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Prostate Cancer (Abiraterone)

Volume 504: debated on Thursday 21 January 2010

Motion made, and Question proposed, That this House do now adjourn.—(Mr. Heppell.)

I am pleased to have secured an Adjournment debate on the diagnosis of prostate cancer and trials of the drug abiraterone.

Ten thousand men die of prostate cancer every year. A welcome recent development was an advertisement on television by Bob Monkhouse. His wife, now regrettably deceased herself, kindly allowed the use of images of her late husband talking about prostate cancer while walking around a graveyard. Having spoken to quite a few people about the advertisement, I know that it is remembered because it was so effective.

I very much hope that in future, when the Government put out public broadcast advertisements, a little more imagination is used, and lessons can be learned from the Bob Monkhouse video. It is important to ensure that people remember the issues rather than thinking, “It is just another Government advert, yet more Labour spin”, and forgetting about it. If we are going to spend this money, we ought to think imaginatively so that we can build on the Bob Monkhouse advertisement in a way that resonates.

I have called this debate because a constituent of mine, Mr. Roger Walker of Shrewsbury, suffers from prostate cancer. Earlier this evening, I sent the Minister a copy of a very emotional letter that I had received from Mr. Walker. I hope that, if the Minister has not yet received the letter, he will take time to have a look at what my constituent has written to me about the extraordinary suffering that he has undergone as a result of not having prostate cancer diagnosed effectively when he first sought help.

My constituent decided to see his local general practitioner because he was going to the toilet far more often than was normal, and his brother, who at the time was dying of prostate cancer, had informed him that that was a symptom. Very regrettably, his brother subsequently died. His father has also died of prostate cancer, as has his uncle. Therefore, there is a history of the men in the Walker family being affected by prostate cancer.

Mr. Walker went to see his GP, but he was not given a screening test, despite informing the practice that his brother, father and uncle had all died, or were dying, of prostate cancer. Nor was he given a prostate-specific antigen—PSA. However, such was the perseverance of Mr. Walker—he is a strong, powerful and persuasive man, who makes his point very well—that he doggedly kept going back to the medical practice until he was finally granted a PSA. He was diagnosed with prostate cancer at the Royal Shrewsbury hospital. That diagnosis, however, came 10 and a half months after his initial approach to the doctor, and that 10 and a half months has had a great impact, as it would have on anybody living with a disease such as prostate cancer without being diagnosed. That leads to huge complications, and any other medication and available treatments were, of course, not used in that period.

I am not criticising in any way any of the NHS staff in Shrewsbury—either people in the medical practice or anybody who dealt with Mr. Walker. I am very proud of the NHS staff in Shropshire; we have very good staff. If there have been individual problems in respect of individual doctors or others who dealt with Mr. Walker, however, that will be addressed by the General Medical Council. My purpose is to let the Minister know what happened to my constituent, and to highlight his case to him.

What would I like the Minister to do? An article was printed in the Daily Mail on 8 July, including an interview with the leading researcher, Dr. Johann de Bono from the Royal Marsden hospital. The title of the article was: “The prostate cancer ‘wonder pill’ set to save thousands every year”. It stated that there had been

“a dramatic breakthrough against a lethal form of prostate cancer.”

Mr. Walker read the article and it gave him significant hope. It said:

“Trials of a new pill have shown that it can shrink tumours in up to 80 per cent. of cases, and end the need for damaging chemotherapy and radiotherapy…Abiraterone is now being used in a 1,200-patient international study, including at ten sites across the UK. If it is licensed as expected in 2011, it will have to await approval by the rationing watchdog NICE before it is made freely available across the NHS.”

I do not want Mr. Walker, my constituent who has been through so much pain, to have to wait for the drug to be licensed in 2011 and then for it to be approved by the National Institute for Health and Clinical Excellence. I very much hope that he will be allowed to be one of the people in the United Kingdom who is involved in this international study, and be given the drug abiraterone so that his life can be prolonged.

I have written to Dr. de Bono about this, and he wrote back to me saying that he will consider Mr. Walker’s case only if he is referred. I therefore want to let the Minister know that I have today written to the chief executive of the Royal Shrewsbury hospital, asking for Mr. Walker’s referral appointment, which is not due until the end of February, to be brought forward. He can then be seen as quickly as possible at the hospital and be referred as quickly as possible to Dr. de Bono at the Royal Marsden hospital, so that he can be considered for the drug abiraterone.

An interesting point is made in the article, to which I would like the Minister to respond. It states that Dr. de Bono

“describes prostate cancer as the ‘Cinderella cancer’ because it receives just a quarter of the funding of breast cancer”.

Interestingly, in the UK the same number of people die from prostate cancer as from breast cancer, but prostate cancer research receives only £10 million per annum, whereas breast cancer research received £40 million last year. I am rather concerned about that big difference.

In the time left available to me, I want to make a few points that were passed on to me by the Prostate Cancer Charity, which has kindly provided me with a briefing paper for this debate. It informs me that the United Kingdom National Screening Committee is reviewing an introduction of a national prostate cancer screening programme later this year. This eminent charity says the following:

“Recent research has found that screening for prostate cancer using the PSA test can reduce the number of deaths from the disease by 20 per cent. However, the authors of this study also stated that a national screening programme would lead to a significant level of over-diagnosis of ‘harmless’ prostate cancers. This means that current evidence does not appear to show that a national screening programme for prostate cancer, using the PSA test, could achieve an acceptable balance between benefit (through lives saved) and harm (though over-diagnosis and false positive and false negative results).”

I would very much like to know the Minister’s attitude to the National Screening Committee’s reviewing and to the point made by the charity.

I feel passionately and very much agree with this point from the charity:

“The Prostate Cancer Charity does not currently support the introduction of PSA-based national prostate cancer screening programme. However, the Charity strongly supports the right of every man over the age of 50 years—and younger men at higher risk of prostate cancer—to make an informed choice about whether he should have a PSA test.”

That is very important, and I would like the Minister to confirm that anybody in the United Kingdom who is over that age or who has a history of prostate cancer in the family, as my constituent had, should be able to go to their doctor and demand a PSA test because of their concerns, particularly if they are showing early symptoms.

The Department of Health policy states that all men are entitled to make an informed decision about whether they should have the PSA test. Currently, information about the PSA test is delivered to men through the prostate cancer risk management programme—PCRMP. Under the current implementation of the PCRMP, for men to receive balanced information about the PSA test from their GP they must first be aware of prostate cancer and the PSA test, and then request to see their GP for further advice. That is the main crux of what I wish to put to the Minister and of what the Prostate Cancer Charity wishes to say.

Recent research by the charity has found that

“around 50 per cent. of 50-70 year old men are not aware of the PSA test”.

That refers to my point about the need for effective advertising. That figure of 50 per cent. is incredible, so I very much hope that through my having this Adjournment debate and my local media taking up the issue in Shropshire, my Salopian constituents will begin to find out more about the PSA test.

The charity also found that

“awareness of the PSA test is lower among men from lower socio-economic groups”

and that

“82 per cent. of GPs were not aware of the PCRMP”.


“20 per cent. of GPs did not think that asymptomatic men should have access to the PSA test.”

That is of great concern to me. I do not understand—I hope that the Minister can give me an answer—how a GP could be against a PSA test if their patient was showing signs of prostate cancer. I am not a medical man, but it seems highly logical that they would always support a PSA test. Perhaps the Minister can enlighten me on that. Those findings highlight the broad lack of awareness about the PSA test as well as the barriers that some informed men might face when requesting a test from their GP.

It has been a great pleasure for me to be able to highlight the risk of prostate cancer and to play a small part in trying to highlight the terrible issues that surround this appalling disease and illness. This is one of those occasions as a Back Bencher when one realises just how worth while this job is—when one can highlight a constituent’s suffering on their behalf and try to cut through the red tape in some way by raising it with the Minister.

I feel passionately about Mr. Walker’s case and want to do something to help him. He is a grandfather with five beautiful grandchildren and I hope that by raising this issue I can ask the Minister, although he is a very busy man, to help me and my office as we try to support Mr. Walker through these difficult times.

May I begin by congratulating the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate? I can think of few things more important than our fight against cancer, and that is why we have put in place the national two-week targets for people to be able to see a cancer specialist. It is also why we recently announced that we need to ensure that cancer diagnosis tests are completed within one week. We want to ensure that these improvements in cancer health are put in place quickly.

This terrible and insidious disease will touch most of our lives at some point—through members of our family, because we know someone who has cancer or because we battle it ourselves. The hon. Gentleman asked what action the NHS is taking to ensure that cancer, patients are given the early diagnosis and treatment that are so vital in dealing with the disease, but before I talk about that perhaps I can first address his concerns for his constituent, Roger Walker. The hon. Gentleman rightly drew attention to the Bob Monkhouse advert, which I, too, thought was extremely effective. People do remember it.

I was very sorry to hear that Mr. Walker has been diagnosed with prostate cancer. I have not had his letter yet, but I shall certainly read it, as the hon. Gentleman requests. I understand that Mr. Walker’s brother, father and uncle died from this disease. We know that this particular cancer can cluster in families, with about 5 to 10 per cent. of cases thought to have a substantial inherited component. At present, there are no definitive guidelines for screening in such high-risk families because of the uncertainties about the effectiveness of testing and treatment, which was mentioned by the hon. Gentleman. However, the leaflet that GPs give to patients who are concerned about prostate cancer clearly states:

“The risk is greater for men who have a family history of prostate cancer”.

Bearing in mind Mr. Walker’s family history and the importance of early diagnosis to successful treatment, I can understand his concern at not being offered the prostate-specific antigen, or PSA, test by his former GP at the earliest opportunity.

On 16 July 2007, Mr. Walker registered a complaint with the General Medical Council about his then GP’s failure to make a timely referral and diagnosis of the cancer. I understand that after looking at the patient notes, the GMC closed the case with no further action as it considered that

“on the basis of the evidence available, there was no realistic prospect of proving his GP’s fitness to practise was impaired to a degree which would warrant action on his registration.”

On 19 May 2008, Mr. Walker provided the GMC with further evidence, leading to the reopening of his case. An investigation is ongoing and I am sure that the hon. Gentleman will appreciate that neither he nor I can comment further on that.

The hon. Gentleman also asked me to consider Mr. Walker’s request to participate in the ongoing trials of abiraterone. Such matters are not for Ministers: quite rightly, they are not political decisions and so are beyond Ministers’ influence. Whether a person is appropriate for trials of a particular drug is a wholly clinical decision, and I am told that subjects are selected according to the strict eligibility criteria that are set to test a drug’s safety and efficacy.

In other words, a group is selected for the testing of a particular drug, but unfortunately, some people do not meet the criteria. I am advised that it appears that Mr. Walker is one of those who do not meet the criteria, but the hon. Gentleman has written to the chairman of his PCT and I hope that the matter will be examined and an appropriate decision taken. Mr. Walker is dealing with a multidisciplinary team at Shrewsbury and Telford hospital, and I am told that the team will be looking at alternative clinical trials that may be more suitable for his condition.

I turn now to the other matters raised by the hon. Member for Shrewsbury and Atcham. Everyone involved in cancer care is dedicated to improving outcomes for people with cancer. The goal of the Government’s 2007 cancer reform strategy is to deliver cancer care outcomes that are among the best in the world.

In 2008-09, the Health Secretary spent more than £5 billion on cancer services in England, and that is more than 5 per cent. of all NHS spending. Spending on cancer services has increased by more than a third over the past five financial years. There are now around 1,500 multidisciplinary cancer teams working to improve the delivery of treatment and care for cancer patients. The result has been that mortality rates for cancer fell by almost one fifth between 1996 and 2008, which means that every year there are more than 9,000 people walking around who previously would have died.

Today, on average, 95 per cent. of people see a specialist within two weeks of referral for suspected cancer. In Mr. Walker’s local hospital, the Shrewsbury and Telford hospital, the rate is even higher, at 99.5 per cent. That is a very good rate and, since April last year, all patients undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment are entitled to free prescriptions.

In 2000, the Government published the NHS prostate cancer programme, in which we set out our commitment to improve prostate cancer services. The hon. Gentleman is right to say that we need to continue to work on prostate cancer, as it is an area in which a lot of improvement is still needed. By improving the early detection and diagnosis of prostate cancer, by improving the treatment and care that patients receive, and by enhancing research into the disease, our aim was to ensure that we could assist those men who may be at risk.

Early diagnosis is an important part of effective treatment for prostate cancer. From next year, and over the following five years, we will roll out diagnostic tests that can confirm or exclude cancer within a week. We believe that faster access to diagnostic tests, alongside work on early detection, will help save up to 10,000 lives a year. Screening is therefore an important tool in early diagnosis, and that is why we have developed world-class screening programmes for breast, bowel and cervical cancers. Although there is currently no automatic national screening programme for prostate cancer, we remain committed to introducing new screening programmes as and when they are proven to be both clinically and cost effective.

Research published last March in the New England Journal of Medicine has shown for the first time that screening for prostate cancer can reduce the death rate by 20 per cent. However, it also showed that more than 1,410 men needed to be screened to save one life—and that 48 of those would end up being treated unnecessarily, with all the side effects that that can cause. There are therefore problems to do with screening that we really need to resolve before any test is introduced on a national basis, because treating 48 people unnecessarily to save one life would pose significant difficulties. We have asked the UK National Screening Committee to review this evidence and to make a recommendation on prostate cancer screening by the autumn of this year.

As part of our prostate cancer programme, we have established the prostate cancer risk management programme, to which the hon. Gentleman referred. This ensures that men considering a prostate-specific antigen test are given the information that they need about it. For a while a PSA test can help with diagnosis, but it is not perfect. Some men with prostate cancer do not have raised PSA levels, and, depending on the cut-off level used, two thirds of men with raised PSA levels do not have prostate cancer, so the test is not perfect. It can lead to false-positive and false-negative results, and that is why PSA tests divide opinion among GPs and, indeed, other clinicians. Some are concerned about them because of those issues, and the PSA test cannot distinguish between men with slow-growing prostate cancer, which may have no effect on a man’s natural lifespan, and those who have a more aggressive disease.

The hon. Gentleman asked about choice. In 2010 all GPs in England were sent a pack of materials to give their patients the information that they need to make an informed choice about the PSA test. Our policy, as he rightly says, is that if a patient wants a test, after considering the benefits, limitations and risks associated with it, they should receive one on the NHS. Based on an evaluation of the ongoing prostate cancer risk management programme, a revised information pack was sent to GPs in July 2009, six months ago. In August the chief medical officer then wrote to all GPs to remind them that their patients should be given access to PSA tests in accordance with the PCRMP.

A lot of information is thrown at GPs, so we need constantly to remind them to do various things, because we ask them to do so many. The hon. Gentleman is right that, sometimes, feedback from polls states that some GPs do not know about the test. It does not mean that they have not been told; it may mean that they have been told but, given the sheer volume of information that they are sent, have forgotten it or do not have it at the forefront of their mind.

It was recognised that some GPs are unaware either of the original pack or of their patients’ right to a PSA test, so an action plan to engage GPs better has been developed. There has already been a trade media launch and a webcast, and GPs now have the PCRMP materials on their IT systems, helping them better to support their patients. Other plans to remind them include a roadshow for GPs and a peer-reviewed paper in the British Medical Journal. The campaign to alert men to prostate cancer is therefore enormously important, and I welcome the stories that have appeared in the Daily Mail. That work is valuable in alerting men and getting them to go to their GP if they have problems, and reminding GPs that men should be given the PSA test. Such campaigns can save the lives of many men, so I welcome the work of the Daily Mail. Whether the drug that we have discussed is a “wonder pill” is another matter, but we will see what the outcome is of the clinical trials.

Once diagnosed, patients are entitled to receive the best possible care on the NHS. The National Institute for Health and Clinical Excellence has published a series of improving outcomes guidance covering all major cancer tumours, including urological cancers such as prostate cancer. It recommended the way in which primary care trusts and cancer networks should organise cancer services to ensure the best outcomes, and the national cancer action team monitors progress against those plans. In 2008, NICE also published new guidelines on the diagnosis and treatment of prostate cancer, and they recommended good practice based on the best available evidence and professional opinion.

However good our treatment today, we must always strive for more, as the hon. Gentleman rightly said. We can still continue to do better. The Government are among the largest funders of cancer research, along with the industry and the cancer research charities. Through the Medical Research Council and the National Institute for Health Research, we fund about £250 million of cancer research every year. The vast majority of this money supports clinical trials and research undertaken by our partners in the public and charitable sectors. We are very proud of our record of excellence in health research and of what its results mean for people not only in the UK but around the whole world. Britain is one of the leaders in cancer research. The Government are determined to continue to do whatever we can in the fight against cancer: it is an enormously high priority for us. Our excellent record of high investment and high ambition is saving more lives today. We have a long way to go in the fight against cancer, but we must, and will, strive to do more.

Finally, I wish Mr. Walker well in his continuing treatment and hope that it brings with it some success.

Question put and agreed to.

House adjourned.