The focus of national guidelines and public health campaigns on promoting a link between prostate cancer and urinary symptoms despite a lack of scientific evidence may make patients with early, curable stages of prostate cancer miss the opportunity to have their cancer detected and treated, according to a review published in BMC Medicine.
Over the last decade, there has been a decline in the survival rate of patients with prostate cancer over a period of ten years in the UK, mainly because the disease is detected at a relatively late stage. Researchers at Cambridge, Vincent J. Gnanapragasam, David Greenberg, and Neil Burnet, reviewed the scientific evidence base of the link between prostate cancer and urinary symptoms. They also reviewed how these perceived causative associations may prevent patients from getting tested early and how it impacts the detection of treatable cancer.
According to the researchers, public health messages often say that a swollen prostate causes urinary problems, but evidence suggests that this is rarely due to malignant prostate tumors. However, recent studies reveal that a lack of urinary symptoms may indicate a higher likelihood of cancer.
“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” said Vincent Gnanapragasam, Professor of Urology at the University of Cambridge and one of the study’s authors. “This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us from picking up cases at an early stage.”
Furthermore, the researchers point to evidence that there is a misconception that prostate cancer is always symptomatic. Researchers looked at a review and found that 86 percent of people think prostate cancer causes symptoms, and only 1 percent know it can happen without any symptoms.
“We need to emphasize that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages,” the authors wrote. “Waiting for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable.”
“We urgently need to recognize that the information currently given to the public risks giving men a false sense of security if they don’t have any urinary symptoms,” Professor Gnanapragasam added.
Screening programs are often able to find cancers at an early stage. However, when it comes to prostate cancer, some argue that screening programs could overburden health services and cause men to be treated for relatively benign diseases.
The researchers stated that they were not advocating for an immediate screening program. However, they recognized that changes in screening messages could lead more men to ask their GPs for a PSA test, which could lead to unwarranted investigations and treatments. They claim there are techniques to lessen this danger. These include using algorithms to estimate an individual’s risk and whether they need to be sent to a specialist. For those referred, MRI scans could rule out “indolent” (mild) disease or negative findings, lowering the chance of a needless biopsy.
“We’re calling on organizations such as the NHS, as well as patient charities and the media, to review the current public messaging,” said Professor Gnanapragasam. “If men were aware that just because they have no symptoms doesn’t necessarily mean they are cancer free, then more might take up offers for tests. This could mean more tumors identified at an earlier stage and reduce the numbers of men experiencing late presentation with incurable disease.”
Source: Science Daily