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I never thought I’d have much in common with David Cameron?
Neither… Robert De Niro, Andrew Lloyd-Webber, Stephen Fry, Ian McKellen, nor Arnold Palmer.
Don’t play golf. Not an actor, nor a politician.
Not in any league with Nelson Mandela. I play the guitar (a bit) but I’m no Frank Zappa. Sadly, not as rich as Warren Buffett, but...
... we all share one thing and it just goes to show, no matter who you are, cancer of the prostate is blind to talent, fame and wealth. It's indiscriminate, but weirdly, likely to be predictable.
I expect, like my famous alumni from the university of life, I’m often asked about prostate cancer screening.
In my case, a blood test for something else flagged up my sinister squatter and as a result; diagnosed early, treated with stereotactic radiotherapy and here to tell the tale.
I’m instinctively drawn to the idea that every man should have the same chance I had, but…
… instincts aren’t evidence.
In prostate cancer, where the balance between lives saved and harm done is unusually tight, we need to give this a bit of thought.
The UK doesn’t have a national, prostate cancer, screening programme.
Geezers can ask for a PSA test. They won’t be invited. The UK National Screening Committee takes the view;
‘… the harms and uncertainties of PSA testing… false positives, over-diagnosis, unnecessary biopsies and the side-effects of over-treatment…outweigh the benefits.’
Are they over cautious?
PSA is a blunt tool… picks up cancers that’ll never cause harm and misses some that will.
Unlike other screening tests, the downstream consequences of ‘finding something’ can be life-altering… incontinence, erectile dysfunction, bowel problems… not theoretical risks. Real and often permanent.
But …
… several countries are showing that intelligent screening… something smarter, more targeted and better governed, may be a way forward.
If we want to move beyond the stalemate, it’s worth looking at what they’re doing.
Sweden… developed regional prostate testing for men aged 50–74, much like any other national screening programme.
What matters isn’t the invitation… it’s the pathway.
If a man’s PSA is raised, the next step isn’t an automatic biopsy. Instead, he’s sent for an MRI…
… exactly what happened to me.
If the scan shows something suspicious only then comes a biopsy…
… exactly what happened to me.
This simple triage halves the number of unnecessary biopsies. Reducing anxiety, cost, complications, over-diagnosis… and still catches aggressive cancers early, which is the whole point.
The data are tracked. Outcomes monitored. The protocol is refined. It’s a structured public-health programme with quality control baked in.
Across Europe, the EU’s PRAISE-U project is running pilot screening schemes in Poland, Spain, Ireland and Czechia… carefully designed, algorithm-driven. Focused on learning what works in the real-world.
Lithuania is generating real-world data the rest of us can learn from.
The European Association of Urology recommends a risk-based approach…
… combine PSA with risk calculators, family history, ethnicity, genetics where relevant and use MRI as a gatekeeper.
… exactly what the good old NHS did for me. My Uncle died of prostate cancer.
None of these programmes are perfect, but…
… they are better than what we generally have in the UK, which is nothing structured and nothing equitable.
Right now, well-informed, confident men get PSA testing. Anxious men, disadvantaged men, or men who don’t know a PSA from a GPS go without….
… opportunistic testing widens health inequalities. Organised, risk-stratified screening narrows them.
There is good news...
... a major screening trial, backed by Prostate Cancer UK, with £42 million of funding. Up to 300,000 men, tested with combinations of PSA blood tests, genetic (spit) tests and fast MRI scans.
So, what’s the upshot?
We need policies made on evidence, not instinct, and…
… we need to move beyond paralysis.
For men like me, who survived because something was found early, this is not an abstract academic debate.
It’s a practical one. We can do better. We can learn from the countries already doing it and places like Barts.
We can build a screening approach that saves lives without causing chaos.
The status quo is the worst of both worlds.
I know one thing for sure; you or someone you care about, won’t want to belong to my elite club.
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