Hearing of Sir Chris Hoy’s tragic diagnosis of prostate cancer made me think again about effective screening. Here’s a very fit man, with no symptoms suggesting anything is wrong. It’s also happened to a relative of mine in the last few weeks. Out of the blue. Both had higher than normal PSA counts. They were lucky, because as you’ll see below, the PSA test is, unfortunately, not that reliable.
Prostate Cancer Risk
Prostate cancer is the most common cancer in men. One in eight will likely be diagnosed in the UK at some point. Not good.
You’re more at risk if you have a Dad or brother who’s had it, but also if you have a Mum or sister with ovarian or breast cancer. Most men are not aware of the link between the BRCA1/2 genes, known to be associated with a higher risk of those female cancers, but also of more aggressive prostate cancers. Note that West African men seem to have a higher risk of prostate cancer generally.
There is currently no screening programme for men in the UK. You’ll generally be offered a PSA test if you are over 45 and have an increased family risk as above. Cancer Research suggests men 50+ should just ask their GP for one. I agree, but it seems a bit haphazard to me!
Current Prostate Cancer Tests
A good place to begin is with the quick online Risk Checker from Prostate Cancer UK. Do that and see what advice that gives you about testing.
Up to now, the only real lab test for prostate cancer has been the PSA and biopsy. The trouble is that it is just not very good. Experts believe it misses about 30-50% of aggressive cancers. Not good! On the other hand, about 70-80% of men with a raised PSA score turn out not to have cancer at all, or not aggressive prostate cancer that needs treatment. This has led to a lot of men having unnecessary biopsies and treatment, when they didn’t need it.
For many men, detecting Prostate Cancer that is very unlikely to cause them harm in their lifetime is more harmful than not detecting it.
Professor Raj Persad
You can see Prof. Persad talking about this more in his video below.
MRI scans are also used to find any abnormal areas that may be prostate cancer, but the problem is that many men over 60 or so will have some kind of lesion in the area that has nothing to do with cancer, so unnecessary biopsies are done. And they are far from pleasant, I’m told!
You can read an overview of screening from Consultant Urological Surgeon, Simon Bott here. Interestingly, he says the PSA/MRI testing approach can be especially useful for West African men, who seem to have a higher risk as we said above. Towards the end, he discusses new prostate cancer tests including the one I recommend – technology has moved on, thankfully. Sadly, as he says, it’ll probably be years before we get it on the NHS, even though it is already being used in Nordic countries, mainly. Happily, I have managed to get it for you.
The New Prostate Cancer Test
We now have the Stockholm3 test which is much more able to detect early cancers at very low PSA levels but also, importantly, the aggressive cancers that really do need treatment. Instead of just measuring one marker, as with PSA, it measures five different markers and over a hundred genetic markers, then uses an algorithm to predict your risk of aggressive cancer. Clever.
It’s taken 11 years to develop the test and it has already been used extensively in some European countries. NICE also agree it is a better way of testing:
…the evidence suggests that Stockholm3 is more effective at predicting risk than PSA testing alone for men aged 45-74 with PSA of at least 1.5ng/ml.
NICE Medical Briefing Note
Experts agreed that the technology has the potential to improve diagnostic accuracy leading to a reduction in unnecessary MRI and biopsies.
The technology is not yet used in the NHS and the main barrier to adoption is the lack of current initiatives or programmes for prostate cancer screening in primary care, and the additional financial cost to the NHS.
So looks like cost is one barrier to introducing it, which seems shocking, if unsurprising, to me. The NHS, as we know, is in crisis mode and just don’t have the available funds for costlier tests.
The results of the Stockholm3 are set out using an easy traffic light system:
- Green light indicates a low risk – repeat test in 6 years
- Yellow Light indicates Normal Risk – repeat in 2 years
- Red Light indicates elevated risk – referral to a Urologist for MRI/Biopsy
You can see Professor Persad talking about it here and see his piece on it here:
Testing Summary
So, my advice would be:
- Do the Online Test.
- Chat with your GP about prostate health generally.
- If concerned from the online test result, you have a history of male family having prostate cancer or female family having breast or ovarian cancer, or you are over 50, ask your GP for a PSA test or get one done privately.
- Follow up with a Stockholm3 test if you can to check – how aggressive is it, does it need treatment, was your PSA a false negative or positive?
I have listed the Stockholm3 test here so you can have it done postally if you need to. You can get it in other private clinics, I am sure. Obviously, I’m not going to comment on the results as that is not my field, but I am doing my bit to make sure it is accessible here in the UK for you.
In general, excellent news, at last, for men who need to test and get a reliable answer. I agree with Sir Chris’s call for better screening, but I’d also lobby for getting the Stockholm3 on the NHS books asap, especially in family history cases of men over 45.
For more on Men’s Health generally, including enlarged prostate and prostatitis, see my factsheet here.
I hope that helps. Please do share this with your male friends and family so more people can find this potentially life-saving info, thank you.
Retiring, but loads of help still here!
I have now retired from Purehealth, but I have left my site, books, newsletters etc all up so that you can still access all this lovely info from the last 30 years! I won’t be updating it now, but there is a LOT of really good info here still. Check My Favourites page for where to find info, supplements, tests, practitioners, courses and more. Anything I think could help. And Start Here if you’re not sure where to start with your symptom or condition.
Please continue to support me by using the links, which might give me a bit of commission and you some discounts, and you can buy me a coffee here if you feel moved to.
You can still follow me here.
Bless your cotton socks from me. Thanks for all your love, support and fun over the past 30-odd years. I will miss you, Micki x