PSA Testing Conducted & Supported by The Graham Fulford Charitable Trust

October 2014

Some thoughts on Prostate Cancer Diagnosis

Within the UK, the rates of PSA testing remain extremely low – approximately 8% of eligible men. This is in marked contrast to the situation in North America and most European Countries, where it is understood over 60 – 70% of eligible men will have undergone a PSA test. As a result many of the cancers identified in the UK are relatively advanced.

Public Health England recently announced that cancer survival rates for Prostate Cancer one year after diagnosis has risen to 96.6%. On the face of it, this looks good. But is it? If 96.6% of men survive a year after diagnosis then 3.4% of them don’t. It is generally accepted that 40,000 men are diagnosed each year, therefore 3.4% or 1,360 men don’t survive a year after diagnosis. It is also generally accepted that 10,000 men die a year of the disease. It follows that 1,360 or 13.6% of these didn’t survive a year after diagnosis. Why is this? See the first point above – only 8% or so of eligible men are tested, therefore the majority of the 40,000, remembering there is no screening programme, are only found because they are presenting with symptoms, and frequently it’s too late.

We have carried out in conjunction with other support groups, close to 40,000 PSA tests all over the country in the last ten years and have helped identify 765 cancers to date in the first 35,000 or so tests followed up by our Consultant Urologist. We follow up abnormal results six months after the test and borderline results twelve months after the test. Our cancer find rate is around 1 in 45 men tested. We believe this dwarfs the find rate for equivalent breast cancer screening. We believe there could be of the order of 100,000 men walking about with Prostate Cancer who are completely oblivious to the fact.

There is much talk of ‘anxiety’ caused by testing and subsequent ‘over treatment’. Let’s look at the first argument. Any medical test – whether it be a blood pressure or cholesterol level check will cause a certain amount of anxiety – that’s the nature of the beast. But as our Consultant Urologist points out it’s not as bad as telling a man he has advanced, inoperable prostate cancer, which with a simple blood test could have been found much earlier. As for the ‘over treatment argument’ how valid is it? An analysis of the results for the first five years of our testing programme indicates around 16% of cancer finds were put on to ‘active surveillance’ i.e. no direct treatment. An analysis of the ten years to date of our testing records this figure has risen to an average 24%. It follows, therefore, that in the last five years the active surveillance level has risen to around 30/32% - or 1 in 3 of all cases. Hardly evidence of ‘over treatment’ we would have thought.

We also believe that whilst we wait for the ‘all singing, all dancing, definitive Prostate Cancer Diagnostic Tool’ we should make best use of the information at our disposal. Our Consultant Urologist, along with some other leading figures in the PC world is a big believer in the importance of the link between raised PSA scores and ‘abnormal’ ‘Free to Total’ ratios. This is the ratio between ‘free’ and ‘total’ antigen in the sample. Our Consultant uses a ratio of 18% or .18 as being the key ratio. Of the 564 cancers found to date where ‘free to total’ ratios are available (all laboratories don’t always offer it) only 62 or 11.35% were 18% or above. In other words a simple secondary blood test – which can cost as little as £3 could be used to help find 88.65% of Prostate Cancers following a raised PSA score. Admittedly this is not a huge sample, but we feel it’s big enough to warrant some serious research. We also believe the current practice of moving straight from a raised PSA score to a biopsy is outdated. Please see our paper on the ‘Three Missing Steps’ on our website – other tests such as HK2 and MRI Scans should, in our opinion, be undertaken before a biopsy is even considered.

If you would like more information about our work to date please visit our website. If you would like to make a difference in your community by putting on a Prostate Cancer Awareness Roadshow – including PSA Testing please do not hesitate to contact us by email or phone. We will do all we can to help to organise an event in your locality but as a very small charity our funds are limited and you would need to raise around £20 a test to cover all direct costs of the initiative. We do not charge any fees or expenses for our input and are happy to travel the length of the UK in our endeavours to help early diagnosis of this insidious disease. We have groups we work closely with in the North and South of the country who can help put events on nationwide.
© 2014 Malcolm Cook Contact Me