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Cocidius, (King of the north, AD122) has barely unpacked the boxes in Downing Street and already there’s something important he’s left behind.
Something we want him to bring to Number Ten.
A possible answer to one of the NHS’s most persistent questions…
… how do we find prostate cancer earlier, particularly among the men least likely to ask for help?
Like they do in Lithuania, Croatia and Sweden.
Prostate cancer is now the most commonly diagnosed cancer in men, but England still has no national screening programme.
The traditional argument against one has become a trope.
The PSA blood test is imperfect… it can miss cancers… raise false alarms… find slow-growing tumours that might never cause trouble... blah, blah...
An abnormal result once could have lead to invasive biopsies, unnecessary treatment, incontinence and impotence.
Screening, the experts argued, might do as much harm as good.
Except…
British researchers at UCL proved nearly a decade ago that MRI should come before biopsy.
Greater Manchester has shown what happens when an NHS region actually organises itself to deliver that evidence, consistently.
An abnormal PSA blood test no longer has to lead directly to a biopsy. Men can have an MRI first. Suspicious areas can be identified, biopsies better targeted and many unnecessary procedures avoided.
Manchesterism put those pieces together.
Greater Manchester Cancer Alliance developed a standardised prostate pathway, including MRI early in the diagnostic process and transperineal biopsy when further investigation is needed, and…
… it is also rolling out an artificial-intelligence tool to help radiologists interpret prostate MRI scans, prioritise suspicious results and reach decisions more quickly.
Most interestingly, Greater Manchester took prostate testing out of the hospital and into the community.
Its This Van Can pilot travelled across the city-region offering prostate-health conversations and PSA tests.
It targeted Black men over 45, who face a substantially higher lifetime risk, and people with a family history of prostate, breast or ovarian cancer.
Mobile case-finding was ~25% cheaper and faster than traditional routes through general practice.
No, it’s not a full population-screening programme. We shouldn’t pretend it is, but…
… mobile clinics diagnose clinically significant prostate cancer in roughly 86% of the positive cases they find, outperforming standard comparable studies, and…
… it has demonstrated something important. Targeted prostate case-finding is practical.
- A mobile clinic can reach higher-risk communities.
- A blood test can identify men needing further investigation.
- MRI can reduce the number sent unnecessarily for biopsy.
- Modern transperineal techniques can make biopsy safer.
The components already exist. The question is whether the NHS can join them together.
The coincidence is irresistible.
… Burnham spent years arguing that decisions are better when they are made closer to communities; that places should be allowed to innovate; and successful local ideas shouldn’t have to wait for permission from Whitehall.
Here’s an early test Manchesterism.
If Greater Manchester can organise targeted prostate checks for higher-risk men, why should men in Margate, Morden, or Middle-Wallop have to rely on knowing enough to ask?
Why should finding cancer early depend on confidence, education, ethnicity, geography or a chance conversation with a GP?
HMG is expanding the TRANSFORM research study, run by Prostate Cancer UK.
Will the charity support the expansion of a well-governed, targeted prostate-testing programme whilst it has £26 million of its charity's money invested in TRANSFORM?
It's a question worth asking.
Manchesterism says we don’t have to sit and wait.
The Government could fund every English region to establish a targeted case-finding pathway…
… beginning with Black men over 45, men with a strong family history and those carrying relevant genetic risks.
Not an indiscriminate PSA free-for-all. A managed pathway...
- Invitation,
- informed choice,
- PSA testing,
- risk assessment,
- MRI where indicated,
- targeted biopsy and
- active surveillance rather than automatic treatment for low-risk disease.
Yes, it would require additional MRI capacity, radiologists, urologists, specialist nurses and proper evaluation.
Yes, yes, it would cost money, and...
Yes, yes, yes... late diagnosis, advanced cancer and avoidable deaths cost a lot more money.
Cocidius spent years telling Westminster to learn from Manchester. Now he has the opportunity to make Westminster do it.
If targeted prostate detection can work in the city-region he led, the rest of England should not have to wait.
A successful Manchester pilot should not remain a Manchester privilege.
-oOo-
Have the best weekend you can...
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