Experts warn that current prostate cancer messaging might actually be harmful

"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," says Vincent Gnanapragasam, MD.

Experts at the University of Cambridge, United Kingdom warn that current public health messaging that labels urinary symptoms as a key indicator of prostate cancer may be detrimental to efforts to improve health outcomes for the disease. The authors of the paper highlight the need for awareness efforts to instead draw attention to prostate cancer as a silent disease, especially in the curable stages.1

Even though many men diagnosed with prostate cancer have more than 10 years of survival, the rate has remained largely unchanged in the United Kingdom over the past decade due to late detection, despite an effort to increase awareness, according to a news release about the paper.2 Awareness efforts often highlight urinary symptoms as a primary indicator of the disease, though, which experts argue may actually be detrimental to disease outcomes due to a lack of scientific backing.

“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. This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage,” said first author Vincent Gnanapragasam, MD, professor of urology at the University of Cambridge, in the news relesae.2

There is little evidence to suggest a link between prostate cancer and urinary symptoms, yet public health messaging continues to promote a correlation, say the authors, who add that prostate cancer arises in the peripheral zone anatomically, whereas urinary symptoms occur more centrally due to a compression of the urethra by prostatic enlargement.

Although urinary symptoms are a result of enlargement of the prostate, mean prostate volume is actually lower in men found to be in the early stages of prostate cancer, the authors write. In fact, the strength of the inverse relationship between prostate size and the probability of cancer has led to a knowledge of prostate-specific antigen (PSA) density being more accurate in predicting a positive biopsy than just PSA level alone.

However, in an effort to reduce overcrowding of health care systems, current health messaging on prostate cancer focuses more on symptoms as indicators, despite their inability to accurately serve as an early detection mechanism, according to the authors. As a result, waiting to rely on symptom presentation before seeking care may have led to higher proportions of men presenting with locally advanced or metastatic disease than if there was a reliance on PSA testing or screenings.

The authors suggest that instead, current messaging should target primary prevention of the disease by encouraging men to get regular screenings for prostate cancer regardless of whether they have symptoms.

“We’re calling on organizations such as the [National Health Service], as well as patient charities and the media, to review the current public messaging,” said Gnanapragasam. “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.”

In order to reduce mortality of prostate cancer through earlier detection, the authors say a restructuring of the current public health messaging needs to occur in tandem with efforts to target men who have the highest risk of disease development.

The authors say that they recognize that a change in public health messaging could result in a significantly higher number of unnecessary tests, but that this could be mitigated by using algorithms to determine an individual’s risk for prostate cancer. If the risk is determined to be high, the patient could then be referred to a specialist who could administer an MRI to further rule out those with mild disease or negative findings. This would eliminate unnecessary biopsies while also working to detect prostate cancer in a more curable stage and improve disease outcomes.

References

1. Gnanapragasam VJ, Greenberg D, Burnet N. Urinary symptoms and prostate cancer—the misconception that may be preventing earlier presentation and better survival outcomes. BMC Medicine. Published online August 4, 2022. Accessed October 6, 2022. doi.org/10.1186/s12916-022-02453-7

2. Prostate cancer cases risk being detected too late due to misleading focus on urinary problems. News release. University of Cambridge. August 4, 2022. Accessed October 6, 2022. https://www.newswise.com/articles/prostate-cancer-cases-risk-being-detected-too-late-due-to-misleading-focus-on-urinary-problems?sc=sphr&xy=10016681