Prostate Cancer – PSA testing
After reading the news a few days ago, a headline struck me "Left in peril, the men told: You're too young for a prostate test". Prostate cancer is the most common cancer in men. Statistics from Prostate Cancer UK state that 1 in 8 men will develop prostate cancer in their lifetime with over 42,000 men being diagnosed every year. At risk are older men and men with a family history of prostate cancer. On average, men are diagnosed between the ages of 70 and 74 years and you are at less risk if you are under the age of 50.
The prostate is the size and shape of a walnut which grows bigger as you get older and is located underneath the bladder and surrounds the urethra. Prostate cancer develops when the cells in the prostate grow in an uncontrolled way; this is slow-growing to start with and may not cause any symptoms. Men can experience urinary problems or new pain in the back, hips or pelvis. However, these symptoms need to be checked out by the GP as there can be other causes for these.
Many men with early prostate cancer do not have any symptoms. Men over 50 are entitled to request a PSA test after having discussed the pros and cons with their GP. This is a simple blood test to measure the amount of prostate specific antigen (PSA) in the blood. A raised PSA level may suggest problems with the prostate including prostate cancer before any symptoms appear. If a fast-growing cancer is detected early enough, treatment may be able to stop the cancer from spreading. If a slow-growing cancer, treatment may not be necessary. Regular tests can help to avoid or delay the side effects of treatment and may be beneficial to those at risk of developing prostate cancer to detect any changes in the PSA level.
However, it must be noted that a raised PSA level does not necessarily mean you have prostate cancer. According to Prostate Cancer UK, around three quarters of men who have a raised PSA level do not have prostate cancer as there are a number of other factors that can also cause the PSA level to rise. A biopsy may then be required which can cause pain, infection and blood in the urine and semen. In addition, 1 in 50 men with fast-growing cancer have a normal PSA level.
Steve Kirby was diagnosed with prostate cancer at the age of 42. There is a strong history of prostate cancer within his family after his grandfather and father were both diagnosed with the disease. Steve was told he should be checked for the disease when he reaches 40 during a discussion with his father's oncologist. Steve approached his GP to discuss the option of having the PSA test and was refused. Two years later, Steve approached a different GP at his surgery who gave him the PSA test. The tests confirmed Steve had prostate cancer. This raises the question, why did his GP initially refuse the PSA test given the strong family history?
Currently, there is no screening programme for prostate cancer. It is argued that the PSA test is not reliable enough at diagnosing prostate cancer and the advantages of a programme do not outweigh the disadvantages. There is a risk that men who develop slow-growing prostate cancer undergo treatment which they do not need because the cancer would not have impacted or shortened their life. In addition, there are conflicting studies regarding whether the PSA test reduces the number of deaths from prostate cancer.
Yet the PSA test can assist doctors in diagnosing prostate cancer and the question is whether the PSA test should be more widely available to men who request it. Steve falls into a high risk category due to the strong history of the disease is his family, so it can be argued that he should have been given the test when requested. Whilst the PSA test cannot say definitively whether a man has prostate cancer, can it help raise awareness of any underlying issues or problems that could be addressed? Is it necessarily wrong to know if you have developed slow-growing prostate cancer regardless of whether it requires treatment or not? Is it up to a GP to make that decision?
As a result of there not being a national screening programme, the Prostate Cancer Risk Management Programme was introduced to provide information to men who are concerned about prostate cancer highlighting the advantages and disadvantages of the PSA test. This allows men to make an informed choice regarding whether or not to have the PSA test. A screening programme will only be introduced in England when the 10 principles of screening have been met and the treatment of prostate cancer has been developed.
In some cases a failure to provide testing and arrange referrals could result in a claim for negligence. It will depend on the reasonableness of the action taken by the doctor or GP at the time of the assessment. If a person does have a negligent failure in diagnosis of prostate cancer, it could result in claims for significant compensation by his children and/or spouse. The critical message is that if anyone is concerned, they must press the medical authorities to undertake a full investigation.
By Gabrielle Gooday, Paralegal