to rush to the lavatory to pass urine, frequent visits to the lavatory at night, starting and stopping while urinating, and having a constant feeling of having not fully emptied the bladder.
They recommend that men experiencing these symptoms see their doctor. Anyone concerned, for example because of their age or family history, can opt to have a PSA test which measures the levels of the PSA protein in the bloodstream, although this test has come under increasing scrutiny owing to the high number of false positives it yields. Because PSA is secreted by both cancerous and non-cancerous tissue in the prostate, around three in four men with an elevated PSA level will not have cancer, while one in seven men with a normal PSA level will have the disease.
While experts feel that PSA still has a role to play as part of the process which leads to further investigation, more sophisticated screening is needed.
“Currently, it’s the best thing we have,” says Oliver Kemp, chief executive of Prostate Cancer Research. “It’s cheap, and it should be part of the process leading to further investigation. But the issue is the false positives, after which a lot of people are then treated quite aggressively with biopsies.”
However, more advanced screening methods are on the way. While Hide benefited from having an MRI scan as part of his clinical trial, the Surrey and Sussex Cancer Alliance is running a pilot study in which men with elevated PSA readings only undergo a biopsy and further investigation once they have had a multi-parametric magnetic resonance imaging (mpMRI) scan. This is new technology that is being called “the male mammogram” and works by creating detailed images of the prostate which are much higher quality than conventional MRI.
September is National Prostate Cancer Awareness Month.