UK government can save lives and smash inequalities by changing prostate cancer guidelines, say experts

A change in NHS Prostate cancer guidelines could help deliver one of the Government’s manifesto pledges to save lives through earlier diagnoses while tackling racial and regional health inequalities in just a year, say leading experts.

The experts from Prostate Cancer UK, The University of Manchester and other institutions argue changing the NHS guidelines will allow GPs to proactively speak to men who are most at risk of getting the disease.

Their paper was published July 22 in the British Journal of General Practice. It supports changes that would see health care professionals telling men about their risk and giving them the choice of a free prostate-specific antigen (PSA) bloodtest, a potentially life-saving conversation.

Prostate cancer often has no symptoms in its earlier, more treatable stages, so it’s crucial men know about their risk of getting the disease and think about the option of getting a PSA blood test, even if they feel healthy.

However, in the current system, the men who are the most likely to get prostate cancer—including Black men and men with a family history of the disease—aren’t told about their higher risk by GPs.

Current data shows only half (53%) of men with prostate cancer get an earlier diagnosis, which falls significantly short of the NHS’s target of 75%.

Black men have double the risk of both getting prostate cancer and dying from the disease, while men living in deprived areas of the U.K. are 29% more likely to be diagnosed with incurable disease.

Black men and men with a family history of prostate cancer also tend to develop the disease at a younger age—from 45—potentially losing decades of healthy life and leaving them and their families to deal with economic hardship and emotional trauma.

“With the publication of this new paper, we’ve shown there’s broad agreement among the top minds in urology and prostate cancer care that the PSA blood test is simple and safe—and that GPs should consider proactively discussing the test with Black men and men with a family history from the age of 45,” says Dr. Sam Merriel.

Prostate Cancer UK estimates that updating the NHS guidance, and implementing plans for raising awareness about the changes, could be delivered in just twelve months.

Amy Rylance, Assistant Director of Health Improvement at Prostate Cancer UK, said, “Leaving men in the dark about their risk means too many men are getting diagnosed with incurable prostate cancer, and this disproportionately affects Black men and men living in deprived areas.

“Prostate Cancer UK welcomes the new Government’s promises to increase earlier cancer diagnoses and to address gross health inequalities. Our message to the Government and MPs in the Commons is that we’re here to help you deliver those promises. Updating NHS prostate cancer guidelines could drive forward significant progress in just a year and, crucially, would give men a fairer chance of living longer.”

In the PSA consensus paper, the panel of clinicians and experts have agreed for the first time that the PSA blood test is a cheap, safe, and effective way of identifying which men would benefit from having further tests—in the first instance, an MRI scan.

Dr. Sam Merriel, one of the authors of the paper, is a GP and Academic Clinical lecturer at The University of Manchester.

He said, “As a GP, it’s frustrating that current Department of Health and Social Care guidelines on PSA testing in men without symptoms provide very limited detail for us and our patients. It is unclear what should be done for men at higher risk of prostate cancer, how often men who choose to have the PSA blood test should have one, and when it would be in a man’s best interest to stop testing.

“There has long been disagreement about the benefits and harms of the PSA blood test. However, with the publication of this new paper, we’ve shown there’s broad agreement among the top minds in urology and prostate cancer care that the PSA blood test is simple and safe—and that GPs should consider proactively discussing the test with Black men and men with a family history from the age of 45.

“Increases in PSA testing are likely to pose a substantial challenge to primary care resources which are already overstretched. The Government should provide NHS primary care with the necessary resources for men to be able to access PSA blood tests if they choose to do so, according to the current PSA testing guidelines for men without symptoms.”