According to a recent study at Oxford, celebrity prostate cancer awareness campaigns have contributed to the over-testing of white, wealthy men from the south of Britain for PSA – prostate-specific antigen, a marker used in the diagnosis of the disease. This over-testing, the Oxford academics say, has led to unnecessary treatment, harm to individuals and expense for the NHS.
My late husband, Jeremy Clarke, would still be here if he’d been offered a test at 50. He was diagnosed at 56 after he got up one morning unable to pee. His PSA at diagnosis was 38 and his cancer had spread to three lymph nodes. Once the cancer has spread, surgery isn’t an option. His brother, who was ten years younger, should’ve been tested after Jeremy’s diagnosis but wasn’t. He was offered a test finally, aged 47, when he presented with symptoms. His PSA was 90 when the disease had already spread to his bones. He died nine years later, last January. Given limited resources, it’s important not to over-test or over-treat, but routinely testing men over 50 and younger men at higher risk – those with a close family history of the disease and black men – would save lives.
Blaming celebrities for over-testing and over-treatment is unhelpful. Awareness is important. If unnecessary treatment and testing is being carried out, it’s down to the medical profession, with up to date research-led guidelines, to stop it. Men aren’t performing radical prostatectomies on themselves. A PSA blood test at Superdrug costs £79. Perhaps the white, wealthy southerners should head there for unnecessary repeat testing.
Before 2015, younger men in their fifties and sixties with a PSA of four, regardless of how aggressive the disease, were offered radical prostatectomy, sometimes resulting in the devastating side effects of permanent impotence and/or incontinence of urine. Nowadays, long-term monitoring (biopsy, scans and blood tests) is advised for borderline results which indicate less aggressive disease.
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