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Love him or hate him… Jeremy Clarkson has done it again.
Upset people. Annoyed experts. Said the thing you’re not supposed to say.
Normally, it’s electric cars, farming policy, health and safety, politicians or something involving a tractor.
This time it’s about something much more serious.
We know, he has prostate cancer and, I am not writing this as an observer. I am writing as someone who has sat in the same tractor, as it ploughed up my life.
A couple of weeks ago I wrote… Clarkson had joined our club.
The prostate cancer club, but he’s not sticking to the rules.
He’s told men worried about prostate cancer to lie to their GP, if necessary.
Say whatever you need to say to get yourself tested.
Say you get up in the night (the code word is ‘urgency’) for a pee.
Say your a dribbler.
Say your Uncle suffered from prostate problems…
Say what you need to say to get tested.
Cue sharp intake of breath.
Doctors will hate that. Public health experts will shake their heads.
They have a point… but they’re missing the point.
A health service cannot operate on the basis that people invent symptoms to access tests. Doctors rely on honesty. The system relies on trust.
In that context Clarkson’s advice is wrong, but… the ugly truth is, he’s right.
We've created organised pathways for some cancers but still rely on male initiative for prostate cancer.
Rightly...
Women are invited for breast screening.
Women are invited for cervical screening.
Men and prostate cancer? We’ve never really known what to do about finding it.
Men and prostate cancer? It’s different. It’s not that no one wants to find it. It’s that for years we haven’t agreed how best to look.
We’re left to trip over it… in the dark, on the way to a 3am tryst with the porcelain.
Or, too often ...
We’re left waiting for symptoms that may never come… until the cancer has already set up base-camp.
The defining prostate cancer indicator, the PSA blood test is not a perfect. A single test might miss cancer. Raise alarms unnecessarily.
Identify cancers that might never have caused a problem.
That matters because…
… a diagnosis is not harmless. Tests lead to investigations. Investigations lead to biopsies. Treatment can bring life-changing side-effects.
Caution is sensible… until an abundance of caution costs wives their husbands, kids their grandad, and mates their lifelong friends.
Now, medicine has changed. The question is whether our thinking has changed with it.
The old prostate cancer argument is the Ford Cortina in a Tesla era.
Today, a raised PSA looks different. We have;
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Better MRI scanning.
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Better targeted biopsies.
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Better understanding of risk.
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Better ways of identifying which cancers need treatment and which can safely be watched.
Finding cancer does not automatically mean a blue light panic and a two-tone rush to treatment.
The conversation has changed. For years we have asked:
‘Is PSA good enough for national screening?'
Maybe the better question now is:
‘Is our current approach good enough for modern medicine?’
And…
… there is another problem. It’s the ‘men-thing’. We’re hopeless. We ignore symptoms. We don’t talk. We put things off.
A strange noise from the car? Out wth the spanners and straight to the garage.
A strange change in our body? Particularly our plumbing…’let’s see how it goes.'
That is why people like Clarkson matter.
A celebrity saying ‘I’ve got prostate cancer’ probably does more to make men think about their health than a pile of official leaflets.
We see it every time a familiar face talks openly about illness. The conversation changes.
I don’t want men lying to doctors. No doctor wants that, but…
... when sensible people start gaming a system, the first question shouldn’t be ‘what’s wrong with them?’
It should be; ‘what wrong with the system?'
… an exaggeration, a mis-truth, a terminological inexactitude? With good intentions we tell porkies about Father Christmas and the Tooth Fairy, it looks very like prostate cancer could add to the list.
It may well be, men will feel the only way to get listened to is by exaggerating.
That’s the real sadness and sadness has no part in a modern health service.
We need a grown-up conversation about prostate cancer.
About risk, age, family history, modern diagnostics. About whether yesterday’s arguments still fit today’s technology.
Jeremy Clarkson may have offered the wrong solution, but…
… we know he’s exposed the right problem.
Men…
Shouldn’t have to lie.
Shouldn’t have to shout.
Shouldn’t have to wait.
They… should have a system where the conversation starts early enough to matter.
Believe me, there's a world of difference between finding cancer and cancer finding you.
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