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Health: Prostate Cancer

Volume 720: debated on Monday 19 July 2010


Asked By

To ask Her Majesty’s Government what steps they are taking to increase general practitioners’ awareness of the symptoms of prostate cancer.

My Lords, in 2005 the National Institute for Health and Clinical Excellence published referral guidelines for suspected cancer. These include symptoms that GPs should be aware of when considering whether to refer a patient urgently for suspected prostate cancer. It is important that we continue to support primary healthcare professionals in detecting the signs and symptoms of cancer and referring patients quickly. We will consider how best to do this as we review the cancer reform strategy.

My Lords, I welcome that Answer and am glad to hear that NICE gave the appropriate guidelines, but I believe that too many GPs are still not vigilant enough and do not recognise the symptoms. Does the Minister agree that it might be sensible for me to ask my PCT to ensure that there is greater awareness-raising about prostate cancer among GPs and patients? Does he share my concern that, with GP commissioning, the necessary strategic view of these issues will no longer be taken in areas of the country, that improvements made to date may be undermined and that control could be put into the hands of the very people who, I believe, have not done the best for their patients to date?

My Lords, there will be plenty of support for GP consortia in the area of cancer diagnosis and treatment, not least from the commercial support units but also from the cancer networks. However, the noble Baroness is right that we are not doing well enough in this country in picking up cases of prostate cancer. Late diagnosis is likely to be a significant contributor to that and is, in itself, the result of a number of factors, poor public awareness being one. Late presentation to primary care is another and, as the noble Baroness hinted, poor detection in primary care is a third. Therefore, supporting GPs in detecting cancer earlier will be a key part of the work that we have to do.

My Lords, given that the prostate-specific antigen test is not in fact pathognomonic of cancer of the prostate but simply of disturbance of the prostate and that significantly high levels of the antigen are likely to lead to an investigative biopsy by a urological surgeon, is the Minister content that we have enough urological surgeons in the country to undertake the level of investigative biopsy that is likely to arise from the higher index of suspicion by general practitioners indicated by the noble Baroness? Entirely separate from that is the question of whether we have enough urological surgeons to carry out the treatment for prostate cancer when it is diagnosed.

My Lords, I am not aware that there is thought to be a significant shortage of urological surgeons or expertise around the country, although the coverage varies from region to region, as the noble Lord will know. However, I shall take his concerns back with me and make suitable inquiries. If I can write to him further, I shall certainly do so.

My Lords, why cannot we have a national PSA screening programme? Would that not help to avoid late diagnosis?

My Lords, the noble Lord may know that the UK National Screening Committee examined this question recently. The matter is out for consultation, which will last until the end of September, when a conclusion will be reached.

Will the noble Earl say whether there has been any progress in the development of a test that is more accurate than the PSA test that is currently used?

My Lords, there is quite a bit of ongoing work to devise such a test but I am advised that no reliable test exists at the moment. The PSA test is the best that we have. The noble Lord will know that the results of tests show that you have to screen about 1,400 men and treat 48 unnecessarily to save one life. It is not an easy equation.

My Lords, with respect to the noble Baroness, we have not heard from a Conservative, so perhaps we can hear from the noble Lord.

My Lords, the Prostate UK charity reckons that 10,000 men a year die needlessly as a result of not being diagnosed with prostate cancer. I agree that the current PSA test is not wholly reliable, but will the Minister agree that all men over 50 should have the test and that their GPs should encourage them to do so?

My Lords, my noble friend raises an extremely important point. He may like to know that last year the department wrote to primary care trusts to remind them that any man without symptoms of prostate cancer who wishes to have a PSA test is entitled to have one. However, it is important that anyone availing themselves of the test does so on a fully informed basis, because, as I said, it is unreliable and can lead to unpleasant side effects.

My Lords, is not one of the problems with the PSA test the fact that it produces a vast number of false positives, meaning that a number of people could be at risk of mutilating treatment? Will the Minister give an answer to the question about advances in genomics, which might help in the long term with regard to prostate cancer?

My Lords, the noble Lord, Lord Winston, is probably in a better position to advise the House on advances in that area of research. I can tell the House that the National Cancer Research Network, set up by the Department of Health in 2001, has brought about a tripling of the number of cancer patients entered into clinical trials. About 12 per cent of cancer patients in England enter NCRN trials, which is the highest per capita rate of cancer-trial participation in the world. The network currently supports about 51 prostate cancer studies, so there is no shortage of research going on.

My Lords, does the noble Lord agree that the recording and quality standards around prostate cancer ought to be considered by the Care Quality Commission? Does he also agree that it is a shame that the CQC has decided not to report at the end of this year on the state of the hospitals that it has been working with across the piece? My own hospital, Barnet and Chase Farm, is predicted to be excellent, but it has been told that the Care Quality Commission will not announce those positions at all.

My Lords, the main reason for that decision is our belief that the regulatory effort should be directed to where it is most needed. Trusts such as the noble Baroness’s, which have been rated excellent, perhaps do not comprise a good use of the CQC’s time. However, it is important to recognise that the CQC is concerned with minimum standards. I think that everyone would want to see more than the minimum achieved across the NHS. We need to aim for excellence everywhere.