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Traffic lights for prostate cancer

There are over 330,000 men in the UK living with or after prostate cancer. Over 47,000 are diagnosed every year and over 11,000 die from the disease – the equivalent of one man every hour.

It’s the most common cancer in men but there is still no national screening programme for the disease and the current diagnostic process is riddled with complexities.

As it stands any man over the age of 50 is entitled to a PSA blood test and can request one from his GP. Men at higher than average risk can request the test from the younger age of 45. These include men who have a family history of prostate cancer or black men who face a 1 in 4 chance of being diagnosed – double the risk of white men.

The PSA test is currently the best available diagnostic tool for prostate cancer but it needs to be treated with caution. The test can be unreliable and can sometimes lead to over-treatment because it records false positive results meaning that some men may undergo biopsies, or even face surgery which they may not need. It is therefore essential that any man who chooses to have the test discusses the pros and cons with his GP beforehand so that he can make an informed choice about taking the test or not.

The PSA test certainly has a place but it can only give an indication that a man may have something wrong with his prostate, and it can’t confirm a diagnosis of prostate cancer. There’s no denying that it’s the best diagnostic tool available at the moment but it’s far from ideal.

As a charity, we decided that we needed to develop a simple risk assessment tool that can be done in a primary care setting and can be used to more accurately determine a man’s risk of prostate cancer than the PSA tests alone. For this reason, we recently brought together a group of international experts to discuss what we could do to not only help men understand their risk of prostate cancer, but also what to do about it. On the basis of this consultation, we are developing our own risk screening tool, which includes the PSA test, but will also incorporate data from other sources into an algorithm that will produce a result. This will hopefully be traffic-light based with a red meaning high risk with advice to go and see a urologist, amber for medium risk with advice to have another test in a certain period of time and green for low risk, when no action needs to be taken in the short term.

Our risk assessment tool is being designed to be flexible, and able to incorporate new streams of research results as they become available.

The USA, Canada and the Netherlands already have screening tools but we wanted to develop a tool that could be used in primary care at a reasonable cost to the NHS. We are now funding a group of researchers who are working on applying a model to the data sets to see where we should set off the ‘cut off’ values between red, amber and green. Another group of researchers, who work in clinical research including primary care, will then look at how the tests can be applied in the real-world setting. There could be an online component, but there is likely to be face-to-face contact between health care practitioners and patients for consultations, physical examinations and blood testing.

We hope that the prostate cancer risk assessment tool will be in the hands of GPs and available to NHS patients within the next five years.

For further information on the work that Prostate Cancer UK is doing in this area, please visit: http://prostatecanceruk.org/about-us/news-and-views/2016/2/new-risk-tool-for-gps-set-to-revolutionise-prostate-cancer-diagnosis-within-five-years

Dr Iain Frame
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