Prostate Cancer Cases Risk Late Detection Because of Misguided Focus on Urinary Problems

Men with early and curable stages of prostate cancer miss opportunities for cancer detection, because of media health campaigns and national guidelines that focus on urinary symptoms, experts at the University of Cambridge in the United Kingdom said.

Despite a lack of evidence that links prostate cancer and urinary symptoms, many continue to promote this link, according to investigators.

In a new analysis, published in BMC Medicine, investigators said that this link could deter men from coming forward for earlier testing and detection of potentially treatable cancer.

“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” Vincent Gnanapragasam, professor of urology at the University of Cambridge, said in a statement. “This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”

Screening programs can detect cancers at early stages. However, in the case of prostate cancer, some contend that these programs could potentially overwhelm health services and cause individuals to be treated for benign disease.

Testing includes a blood test that looks for a prostate-specific antigen (PSA) that is made only in the prostate gland, though this is not always accurate, according to investigators.

PSA density has been shown to be significantly more accurate than PSA alone.

Evidence shows that there is a misconception that prostate cancer is always symptomatic, with a previous study citing that 86% of the public associated prostate cancer with symptoms, and just 1% were aware that it could be asymptomatic, investigators said.

“We need to emphasize that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages. Waiting out for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable,” Gnanapragasam said in the statement.

“Men shouldn't be afraid to speak to their [physicians] about getting tested and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors, such as being of Black or mixed Black ethnicity,” he said.

Individuals are not advocating for immediate screening programs, investigators said.

They also acknowledged that changes in messaging could mean more men approaching their physicians for a PSA test, which they said could potentially result in unnecessary treatment.

However, they also said there are ways to reduce the risk of this happening, including the use of algorithms to assess an individual’s risk and whether they need to be referred to a specialist and for those who are referred, MRI scans could help rule out mild disease or negative findings.

“If men were aware that just because they have no symptoms doesn’t necessarily mean they are cancer-free, then more might take up offers for tests. This could mean more tumors identified at an earlier stage and reduce the numbers of men experiencing late presentation with incurable disease,” Gnanapragasam said.

Reference

Prostate cancer cases risk being detected too late due to misleading focus on urinary problems. News release. ScienceDaily. August 3, 2022. Accessed August 10, 2022. https://www.sciencedaily.com/releases/2022/08/220803203926.htm