During the pandemic, urgent referrals for suspected urological cancer in England dropped by 56,000 from April 2020 to December 2021, resulting in approximately 13,500 fewer men in England starting treatment for prostate cancer compared to the same period in 2019 (Prostate Cancer UK, 2021). This is worrying considering prostate cancer is the most common cancer in men in the UK (Prostate Cancer UK, 2021). 

According to the latest report from the National Prostate Cancer Audit (NPCA, 2022), of the men diagnosed with prostate cancer in 2020, more men (21%) were diagnosed at stage 4, where the disease is no longer curable, versus 17% in 2019.

OUR MEN AT RISK CAMPAIGN  

NHS England have partnered with Prostate Cancer UK in a campaign to find the men whose prostate cancer has gone undetected due to the pandemic. As a result of the campaign there were 24,331 urgent suspected urological cancer referrals in March this year. This marks an all-time high. Referrals were up almost a quarter (23%) on the previous month and 28% above pre-pandemic levels.  

Prostate Cancer UK recently developed a 30-second online risk checker (https://prostatecanceruk.org/risk-checker) to help inform men of their risk and support them in deciding if they should have a conversation with their GP (Prostate Cancer UK, 2022). Healthcare professionals who speak to men worried about their risk of prostate cancer can signpost men to the online risk checker.  

SHOULD MEN WAIT FOR SYMPTOMS BEFORE BEING TESTED?  

Prostate Cancer UK’s specialist nurses speak to many men who are worried about their risk of prostate cancer, new symptoms they may be having, or men who have questions about the prostate specific antigen (PSA) test after reading information online. We often speak to men who have been advised against having a PSA test because they have no symptoms, or because they have been told it is not a good enough test. Early prostate cancer does not usually cause any symptoms. Although prostate cancer can grow anywhere in the prostate, the most common place for it to grow is the part that can be felt on digital rectal examination. Symptoms usually only appear when a growing tumour causes pressure on areas like the urethra, leading to urine symptoms, or other areas in the body like the bones, causing bone pain or weight loss. This means waiting for symptoms to appear before being tested may be too late, especially for men at a higher risk of getting prostate cancer. 

WHAT ARE THE RISK FACTORS?  

Risk factors for developing prostate cancer include age, ethnic background, and family history:  

• Prostate cancer is more likely to develop once a man reaches 50 and his risk continues to increase as he gets older, with the most common ages of diagnosis being 65–69 (Prostate Cancer UK, 2019).  
• One in four black men will get prostate cancer in their lifetime, compared to one in eight other men (Prostate Cancer UK, 2019).  
• Men who have a close relative (father or brother) diagnosed with prostate cancer are 2.5 times more likely to get prostate cancer compared to someone with no family history (Prostate Cancer UK, 2019). 

THE PSA TEST  

Prostate specific antigen (PSA) is a protein that all prostate cells (benign or cancerous) make. It can be measured using a simple blood test called the PSA test. The prostate tends to produce more PSA when there is a problem inside the gland. This may include infection and inflammation (prostatitis), benign prostate enlargement (BPE) and prostate cancer. PSA levels can also be affected by a urine infection, investigations such as cystoscopy and prostate biopsy, catheterisation, ejaculation, cycling and vigorous exercise. Healthcare professionals should discuss the advantages and disadvantages of the PSA test and provide clear and balanced information to help men make an informed decision about being tested (Prostate Cancer UK, 2022). 

This variability, coupled with the fact that roughly 1 in 7 men with prostate cancer and 1 in 50 men with aggressive prostate cancer do not have a raised PSA level, means that the PSA test cannot be used as a reliable diagnostic tool on its own (Public Health England, Cancer Research UK, and Prostate Cancer UK, 2020). Evidence has also shown that the PSA test is not suitable for a national screening programme (Cancer Research UK, 2022). Although it would detect some aggressive cancers, it would result in over diagnosis and overtreatment for many men, significantly affecting their quality of life (Schröder et al, 2014). 

Despite these challenges, the PSA test remains the best initial test to have to check for a problem in the prostate and to indicate whether further testing is needed, such as a magnetic resonance imaging (MRI) scan (Prostate Cancer UK, 2021).  

The NHS informed choice programme called the ‘Prostate Cancer Risk Management Programme’ (PCRMP, 2020a, b) allows any man aged 50 and over the right to a PSA test, free on the NHS, provided they understand the pros and cons of the test  and have discussed it with their GP or practice nurse.  The PCRMP recommends urgent referral under the NHS two-week rule if the PSA value for asymptomatic men aged 50–69 years is 3ng/ml or more (PCRMP, 2020a; b). Recent updated guidance from the National Institute for Health and Care Excellence (NICE) suggests age-specific PSA thresholds for men with possible symptoms of prostate cancer as guidance for referral (see useful links below) (NICE, 2022).  

The charity has developed freely available and comprehensive online learning modules and webinars for health professionals and offers education bursaries. Prostate Cancer UK’s specialist nurse service provides confidential, unbiased support and evidence-based information to anyone affected by prostate cancer through its helpline, email, live chat and social media platforms, and welcomes calls from healthcare professionals too.