The Prostate Cancer Risk Management Programme – answering important questions

Deciding whether to have a PSA test is a complex decision

(Here’s a guest post by Martin Ledwick, Head of the Cancer Research UK Information Nurse team)

It was good to read this week that the Prostate Cancer Risk Management Programme has been updated and re-launched.  The programme is a resource pack for GPs to help them talk men through the advantages and disadvantages of having a test for prostate cancer.

My team of Cancer Information Nurses answer questions about all aspects of cancer and its treatment, on Cancer Research UK’s telephone helpline.  I have been working on cancer helplines for nearly 15 years and have had lots of conversations with men wondering if they should have a PSA test, so am only too well aware how difficult this can be.

Spotting the symptoms
If you have symptoms that might be caused by prostate cancer, it is important to get them checked out with your GP and talk through whether or not you should be investigated for cancer.  These symptoms include:

• needing to pee often, especially at night
• difficulty starting to pee
• straining to pee or taking longer to finish than usual
• pain when peeing

And less commonly:

• blood in the urine or semen
• impotence (difficulty getting an erection)
• pain in the back, hips or pelvis

It is important to remember that these symptoms can also be caused by other conditions, but if you have them you should tell your GP about them just in case.  They may recommend a PSA test.  One of the biggest risk factors for developing prostate cancer is age, so for younger men these symptoms would probably be caused by something other than prostate cancer.

No symptoms?
If men don’t have symptoms, but are interested in being screened for prostate cancer, the decision about whether or not to have a PSA test is less cut and dried.

The test measures a substance in the blood called Prostate Specific Antigen.  If it is raised, it can mean that you might have prostate cancer, but it can also be raised in other conditions.  So if PSA is higher than it should be, a biopsy needs to be done to check for cancer.

Unfortunately the biopsy is not 100 per cent accurate either.  To complicate things still further, when prostate cancer has been diagnosed it is not always clear which cases need to be treated and which it is safe to leave alone.

Some may need treatment early, to prevent the cancer becoming life threatening.    But other prostate cancers seem to grow very slowly and never become life threatening.  In these cases, the treatment could cause more problems than the cancer.

To treat or not to treat?
The uncertainties don’t stop there, even when treatment aims to cure prostate cancer, there is always a chance it might come back in the future.  Again it isn’t possible to predict who this will happen to.  As the treatments themselves have side effects, having treatment is not necessarily an easy option.

So there are lots of uncertainties and difficult decisions a man may face if he decides to have a PSA test.

Of course many men want to know whether or not they might have prostate cancer, and a lot of men instinctively feel they would rather be treated than not treated.  But, because of all the uncertainties, it is really important that they have full information about the potential risks, benefits and uncertainties associated with the test and treatments so that they can make a fully informed decision.

Explaining all these issues isn’t easy.  So it is great that GPs have access to the Prostate Cancer Risk Management Programme, to help them talk men through the advantages and disadvantages of being tested.

There are also other good sources of information about prostate cancer and about the PSA test.  Cancer Research UK’s patient information website CancerHelp UK has information about prostate cancer and screening for prostate cancer.

Finally, UK Prostate Link is a unique project, supported by several cancer charities, including Cancer Research UK.  It’s essentially a search engine for prostate cancer, where all the information listed has been checked for quality and given a rating.  So you can be sure that you are finding reliable, good quality information about prostate cancer.

Martin Ledwick, Head of Cancer Research UK’s Cancer Information Nurse team

If you are concerned about prostate cancer, please contact our team of trained cancer information nurses.  We cannot answer medical enquiries on the blog.