12 Feb 2024

Caught off guard: the reality of incidental prostate cancer diagnosis

 Jonathan Noël, MBBS (UWI) FRCS (Urol) on incidental prostate cancer diagnoses

Over 52,000 men across the UK are diagnosed with prostate cancer each year, making it one of the most common cancers in men. While the risk of prostate cancer increases with age, family history and ethnicity, sometimes there are no symptoms or early warning signs. Jonathan Noël, MBBS (UWI) FRCS (Urol) Consultant Urological & Robotic Prostate Surgeon tells us about too many men being diagnosed by chance.

Incidental diagnosis: insights from Dr. Noel

The majority of men that I see with prostate cancer have presented with an incidental diagnosis. It is incidental because they’ve had another medical issue that brought them to the GP’s surgery and the GP, for whatever reason, has offered a PSA blood test.

A primary care practitioner requesting a PSA test, could be due to the patient’s age, their ethnicity, issues with urinating, or the patient is well informed and has requested one. Whatever the reason, the constant thing we know in the urology community is that PSA testing is inconsistent and opportunistic, it’s not routinely performed in the UK, even for men over age 50. It is left to the discretion of the particular clinician.

As a result too many men present too late, and more invasive treatments like surgery or chemotherapy need to be considered.

On average I consult with eight new patients with a suspicion of prostate cancer per week. In addition, my working week involves counselling patients on radical surgery treatment (prostatectomy) as an option and performing the surgery as needed. Once a week, the stage of the prostate cancer I see in newly referred patients is advanced and not treatable by radical surgery.

202402 DRTV chance Dr Noel

The earlier the diagnosis, the better

An early diagnosis of low-risk cancer means radical treatments can often be delayed or avoided entirely, and treated with active surveillance. Ultimately, when prostate cancer diagnosis is left later then more radical surgery is needed, which can come with side effects. And if it spreads beyond the prostate, then whole body chemotherapy treatment is recommended.

The majority of patients have some awareness of the prostate gland and cancer. Some just may hope it would not happen to them and avoid getting assessed, which can be understandable but could make things worse. What is important is men being aware that symptoms will not occur in prostate cancer most of the time. Many men

believe that as they have not been called for a PSA blood test by their GP, it equates to a ‘clean bill of health’. I see it every week in my consulting room, it couldn’t be further from the truth.

Often we repeat the PSA blood test and if the patient needs an MRI Scan of the prostate, this will pinpoint any areas of concern. The MRI of the prostate can tell us just about everything we need to know at this stage. We get a whole picture of the prostate gland, which the digital (finger) rectal examination can not offer.

If there is anything to investigate on the MRI, we can guide our patients accordingly. If it’s a prostate biopsy that is necessary, these are targeted, unlike in the past. This targeted and limited approach to prostate biopsy has allowed Urologists to reduce the risks to many men. Also, we are likely to get the clinically significant results we need to help a patient’s journey start right

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