David Cox
Sun, September 11, 2022
Bill Turnbull, the much-loved BBC Breakfast presenter,
died earlier this month at the age of 66 - Andrew Crowley
LONG READ
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.
Gabby and Kenny Logan -
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.
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.
Gabby and Kenny Logan -
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.
Will Hide - Geoff Pugh
“Around a third of patients with elevated PSA who then have an mpMRI scan do not have prostate cancer and can safely avoid biopsy, which involves inserting a needle into the prostate to take tissue samples,” says Kemp. “The procedure can be uncomfortable and unnecessary for those with low-risk cancers which are unlikely to progress, and it also comes with the risk of infection.”
Because mpMRI is much more cost effective than standard MRI, Kemp feels that if the Surrey and Sussex Cancer Alliance trial proves successful, there is a case for making regular screening available on the NHS for all men deemed to be at greater risk. In the best-case scenario, this could happen by 2024.
For the most aggressive forms of the disease, it seems that genetics play a key role. “Our research has shown that at least one in 10 cases of aggressive prostate cancer is linked to inherited mutations of DNA repair genes,” says de Bono. “Developing new focused prevention strategies for these at-risk men is particularly important. These strategies could, for example, involve genetic screening of men for these high-risk genes, and then offering more frequent monitoring for early signs of prostate cancer where necessary.”
One approach being explored by the Institute of Cancer Research and the Royal Marsden Hospital is the use of genetic risk scores and socio-demographic targeting. This would involve giving a DNA test to men believed to be more susceptible to the disease, either because of their ethnicity or family history of prostate cancer, and using the results to calculate their risk. Individuals with a high-risk score could then be recommended for regular mpMRI scans.
“The current way we do things, waiting for men to spot symptoms and get checked by their GP fails at least one in three men,” says James. “GP appointments are hard to get and they don’t offer automatic health checks for prostate cancer.”
Kemp also points to the biotech company GlycoScoreDx, which is developing a simple blood test specifically aimed at detecting aggressive forms of prostate cancer, based on more than a decade of research by scientists at University of Newcastle. This has found that malfunctioning glycans – sugars that coat cells and decorate most proteins – are an important driver of prostate cancer growth and spread, and a test that can detect a unique combination of these glycans could help identify patients at risk of more aggressive disease.
Overall, Kemp feels that the future is positive for identifying prostate cancer early and making it a more treatable disease.
“A national screening programme based on PSA alone would not be viable because it is not considered accurate enough to be justifiable,” he says. “The Surrey and Sussex Cancer Alliance pilot screening programme is important because the evidence generated could support rollout of screening across the UK if successful. In addition, cancers are more likely to be detected earlier, reducing risk for patients.”
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