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12 May 1998 : Column 283

Prostate Cancer Screening

Motion made, and Question proposed, That this House do now adjourn.--[Mr. McFall.]

11.15 pm

Mr. Christopher Fraser (Mid-Dorset and North Poole): I confess at the outset that I am not an expert on prostate cancer, its research, screening or treatment--nor do I have any medical training. I am also pleased to say that I do not have prostate cancer. For this debate, I have consulted widely within the medical profession; I am extremely grateful for the advice and guidance that I have received. I particularly grateful to Dr. James Dobbie, senior clinical research fellow at the university department of surgery at Edinburgh royal infirmary, for the time that he took to explain the issues involved.

I decided to move outside my field of knowledge because I realised that prostate cancer, its protection and treatment, is a matter of great concern to many of my elderly constituents and to the elderly male population of this country. However, prostate cancer and its associated problems can develop at a relatively early age; as with other cancers, it must be sensible to have periodic checks when young to detect it.

Nearly everyone to whom I have spoken about the subject knows someone who has been diagnosed as suffering from prostate cancer. It is the third most common cancer death in men--after lung and large bowel cancer--with a mortality rate of about 34 per 100,000 males. Currently, it kills more than 10,000 men a year in this country; by 2015, the figure is predicted to double. It has become a real threat to men's lives, yet many in my constituency believe that it has been largely ignored, whereas medical research on other cancers has been much more generously funded.

Cynics among us might think that, if the prostate were a female organ, we would be far further advanced in establishing a strategic approach to treatment. As a man, I bow to the dedication with which women campaign vigorously for research into the cancers that affect them, and for the ever-widening screening programmes that are available to them. I suspect that the male of the species is much more reluctant to discuss such intimate matters; many of us believe that our aches and pains will go away if ignored. Sadly, that is not always the case. The Institute of Cancer Research is campaigning to bring men's health issues to light, and to ensure that, where possible, cancers are caught early. I hope that this debate will add weight to that campaign.

The incidence of prostate cancer increases with age--it is sometimes described as an old man's disease. Only 12 per cent. of clinically apparent cases arise before the age of 65. The prostate is a male sex gland, about the size of a walnut, located below the bladder and in front of the rectum. Symptoms of prostate cancer include difficulties or delays in urinating, urinating more often than usual, pain during urination, a weak stream or blood in the urine, and pain or stiffness in the lower back or hips.

In contrast to other types of tumour, a unique feature of this cancer is the relatively high incidence of what is known as latent cancer in men over 50. The incidence increases steadily with advancing years, such that more than half of males over 80 have small focal areas of tumour in the prostate.

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Is it any surprise that many of my constituents are fearful for the future, and distressed that so little is apparently being done? They may not appreciate the fact that only in a restricted number of individuals will those small areas of tumour become aggressive and extend outside the gland to cause clinical problems, and ultimately, for some individuals, death.

The difficulty is that the medical profession cannot predict with any great accuracy which of the small areas of latent tumour, when detected, will in time become aggressive and life-threatening. The on-going clinical debate concerns how one should treat the finding when a doctor discovers evidence of a focus of latent prostate tumour.

The characteristic features of a prostate tumour and its behaviour are absolutely central to understanding current medical consensus on the issues of the diagnosis and treatment of prostate cancer. As the House will know, there is currently no national screening programme for prostate cancer. In the absence of such a programme, patients diagnosed with the disease have usually sought help from their doctor following the classic symptoms that I described. Their discomfort is such that their condition is often well advanced.

Most informed opinion is in favour of careful clinical monitoring of the patient, together with regular blood tests for a protein specifically released by the prostate, known as prostate-specific antigen, or PSA, the level of which in the blood rises if the tumour changes from latency to local expansion and spread.

Dr. Ian Gibson (Norwich, North): Is the hon. Gentleman aware that the PSA test is not absolutely reliable--many women with breast cancer also give off PSA--and that we really need a sensitive genetic test, which will probably come from the human genome project, allowing us to determine whether a benign cancer will move into the malignant state? Treatment could then be targeted accurately to the individual.

Mr. Fraser: I agree entirely. The problem concerns the way in which the research is done and how the gene is to be identified. Currently, there is literally a wait-and-see process, which is unhelpful and desperately upsetting for those who suffer from the cancer.

The patient and his family suffer considerably, because it is not clear how the cancer is caused and what can be done when it is diagnosed. It has been said that the majority of sufferers die with, and not of, prostate cancer. My concern is that that cliched prognosis is breeding complacency.

Jane Griffiths (Reading, East): The hon. Gentleman mentioned the Institute of Cancer Research. Its campaign, designated Everyman, concerns male cancers in general. Early diagnosis is important, but so is early awareness on the part of the patient and his family. It is especially important to be aware that symptoms such as he described will not be attributable simply to old age, but may indicate a disease that can be treated. With early diagnosis, the trauma can be minimised.

Mr. Fraser: I thank the hon. Lady; I am indeed aware of that, and such awareness is spreading across a wide age group.

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I am concerned that funding for vital research is far too low. Prostate cancer research receives less than £1 million a year, compared with £16 million for breast cancer and £40 million for heart disease. Prostate cancer, however, is the third most common cause of male cancer death. It is predicted that it will overtake both lung and breast cancer, and become the most common cancer in the United Kingdom by 2018.

One obvious possible reason is the increasing age of the population, but we do not know what causes prostate cancer. We do not know whether diet or the environment are relevant factors. There is evidence that men with brothers or fathers who develop the disease are at a higher risk, and incidence is thus likely to spiral. To address that grim future, the medical profession must now actively seek ways in which to treat the cancer, and to try to reduce the number of deaths from it.

There are three ways in which the medical profession can do that: prevention, the development of more effective treatment methods, and early detection. Although much work is being done on treatment strategy, only early detection is currently available--but here we return to the problem of predicting the future behaviour of any latent focus of the disease.

In the past few years, a considerable professional and public debate has developed in the United States. Urologists, oncologists and primary care practitioners--along with health planners, health economists and the lay press--have struggled with the complex issues of early detection and screening. That has given rise to both American and European randomised studies in screening for prostate cancer.

The aim of a screening programme must be to identify, as early as possible, latent tumours that will become aggressive, and to offer treatment that will increase the quality and length of life. Huge strides in molecular genetics are beginning to offer the prospect of more effective screening and more successful treatment. Surely, however, society cannot wait 10 to 15 years until the unequivocal results of the efficacy of early detection and treatment are provided by several international studies that are currently under way.

I accept that screening creates its own problems, including the over-detection of cancers that are not necessarily life-threatening; the unknown natural history of the disease in different individuals; the fact that screening is costly--although there is a relatively cheap prostate specific antigen test--the natural anxiety associated with screening tests; and the potential harm involved in investigating healthy men. There are also ethical and legal implications, as well as people's natural concern about their insurance premiums.

We must remember, however, that screening programmes have been accepted by women, who recognise that there may be something wrong with them and who clearly welcome the fact that they are taking control of the situation. The disadvantages that I have listed are considered to be a price worth paying when they are offset against the advantage of early detection and early treatment.

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