Risks of late detection of prostate cancer due to focus on urinary problems
There is little evidence of a direct link between symptoms of urinary problems and prostate cancer.
According to experts at the University of Cambridge, men with early and treatable prostate cancer are missing a golden time to diagnose their cancer despite a lack of clinical evidence and relying on national guidelines on urinary symptoms only.
Prostate cancer is the most common type of cancer in men. According to Cancer Center England research, more than 52,000 men are diagnosed with prostate cancer each year and there are more than 12,000 deaths from prostate cancer.
Over three-quarters (78 percent) of men diagnosed with the disease survive for over ten years, but this proportion has barely changed over the past decade in the UK, largely because the disease is detected at a relatively late stage. In England, for example, nearly half of all prostate cancers are picked up at stage three of four (stage four being the latest stage).
Despite little evidence and documentation of a link between urinary symptoms and prostate cancer, national guidelines, health recommendations, and public health campaigns continue to promote this link. In a review published in BMC Medicine, Cambridge researchers argue that relying on this connection is not only unhelpful, but may even prevent men from getting early tests and detecting potentially treatable cancers.
“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” said Vincent Gnanapragasam, professor of urology at the University of Cambridge and an Honorary Consultant Urologist at Addenbrooke’s Hospital, Cambridge. “This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”
An enlarged prostate can cause urinary problems that are often included in public health messages, but evidence suggests that it is rarely due to malignant prostate tumors. Instead, research shows that the prostate is smaller in cases of prostate cancer. A recent study – the UK PROTECT trial – even went so far as to suggest that a lack of urinary symptoms may actually indicate a higher chance of cancer.
Screening programs are one way to detect cancers often at an early stage, but they should not lead to treating men for relatively benign prostate disease and increasing pressure on the health system.
Prostate cancer testing involves a blood test that looks for a protein called prostate-specific antigen (PSA), which is made only by the prostate gland. However, it is not always accurate. Prostate Health Index (PHI) test is an accurate calculation method that includes a series of blood tests including PSA-free PSA-pro PSA and analytical ratios regarding this parameter, as It is significantly more accurate than PSA alone in predicting, reducing treatment costs and performing biopsy.
As emphasized, prostate cancer can be a silent or asymptomatic disease, especially in treatable stages. Waiting for urinary symptoms may mean missing an opportunity to catch the disease when it is treatable.
“Men shouldn’t be afraid to speak to their GP about getting tested, and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors”
“If men knew that just because they don’t have anyurinary symptoms it doesn’t necessarily mean they don’t have cancer, more people might be offered tests,” says Professor Gnanapragassam. “This could mean detecting more tumors at an earlier stage and reducing the number of men who develop incurable diseases later.”
Reference
Gnanapragasam, VJ, et al. Urinary symptoms and prostate cancer—the misconception that may be preventing earlier presentation and better survival outcomes. BMC Medicine; 4 Aug 2022; DOI: 10.1186/s12916-022-02453-7
https://www.cam.ac.uk/research/news/prostate-cancer-cases-risk-being-detected-too-late-due-to-misleading-focus-on-urinary-problems-say