World must ‘start screening for prostate cancer to stop men being left behind'

Telegraph

2 days ago

Every country should have a strategy for tackling prostate cancer with dedicated screening programs for men over 50, a leading health charity has said.
Global Action on Men's Health, the leading international charity for men's health, is calling for prostate cancer – now the third most common cancer worldwide – to be dramatically elevated on the health agenda.
On Monday it will launch a campaign to encourage all countries with adequate resources, including the UK, to launch national screening for the disease in a bid to cut unnecessary deaths.
It will also call for the World Health Organization (WHO) to introduce a Global Prostate Cancer Initiative which 'covers every stage of the prostate cancer pathway from prevention to palliative care'.
Prostate cancer is now the most frequently diagnosed cancer in men in 112 countries and the leading cause of cancer death among men in 48 countries.
In England, it is now the most common cancer, killing some 12,000 men every year, according to Prostate Cancer UK.
Writing in today's Telegraph, Peter Baker, the director of Global Action on Men's Health, said that men were being short-changed when it comes to healthcare.
'Men's health has been neglected for far too long with devastating consequences,' he writes. 'Globally, men's life expectancy lags five years behind women's. Men are significantly more likely to develop and die from cancer, heart disease, diabetes and tuberculosis. They are also at much greater risk of dying from suicide or an accident on the roads or at work.'
Mr Baker calls for reform across health care systems – ensuring men have better access to GPs, for instance – and believes that a focus on prostate cancer is a good place to start.
Rapid advances in screening technologies now mean that developed nations should soon be able to launch screening programs that will cut death rates by a third or more and reduce the dramatic social inequalities associated with the disease.
Men with a family history of prostate cancer run a significantly higher genetic risk of developing prostate cancer, as do black men. Men from lower socioeconomic backgrounds are also much harder hit, due to a combination of poor health literacy and access to healthcare.
The European Commission recently recommended introducing national prostate cancer screening across all 27 member states of the European Union, and already countries including Sweden and Norway have either launched or are on the brink of launching national screening programs.
While blood tests for prostate cancer, known as prostate-specific antigen tests (PSA), have been available for many years, they throw up a large number of false positives.
This in turn led to many unnecessary prostate removals and biopsies being performed, meaning the risks outweighed the benefits of running national screening programmes.
But now, with the advent of more specific blood tests and high resolution MRI scans, which allow for much more accurate biopsies, the balance has changed, with several high quality studies showing the benefit of screening.
The largest of these studies was the European Randomised Study of Screening for Prostate Cancer (ERSPC), which included over 182,000 men and showed a 20 per cent reduction in prostate cancer mortality among those screened.
Another study in Gothenburg, Sweden, found that after 18 years of follow-up, men in the screening group were 35 per cent less likely to die from prostate cancer than men who were not screened. Men who started screening at age 55-59 were 53 per cent less likely to die.
Professor Jonas Hugosson, a urologist at University of Gothenburg in Sweden who led the Swedish study, said he expected national screening for prostate cancer to be rolled out across most western European nations in the next few years.
In Sweden a move to nationwide screening was already progressing and in Norway he expected a national screening program to be announced shortly, he said. However, just as with the roll out of breast cancer screening more than three decades ago, it would take most countries many years to gear up.
'In my view, we have quite a new situation today, and I think it's time for the health authorities to take a new standpoint,' he said.
'I'm quite sure about that and we will see screening come all over Europe during the coming years, but it takes 10 years to build up, at least.'
'Alarming and unacceptable' rise in cases
The NHS in England does not have a dedicated men's health strategy but one has been promised by the end of the year by the new Health Secretary, Wes Streeting.
Although the new strategy is unlikely to include the imminent launch of a national screening program for prostate cancer – the UK currently does not have the MRI machines and trained staff needed to launch one – it may include screening for high risk groups.
These include black men, who have double the normal risk, and men with a family history of prostate and related cancers – including breast and ovarian cancer on the female side.
In October last year, six-time Olympic cycling champion Sir Chris Hoy, 49, revealed that he had terminal prostate cancer. Both his father and grandfather had the disease but his was not caught by early testing, sparking an outcry.
'The rapid rise in prostate cancer cases is not just alarming, it is also unnecessary and therefore unacceptable,' said Global Action on Men's Health. 'Prostate cancer is currently inadequately addressed in global and national cancer policies'.
In addition to national testing where possible, the charity is calling for the WHO to support a new Global Prostate Cancer Initiative covering 10 areas.
These include governments being urged to introduce national cancer plans which specifically address prostate cancer with clear performance indicators, education programmes to raise awareness and tackle stigma, and investments in research, infrastructure, workforce development and treatments for prostate cancer.
The WHO does not currently have a programme that focuses specifically on prostate cancer but 'integrates' it to its wider program for tackling cancer more generally.
Cervical cancer, in contrast, has a dedicated programme dedicated to its global eradication but that is because the HPV vaccine makes it possible to wipe out the disease completely.
Dr André Ilbawi, technical lead for cancer control at the WHO, welcomed the prostate campaign launched by Global Action on Men's Health, and said the disease was moving up the WHO's agenda.
The organisation had just five countries involved in its cancer programme in 2015 to but has 100 today.
'We see prostate cancer as a priority and, in 2023, elevated it in our guidance because it can be treated,' said Dr IIbawi.
'If treatment is available, survival is extremely high. And if treatments are not available, those men will die.
'We agree that prostate cancer should be seen in the cancer agenda as high impact, cost-effective and meeting community needs'.