Prostate cancer can often progress silently for years, making early detection challenging. Dr. Max Pemberton emphasizes that for many men, catching the disease early hinges not on noticing symptoms, but on proactively seeking medical advice, often with the encouragement of a partner.
When television personality Jeremy Clarkson announced his cancer diagnosis, he did so with a characteristic directness, stating he had "aggressive" but "caught early" cancer amidst his farm's harvest. Pemberton notes that Clarkson's situation underscores the importance of regular medical checks, suggesting this proactive approach is likely why Clarkson is still able to discuss his condition.
Early-stage prostate cancer typically grows on the outer edge of the gland, away from the urethra, meaning it can remain undetected for extended periods. By the time symptoms like difficulty urinating or a weakened stream appear, the cancer may have advanced. Pemberton clarifies that these urinary changes, while warranting a doctor's visit, are more commonly due to age-related prostate swelling, which is treatable and not necessarily cancerous.
The PSA (Prostate-Specific Antigen) blood test is available, but Pemberton describes it as a "blunt tool." It can miss some cancers and also produce false positives, leading to unnecessary biopsies and treatments for slow-growing cancers that would not have impacted a man's lifespan. Consequently, the UK does not screen all men for prostate cancer as it does for breast or bowel cancer, partly due to the potential side effects of treatment, such as impotence and incontinence.
Who Should Be Screened?
Men over 50 are entitled to request a PSA test from their GP, provided they understand the potential implications. The risk is significantly higher for Black men, or those with a family history of prostate cancer (father or brother). For these individuals, the conversation about screening should begin earlier, around age 45. Doctors encourage these men to discuss their risks with their GP rather than demanding immediate testing.
Advancements in diagnostic tools have improved the process. If a PSA test or examination raises concerns, an MRI scan is often performed first. This imaging helps distinguish aggressive cancers from less serious ones, potentially sparing many men from invasive biopsies and undue anxiety.
Pemberton identifies fear of treatment side effects, particularly impotence and incontinence, as a primary reason men delay seeking medical attention. However, he stresses that early detection allows for treatments that can preserve nerve function. Conversely, delayed diagnosis often necessitates more aggressive treatments with a higher likelihood of causing the very side effects men fear.
The Partner's Role
Pemberton highlights the critical role partners play in supporting men through the diagnosis and treatment process. Surgery and radiotherapy can impact sexual function and bladder control, while hormone therapy can affect mood and energy levels. Men who have strong partner support tend to cope better with these challenges. He points to Clarkson's girlfriend, Lisa Hogan, as an example of the crucial support a partner can provide, both in encouraging medical consultation and offering comfort afterward.
Pemberton concludes by urging women to encourage the men in their lives who are over 50, Black, or have a family history of prostate cancer to have a conversation with their doctor. This proactive step, he suggests, is more impactful than waiting for symptoms that may never appear.