Prostate cancer 2018: our time is now
Urology This year, Prostate Cancer UK have grabbed the attention of the media, the nation and the government. We have a golden opportunity to push through our plans to stop prostate cancer killing men.
Prostate cancer research has been underfunded for far too long. In the UK, one man dies from the disease every 45 minutes, and that’s not simply because men don’t know when they’re at risk. Tests to diagnose the disease early are not accurate enough and the treatments currently available aren’t always effective for each man’s cancer.
Earlier this year we shone a spotlight on the shocking statistic that deaths from prostate cancer now outnumber those from breast cancer, making it the third biggest cancer killer in the UK for the first time.
The story dominated the news across the media and, thanks to the public response, has kept prostate cancer on the agenda. Shortly after, TV personalities Stephen Fry and Bill Turnbull spoke about being diagnosed with aggressive prostate cancer, helping to raise the profile of the disease even further.
The work we have done together has made prostate cancer a problem that society can no longer ignore. But, as the statistics show, we are at a critical point in our mission to halve the number of men dying from prostate cancer. We have to turn this around urgently.
Long term investment in research can turn the tide
Prostate Cancer UK was formed as a charity not only to support the hundreds of thousands of men living with the disease, but also to tackle the unjust lack of research into stopping prostate cancer being a killer. In 1998, the government spent just £47,000 on prostate cancer research. Back then, relatively little was known about prostate cancer, but now understanding of the disease is approaching the point where we can begin to see real change in how we diagnose and treat men.
With better tests, we could have a system where all men over a certain age, would be invited for screening on a regular basis.
With the heavy focus on prostate cancer in the media this year, Theresa May announced an additional £75 million (spread over five years) towards recruiting more men into prostate cancer clinical trials. This at last shows recognition of what a huge issue prostate cancer is and the focus needed to stop it being a killer. It’s further testament to what we have achieved together, but there is still a long way to go.
The difference you can make through serious, long term investment in research is clear when you look at the impact it has had in other diseases. By the late 1990s, there was already a screening programme for breast cancer, as well as genetic tests and precision medicine – all things that we are still working towards.
Since that time, there has been only half as much spent on research into prostate cancer compared to breast cancer with the shortfall totalling hundreds of millions. The effect of that has been that the number of men dying from prostate cancer continues to rise.
If we want to reverse that trend for men, we need to invest heavily in research. One of the biggest and most important aspects of our research strategy that we need to fund is our work towards a screening programme.
Our plan for screening in the next five years
We know that getting diagnosed early gives men the best chance possible, but the current tests are not reliable enough to be offered to all men regardless of their risk or potential symptoms. Too many men would have unnecessary biopsies and treatments, while lethal cancers continued to be missed. The harms would outweigh the benefits. But with better tests, we could have a system where all men over a certain age, would be invited for screening on a regular basis, similar to the way it works for breast and bowel cancer.
In the graphic on the next page, we set out what this could look like. We know that there won’t be a single perfect test. Instead we expect it to be a series of tests that can help to filter men out based on establishing their risk of having significant prostate cancer, so that only those who really need it have to have a biopsy.
Our hope is to be able to call for a nationwide screening programme within five years.
Until recently, the standard approach was to have a biopsy after a suspicious PSA test result. Now, thanks to our work, many men have access to multiparametric MRI scans (mpMRI). This has already been a major step forward but isn’t enough on its own.
We need new tests and improvements at each stage of diagnosis including a more specific test that could follow the PSA test to rule out some false positives (men who have a raised PSA but don’t have cancer) before an mpMRI scan. This will most likely be an advanced type of blood test that looks for several markers of cancer, including proteins and genes that are linked to a high-risk of cancer. It is difficult to find reliable markers that will work for everyone, which is why we’re investing heavily in this area, including Dr Hayley Whitaker’s research which you can read more about on pages 9-11.
There are a few promising tests on the horizon. One of the best established is the STHLM3 blood test – this was tested in Stockholm in 2015 in almost 60,000 men and showed that it could reduce biopsies by 27 per cent as well as being better at detecting potentially dangerous prostate cancers than PSA alone. We are now working towards validating this test to see how well it could work within the NHS and with a more ethnically diverse population.
We can make the PSA test work harder
We also want to improve our understanding of what a PSA result means for an individual man. We are currently funding research into a risk assessment tool, which will be able to take into account various different factors that influence a man’s risk of prostate cancer. This will help GPs to decide the best course of action for a man with a suspicious result.
Building on the progress that we’ve made so far, and other research evidence we want to collect over coming years, our hope is to be able to call for a nationwide screening programme within five years. By then, we hope to be able to approach the National Screening Committee to present the evidence from our research and get a screening programme approved.
That is the scale of our ambition and what we think is needed to halve the expected number of men dying from prostate cancer. But if we’re to stay on track to deliver that, we need to raise significant sums.
Prostate cancer has caught the public’s attention in a way that it never has before. The nation is listening, but to take this movement for men to the next level, to make the progress that can stop prostate cancer killing men, we need their support and yours.