THE prostate, a small gland only found in men, is located at the junction where the bladder meets the urethra (water pipe). It wraps round the urethra like a ring round a finger. Its role is to produce fluid that nourishes and transports sperm to the outside.

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Former BBC Breakfast presenter Bill Turnbull was diagnosed with advanced prostate cancer in 2017. The media response to his story resulted in a huge increase in the amount of men contacting their GP

At present there is no formal screening programme for prostate cancer, unlike those for cervical and breast cancer which are organised at a national level. However, the PSA (prostate specific antigen) test is commonly enquired about, usually by men over the age of 50, although individuals under this age are becoming increasingly concerned by the possibility of the condition.

Recent statistics show that just under 50,000 men in the UK are diagnosed with the disease every year. Sadly, there are roughly 11,500 deaths per annum. The commonest age to be diagnosed with prostate cancer is between 65 and 69.

Rolled out in 1994, the PSA test was held as the start of a new era in the diagnosis of prostate cancer. Numbers of casesi dentified, including aggressive tumours skyrocketed. The five-year survival statistics certainly looked favourable. But on the flipside, many men with slow growing tumours ended up with a diagnosis they had to carry for the rest of their lives. Worse still, others without the disease were given an incorrect diagnosis, something known as a false-positive.

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Stephen Fry announced in 2018 that he had prostate cancer. The actor and TV presenter underwent an operation

A raised PSA most often resulted in a prostate biopsy, done through the rectum, with two in five individuals resulting in significant pain as a result.

The PSA test certainly has its pros. A raised PSA can alert to the possibility of prostate cancer prior to symptoms. This is the goal of all screening tests. However, it fails to be a suitable tool because it is neither sensitive nor specific enough.

Sensitivity refers to the accuracy of a test to positively identify a disease. Three-quarters of men with a raised PSA will not have prostate cancer. This is known as a false positive. One in seven with a normal PSA may have prostate cancer, and 1 in 50 with a normal PSA may have a fast-growing tumour. This is known as a false negative.

The PSA test also falls down because on specificity, meaning its ability to say that a raised level is specifically due to prostate cancer. PSA levels can be raised in the 48 hours after ejaculation, receptive anal intercourse, vigorous exercise, and indeed for six weeks after a urinary tract infection or inflammation of the prostate (prostatitis).

PSA results should to be interpreted with caution.

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65-year-old Nile Rodgers was diagnosed with an aggressive form of prostate cancer in 2010 but got the all-clear in 2013

Perhaps most importantly a raised PSA level cannot advise as to whether a tumour is slow growing or aggressive. Certain forms of prostate cancer could be viewed as a natural part of ageing. A man’s lifetime risk of prostate cancer is around 30 per cent, but only three per cent die from the disease. Many prostate cancers are identified at post mortem without a diagnosis being made while the man was alive.

Certain groups of men are at higher risk and it would be wrong to discourage anyone from having a discussion about the test. The risk of prostate cancer increases with age, In the UK any man can have the test from 50 onwards, hopefully having evaluated the risks and benefits. Not all ethnicities have the same risk. Afro Caribbean men have double the incidence of prostate cancercompared to their Caucasian counterparts. Any family history of the disease in a first degree relative ie a brother or father should also be raised in the consultation. For some individuals it may be wise to consider testing before the age of 50.

The identification and risk stratification of prostate cancer has moved on since the start of PSA testing. Previously, if a man had a raised PSA level or the prostate felt abnormal on rectal examination, referral to a urologist would result in a trans-rectal prostate biopsy as mentioned above. As well as being painful, the random selection of biopsies from the prostate gland may not have identified cancer, even in those with abnormal cells.Nowadays multi parametric MRI scanning (mpMRI) is able to locate significant hotpots of concern, allowing targeted biopsy. It has also increased the detection rate of less concerning cancers, reducing the number of men subjected to biopsy.

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Oscar-winning actor Jim Broadbent joined a Prostate Cancer UK campaign titled Men, We Are With You

While prostate cancer is notoriously asymptomatic, benign enlargement of the prostate gland produces a triad of complaints designated Lower Urinary Tract Symptoms. These are struggling to commence urination, poor flow, and dribbling at the end. I would strongly encourage any man who has symptoms to consult their doctor, rather than ascribing this to “just old age”. A PSA blood test and rectal examination are part of the investigation of LUTS as well as providing an opportunity to discuss any concerns about prostate cancer.

Although the term cancer is riddled with negative connotations and fears of the unspeakable, perhaps the following, by American Urologist Henry Rosevar, will provide some reassurance: “Not everyone needs to be screened, not everyone found to have an elevated PSA needs to be biopsied…. not everyone with prostate cancer needs aggressive treatment.”