Download Our position What is early diagnosis? Background

Our position
Prostate Cancer UK believes that there should be a UK-wide awareness campaign to make men aware that
they have a prostate, what it does and what can go wrong. However, there is no evidence that greater
awareness of symptoms correlates with greater survival. This is because first, symptoms are often associated
with either benign prostate disease or advanced prostate cancer, and second, many men with early prostate
cancer are asymptomatic.
We want: a UK-wide awareness campaign around prostates and prostate problems.
What is early diagnosis?
In this context, early diagnosis means the early detection of cancer. This should lead to benefits in survival if it
involves in the diagnosis of disease at an earlier, more treatable stage, and that effective treatment for the
disease exists. The National Awareness and Early Diagnosis Initiative (NAEDI)i, a public sector/third sector
partnership with the Department of Health, has been established in England to improve overall cancer
outcomes. One of the key priorities has been to establish the link between late diagnosis with poor survival
and avoidable deaths. In Scotland, there is a ‘Detect Cancer Early’ programme which aims to improve survival
outcomes for people with cancer to amongst the best in Europeii.
Background
Research shows that screening using the PSA test could prevent a significant number of men from dying from
prostate cancer. Unfortunately, these studies also show that screening will lead to many more men being
unnecessarily treated for a harmless form of the disease. The problem with the PSA test is that it cannot
identify the difference between the harmless and aggressive forms of prostate cancer. This means that many
men with harmless cancers would undergo unnecessary treatment and therefore experience significant side
effects if a national screening programme was introduced. Please see our position on screening for more
information.
It is essential that men are receiving sufficient information about the PSA test, so that they are aware of the
test, and can make an informed choice about whether to take it. However, not all men have access to
information about the test. Although not all men with prostate cancer will be symptomatic, 1 in 5 GPs never
talk to men about the PSA test unless they have potential symptoms of prostate canceriii. A survey of UK
health professionals carried out for Prostate Cancer UK revealed that one in four respondents thought that
counselling men effectively about the PSA test was the biggest barrier to good quality careiv.
Ideally, we would like to be able to detect aggressive prostate cancers at an early stage, where treatment can
be considered either curative or very much reduce the chance of the cancer developing and spreading. For
other common cancers, such as breast and bowel cancer, early detection through symptom awareness and
screening has been shown to save lives. However, this is not yet the case for prostate cancer.
Prostate Cancer UK is a registered charity in England and Wales (1005541) and in Scotland (SC039332). A company limited by guarantee registered number 2653887 (England and Wales).
A Quality Checklist: your standards of care
Prostate Cancer UK wants to improve prostate cancer services for men across the UK. We have developed ‘a
quality checklist: your standards of care’ for men with prostate cancer, based on research with people affected
by prostate cancer and health professionals. The checklist outlines the quality of care and support men with
prostate cancer should expect to receive. The checklist is needed because we know from surveys such as the
National Cancer Patient Experience survey and our survey on quality care that experiences of care varies
across the country.
Which standards of our Quality Checklist does this issue fit within?
Early diagnosis comes under diagnosis:
4. You should be given balanced information about the PSA blood test, digital rectal examination (DRE) and
biopsies. You should have the opportunity to discuss the pros and cons of the test with a doctor or nurse.
References: Special Issue: Diagnosing cancer earlier: Evidence for a National Awareness and Early
Diagnosis Initiative http://www.cabdirect.org/abstracts/20103035278.html
Internal data/Evidence: Internal policy paper on early diagnosis in prostate cancer
Date created/by whom: 25/2/2013 Holly Mitchell, Policy Officer
Review dates: 25/04/2013
i
Richards, M. A., & Hiom, S. Special Issue: Diagnosing cancer earlier: Evidence for a National Awareness and Early
Diagnosis Initiative. British Journal of Cancer, 2009. 101(Suppl. 2), S1-S129.
BJC. 2009 101;S2.
ii
http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/DetectCancerEarl
y
iii
Survey of 505 GPs conducted by Kantar Health on behalf of Prostate Cancer UK in February 2011
iv
Prostate Cancer (2012) Quality of Care: A survey commissioned by Prostate Cancer UK carried out by Kantar Health