The Journey

We need better screening – and new drugs, says prostate cancer treatment pioneer PROF JONATHAN WAXMAN

For those of us who work with patients and families affected by prostate cancer, it sadly comes as no surprise that this disease is now the third biggest cancer killer in the UK. We have seen prostate cancer death rates rising year on year, from around 3,500 in the mid-1960s to more than 11,800 currently – and now overtaking deaths from breast cancer for the first time. It is a shocking and ghastly statistic. Each and every one of those deaths is important. They are more than just a contribution to national statistics; they represent the suffering of individuals and their loved ones, and they remind us all, doctors, scientists and policy makers, that we must do more on all fronts to combat the scourge of this disease.

We have seen prostate cancer death rates rising year on year, from around 3,500 in the mid-1960s to more than 11,800 currently. And we know that it can be done. The death march of prostate cancer patients is in vivid contrast to the rather happier figures for breast cancer, the equivalent cancer in women. Breast cancer death rates have fallen by over 30 per cent in the last 15 years with a ten-year survival rate of 78 per cent, due to effective screening and research investment that has led to a range of life-prolonging treatments.

First, though, we need to understand what is behind the steep rise in prostate cancer deaths. It is, of course, a disease that generally affects older men and becomes more common with age. As the average life expectancy of a man has increased since the Second World War from 65 to 79, so the blame for the rise in prostate cancer deaths has been attached to this triumph of longevity. However, that is not the sole cause of a near quadrupling in deaths. The main culprit is our changing diet. Since the 1940s, the British diet has changed dramatically from the frugal rations of the post-war era to an abundance of high fat, highly-processed foods. We know that death rates from prostate cancer in men who are vegetarians are half those of meat eaters, and studies indicate that smoked foods, such as bacon, are clearly culpable. If we are to do something as a nation about prostate cancer, then in my view we need to think very seriously about what we are putting in our bodies. However, public health initiatives to improve awareness of environmental factors must run in tandem with effective national screening and well-funded research that leads to more effective treatments.

In stark contrast to the great advances made in breast cancer diagnosis and management, prostate cancer retains the status of a ‘Cinderella disease’, lacking the adequate funds to develop the screening and further the research needed to make a real breakthrough. The figures speak for themselves: In the past decade £185million has been spent on prostate cancer research while £419million went to breast cancer. To date, there is no equivalent to mammography screening for prostate cancer. The current tests for prostate cancer (a blood test that measures levels of a protein called Prostate Specific Antigen) are inaccurate and proven to have no effect on survival rates. We need a better test, one that diagnoses prostate cancer accurately. Only then can we start to limit the death toll.

That’s not to say it is all bad news – largely thanks to the Daily Mail and its readers. It is 22 years since I founded Prostate Cancer UK (PCUK) to provide support services for men and their families that was so lacking, and to stimulate research.

The figures speak for themselves: In the past decade £185million has been spent on prostate cancer research while £419million went to breast cancer. Back in 1996, the national spend on prostate cancer research was a paltry £48,000. A prolonged campaign by the Mail brought government attention to bear on the matter. As a result, Yvette Cooper, who was minister for public health at the time, increased central spending on prostate cancer to match that for breast cancer. However, it was left to charities to fund research into prostate cancer. In 1999, Mail readers donated more than £1million to PCUK to kickstart studies. Since then a combination of charity, government and pharmaceutical investment has led to tangible benefits; men are now living much longer with prostate cancer than they were. But even £1million is insufficient in the context of an average cost for the development of a ‘game-changing’ new cancer drug, which is around £1billion.

In men whose cancer has spread, for example, the survival rate has doubled from three to six years since the mid-1990s. We also know that some forms of prostate cancer are ‘mild’ and may not need treatment, sparing patients stress and drug side-effects.

It is only with greater and more radical investment – boosting our research spend to improve screening and identify new drugs, sponsoring the best academic studies and developing effective public health programmes – that will we stop the epidemic of prostate cancer deaths.

By Professor Jonathan Waxman For The Daily Mail

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