Thousands of men from deprived areas are missing out on a timely diagnosis of prostate cancer, a national audit has found.
The National Prostate Cancer Audit, published on Thursday, revealed men from the wealthiest parts of England were twice as likely to receive a diagnosis than those in the poorest. Black men, who are at twice the risk of prostate cancer than white men, were also diagnosed at far lower rates than expected.
Campaigners say the data bolsters the case for an urgent national prostate cancer screening programme. They are planning a publicity blitz in the coming weeks in an attempt to force the government to act.
Dr Alison Tree, consultant clinical oncologist at the Royal Marsden hospital in London, who worked on the audit, said educated men were taking matters into their own hands “in the absence of a screening programme”. They are demanding PSA (prostate-specific antigen) tests from their GP, or obtaining tests through private health schemes.
She said: “But men who live in more deprived areas, or are not so aware of prostate cancer, are less likely to ask for a PSA test. If we find prostate cancer early, we can cure it.”
Prostate cancer is the most common cancer in Britain, affecting 56,000 men each year and killing 12,000. If caught and treated early, virtually all men survive. But if it is not caught until the most advanced stage, 50 per cent die within five years.
The audit found 25 per cent of men diagnosed in 2022 lived in the 20 per cent of the most affluent areas in England, whereas only 13 per cent were in the poorest 20 per cent.
Experts said the UK had reached a “tipping point” in which too many men were needlessly dying from prostate cancer.
The Olympic cyclist Sir Chris Hoy, 49, revealed last October that he had terminal prostate cancer. He had never been offered a PSA test despite a history of the disease in his father and grandfather. If a targeted screening programme had been in place, his disease would have been picked up earlier.
Decision time
The government’s independent national screening committee will meet next month to discuss whether there is enough evidence to recommend a programme of regular checks along the lines of breast cancer screening. Between the age of 50 and 53, a woman is invited for her first breast screening, and one then takes place every three years until the age of 71.
Officials and campaigners believe the committee is unlikely to recommend a mass screening programme.
The Prostate Cancer Research charity, which is leading the charge for screening, said at the least targeted screening should be introduced for black men, who have twice the risk of prostate cancer; those with a family history of prostate, breast and ovarian cancers; and men with inherited genetic mutations which raise their risk such as the BRCA2 mutation.
But the committee is understood to be concerned that identifying these patients would be impractical and costly. Family medical history is rarely held on GP records, and few people know whether they have a relevant genetic mutation. Even identifying black men from their medical records is not straightforward.
David James, director of patient projects and influencing at Prostate Cancer Research, said: “We cannot keep leaving early detection to chance and geography. A targeted screening programme, starting with those most at risk — black men, men with a family history, and those with certain genetic mutations — would begin to close the gaps that have opened up between rich and poor and ensure that every man, regardless of his postcode or background, has an equal chance to survive prostate cancer.”
On Tuesday, the charity will release a report making the case for screening. It will take place at a parliamentary event co-sponsored by the former prime minister Rishi Sunak, the justice secretary, David Lammy, and the Labour MP Calvin Bailey, chair of the all-party parliamentary group on prostate cancer.
‘My father had it, my grandfather had it’
Nick Boorman, 72, from Surrey, would have had his prostate cancer spotted had screening been available for men with a family history. “My father had prostate cancer and died with complications. My grandfather also had it.” In his mid-fifties he asked his GP for a PSA test but was told the risk was low and the test inaccurate.
He was not diagnosed until the age of 62. By then the cancer had spread. “I have had surgery, radiotherapy and hormone treatments and I’m still here,” said the married father of three, who worked in the engineering industry before retirement. “But if I had been screened I wouldn’t have had to go through so much agony.”
When the national screening committee meets next month, the 11 members, including oncologists, geneticists, ethicists and economists, will consider whether the benefits of catching cancers early outweighs the potential harms of screening.
The committee is chaired by Sir Mike Richards, former NHS national cancer director and chief inspector of hospitals. Campaigners are concerned that six other members of the committee, including the the vice-chair and paediatrician Graham Shortland, the ethicist Anne Slowther and the health economist Chris Hyde, were also on the panel when they reviewed and rejected prostate cancer screening in 2020.
Anne Mackie, director of screening at the Department of Health and Social Care and head of the committee’s secretariat, told a conference about neonatal screening in Oxford earlier this year: “I’m often accused of only considering the harms [of screening]. But it seems to me that we are the only people who do think about harms.”
These harms are the reason many doctors have long been opposed to a national prostate screening programme. PSA tests are notoriously inaccurate. Even when prostate cancer is accurately diagnosed, there is a risk of overtreatment. Many tumours of the prostate are slow-growing and come without symptoms — a man might live a whole life without knowing he has the cancer, and die of something else entirely. Sceptics argue that screening every man at the age of 50 would lead to huge overtreatment.
The consequences of that treatment can be severe. Depending on the surgical technique used, between 40 and 80 per cent of men who have their prostate removed suffer erectile dysfunction, and 10 to 15 per cent are left incontinent.
But Prostate Cancer Research says technology has moved on. The use of MRI scans to detect prostate cancer has been a huge breakthrough, picking up more aggressive cancers and fewer insignificant tumours.
Not all charities agree on the correct approach. The Prostate Cancer UK charity, unlike Prostate Cancer Research, is less convinced that the technology is advanced enough for a mass screening programme. But their voices are increasingly united behind the idea of targeted screening.
Chiara De Biase, the director of health services, equity and improvement at Prostate Cancer UK, said last night: “We’ve reached a tipping point in the UK, with too many men dying from a curable disease and worse outcomes for men from black or working-class communities. Prostate cancer is the last major cancer without a screening programme, and we need change now.”
She added: “Modern diagnosis is safer and more effective than ever, which we strongly believe has tipped the balance in favour of targeted screening for men at the highest risk of prostate cancer — black men and those with a family history.”
The Department of Health and Social Care said: “This government has been clear it would like to see screening in place, but the decision must be evidence-led. The independent UK National Screening Committee is looking at this as a priority and we will consider its advice.”