Prostate cancer is a condition which arouses strong emotion. Unlike cervical, breast and bowel cancer, there is no national screening programme in place in the UK. Some patient groups argue passionately for national screening using the PSA blood test. The NHS Prostate Cancer Risk Management Programme reminds us that this test has limitations as well as benefits.
As with every cancer, there’s bad news and good as far as prostate cancer is concerned. Every year, 37,000 British men are diagnosed with prostate cancer and 10,000 die from it. About 50% more men are diagnosed with it over the course or a year today compared to 20 years ago. However, far more men are surviving long term (more than five years) after a diagnosis of prostate cancer – 80% today compared to 63% in the early 1990s.
Some of these men will have very ‘low risk’ cancers. The likelihood of dying from prostate cancer can be predicted on the basis of how far it has spread and how abnormal the cells are. Far from always being a death sentence, men with the lowest risk cancers have a 96% chance of surviving their cancer.
But if we turn these statistics on their heads, we’re reminded that one in four cases affects someone under 65, and some patients have ‘high risk’ cancers which can kill up to seven out of eight sufferers. At its worst, there have for many years been very limited options for treatments which alter the course of the disease and keep people alive for longer once all the standard treatments have been exhausted.
One issue on which everyone agrees is that medicines which extend life are good news. The sad reality is that in today’s cash-strapped world, the NHS sometimes decides it simply can’t afford them. Today the National Institute for Health and Clinical Excellence (NICE) has decided provisionally that abiraterone should be available on the NHS for men in England and Wales, after the drug manufacturer reduced its price. For now, this new drug is not available in Scotland. Abiraterone has been shown to extend life for up to three months in men with very advanced prostate cancer which hasn’t responded to other treatments. Three months may not sound long, but for some families it could make all the difference in the world.