Prostate Cancer: National Screening Programme

Question

11:40:00

Asked by

To ask His Majesty’s Government what plans they have to introduce a national screening programme for prostate cancer.

My Lords, we are investing £16 million in the Prostate Cancer UK-led TRANSFORM trial to look for better tests than we have currently. Evidence shows that the current best test available, the PSA test, is not accurate enough to use in men without symptoms. As noble Lords will appreciate, policies must be evidence-based, so the UK National Screening Committee is actively reviewing the evidence for prostate screening programmes and will complete its review this year, to be followed by consultation.

My Lords, I declare an interest, in that just a year ago I was unexpectedly and rapidly diagnosed with prostate cancer and received wonderful treatment from the NHS, to which I pay tribute today. Some 12,000 men die each year, many needlessly, because of late diagnosis. It is a postcode lottery. It is quite clear that in areas of socioeconomic deprivation, and among black men between the ages of 45 and 70, there is a much higher incidence. When can we expect to hear news about a national screening programme? What assessment is being made of the new tests that are being reported at the moment, which are much more successful in diagnosis?

My Lords, I am glad to hear that the right reverend Prelate had such good care in the NHS. His comments are appreciated, and we are very pleased that things have out turned so well for him. The issue, as I know he will he understand, is that we cannot offer an inaccurate test to high-risk groups, not least because that increases the risk of adverse effects, unnecessary treatment and misdiagnosis. We are not yet in a scientifically and evidence-based position to offer the national screening programme, and that is why we are taking the action that I outlined in my Answer.

My Lords, while we wait for a more reliable screening tool, what are the Government doing to inform men about the very clear risk factors that are known about? To that I would add that maintaining a healthy weight reduces the risk. Additionally, what can the Minister do to reassure men that, if they are in any way worried about any symptom, they are not wasting their GP’s time if they go along and get it checked out?

The noble Baroness is absolutely right. I encourage everyone, men and women, to be aware of any changes in their bodies. They are not wasting the time of their GP. That is exactly what they should do. As she says, men are disproportionately affected by a number of health conditions, including some cancers, heart disease and type 2 diabetes. As part of addressing this, the Secretary of State has announced that we are developing a men’s health strategy, not least because we know that men are less likely to come forward to deal with health matters.

My Lords, in the absence of a national screening programme and given the difficulty in getting access to GPs, particularly in deprived areas, how are the Government improving access to GPs? In some areas, it is two to three weeks before people can get an appointment.

Again, I am sure that the noble Baroness would agree that the important thing is that people ensure that they do not ignore the situation. I agree that the situation that we inherited was hugely difficult, particularly in some areas, around GPs. In the 10-year plan, which will be published in the coming months, there will be a big focus on the move from sickness to prevention, from analogue to digital, and from hospital to community. In all three pillars, greater access to GP appointments will be included.

My Lords, as the Minister rightly highlighted, there are detection gaps, and one in 50 people have aggressive disease at the time of diagnosis. When this proves to be hormone-therapy or chemotherapy resistant, how many centres can offer strontium, which can be very effective for metastatic bone pain, as that is how some people present?

I was glad to have the opportunity to discuss this with the noble Baroness. Having looked into it, we do not currently hold this data. However, where strontium therapy is appropriate and preferred to improve patient outcomes, it will be offered. This is, of course, a clinical decision.

My Lords, when I worked in Belgium, a urologist told me that men over 45 years old should seek a test every year for this. When I came back and asked my GP, he was dismissive of that, saying that I should seek a PSA test. When I asked a nurse at my next blood test for a PSA test, she said, “Are you sure? They’re not very reliable”. Given that the last Government introduced trials, and that one of the tests seems to be 96% accurate, can the Minister say any more about that trial and its evaluation, and whether we are any closer to a definitive test? If not, what guidance is available to medical practitioners for the PSA test?

The advice and guidance is that GPs should counsel asymptomatic men about the potential benefits and harms of PSA testing, so that they can make an informed decision. However, the guidance is that GPs should not proactively offer a PSA test, for the reasons that we have covered. That is why we are investing in this trial, to find a better test so that we can address this. This is a complex area, as often it is, but we are making progress, as I have already outlined.

My Lords, it is very welcome that new diagnostic tests are being investigated. However, can we be careful not to give out the wrong message? I was diagnosed with prostate cancer—and I was completely symptomless—thanks to the PSA test. In giving out that message, can we make it clear that GPs should not stop men getting a PSA test, even when they are symptomless, if they are at the right age and in the right bracket?

I certainly agree with my noble friend. As he knows from his experience, tests are available. The point is that they should be used in the right situation. As he knows, one of the issues is people being asymptomatic, which is why it is very important that men take note of their health and report any change or concerns that they have.

My Lords, I am also here thanks to early diagnosis. I understand what the Minister is saying about the PSA test, but very many people are here today because they had such a test. It worries me that the message is that, because it is not reliable, it should not be at the forefront. I ask the Minister not to rule out using PSA tests more widely. If it is the best we have got, it may be the only thing we have got.

I thank the noble Lord for sharing his personal experience. I am not suggesting that the PSA test should not be used, but we are talking about extending it and using it in a screening program. I thank him for giving me the opportunity to reassure your Lordships’ House that that is why we have the trial, which will report later this year, to find a better answer; the answer we have currently is not where we need it to be. Yes, there is a role for it, but we must strive for better than we have got currently.

My Lords, 13 years ago, a PSA test saved my life. I had an operation in Leeds hospital and I now have no sign of that, and every year they test me by the same method. I encourage the Minister not to give mixed messages. We need a very clear message that, at the moment, the PSA test saves a lot of lives.

I agree about the need for clear messages, and I hope the noble and right reverend Lord will agree on the need for striving to do rather better.

My Lords, in many deprived communities, and in the black community in particular, there is a very high incidence of prostate cancer. Before they get to the PSA test, what work is being done to educate communities even to be involved with seeking out that test in order to protect their health?

The noble Lord is quite right to raise this. I am glad to say that the TRANSFORM trial I referred to will help to address this by ensuring that a significant proportion of participants are black men, who suffer disproportionately in this regard. That is really important, because previous trials have not included enough black men. The trial will address those disparities, and therefore the results that we get from that will be really important. It is always the case that working with specific communities to get the right message out is key to what we do.