Historically, the DRE was the standard, and at one time only, method available for evaluating prostate health. However, we now have far better, less invasive and more accurate first steps, starting with a conversation with a GP and then a simple blood test, the PSA test.
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“In fact, this year, the British Association of Urological Surgeons put out a statement to say that the DRE is no longer useful,” says Hasan. “The main reason is that when we do it, we often miss things because you can only feel a part of the prostate. You might miss a very small lesion or it might be on a part of the gland that we can’t access.”
The DRE only enables a doctor to feel the back wall of the prostate, and most prostate cancer develops on the front wall so it’s easily missed. “In addition, if you have a DRE and then a PSA blood test, it’s possible that you agitate the prostate and artificially elevate the PSA result,” she says. “Most GPs I know would not even consider giving a DRE for prostate cancer now.”
Myth 2: My sex life will suffer if I put myself forward for testing
Nearly three in four men surveyed by PCR believed that men’s worries about sexual function deters them from getting tested for prostate cancer.
“Historically, this view is understandable,” says Hasan. “In the past, treatments were much more limited and could very often have lasting side effects which includes impact on sexual function.
“Modern medicine and the evolution of how we understand and treat the disease have changed that picture completely,” she continues. “So now, many times that prostate cancer is found, men don’t actually need immediate treatment – it’s active surveillance, watch and wait. They are safely monitored. When men do require intervention, the surgical and radiotherapy techniques are far more precise and that significantly reduces the risk of the side effects men worry about most – which includes sexual function, but also incontinence.”
A key example here is the development of nerve-sparing radical prostatectomy where the whole prostate is removed but the neurovascular bundles that control erections and pass close to the prostate are carefully preserved. “Most important, the earlier the diagnosis, the safer and simpler the treatment and the less likely you are to have side effects,” says Hasan.
The latest techniques for treating prostate cancer mean there is often little or no impact on sexual function.Credit: iStock
Myth 3: Taking any tests for prostate cancer can put me on the pathway to unnecessary treatment
This is a very common belief that stems from old pathways which took men with an elevated PSA straight to a biopsy. “It comes back to modern medicine and our better understanding which means we can now gather a much more detailed picture and make better decisions about whether a biopsy is necessary,” says Hasan.
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“The utilisation of the multi-parametric MRI has really improved this picture, and AI is improving it further – there are amazing trials going on now.”
A multi-parametric MRI combines several imaging techniques to provide a more detailed picture of the prostate. As the “next step” after an elevated PSA test, it means fewer men will require a biopsy. “Learnings from global data and our better technology also means that we can more safely monitor people – for example, someone with a borderline PSA – without necessarily needing any further investigation or treatment.”
Myth 4: I feel healthy so I don’t need testing
Most men don’t understand the risks around prostate cancer. Research by PCR showed that 61 per cent did not believe a test was necessary when they had no symptoms.
“Early-stage prostate cancer often has no symptoms,” says Hasan. In fact, symptoms might not appear until the cancer has metastasised – and these can be so general, for example, pain in the lower back – that they fall under the radar. A quarter of men surveyed by PCR wrongfully believed that one in 25 men will be diagnosed with prostate cancer at some point in their lifetime – in fact, the statistic is much higher. The risk for white men is one in eight, for black men one in four and South Asian men, one in 13.
“That’s very broad though, and it’s important to personalise risk in order to really understand whether you should be tested,” says Dr Hasan.
“Risk rises with age – at 50 for white men and 45 for black men. A family history raises it more.” A close relative with prostate cancer increases the risk of developing the disease and this becomes greater if the relative was diagnosed before the age of 60. Less commonly, the presence of the BRCA mutations, BRCA1 and BRCA2, which are more commonly associated with a family history of breast and ovarian cancer, can also significantly raise the risk of prostate cancer, including a more aggressive form.
“Men sometimes come to me as a GP to discuss their risk and I really welcome the conversation,” says Hasan. “Sometimes, it might turn out that their risk is very low and they don’t need a test – or it might be that they really do.”
The Telegraph, London
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