Many men with prostate cancer may be making treatment choices without understanding all options

One of the bi-products of the COVID-19 pandemic has been a decrease in the number of patients seeing or talking to their GPs, as findings from a Institute of Fiscal Studies report identified late last year. Of particular concern, those most affected were older people and those with ‘poor’ or ‘fair’ health. This is echoed in a recent analysis of NHS England data, showing that 1.85 million urgent cancer referrals were made by GPs between March last year and January this year, a 16% drop on the 2.2 million in the same period the year before.

Prostate cancer is the most prevalent cancer amongst British men, particularly those over the age of 50. Yet unlike the female equivalent – breast cancer – there is no automatic screening. Many men have to request the prostate cancer blood test, or PSA test, themselves.

In addition, many men may not experience any symptoms of prostate cancer at all. Others often put a key symptom – the need to urinate more frequently – down to ageing.

The concern is that in the coming months, men are likely to present themselves with more advanced prostate cancer, which will affect health outcomes and quality of life.

Ongoing research from BXTAccelyon, from a Facebook survey which has been running since May 2017, suggests that once diagnosed, 59% of patients have not asked for alternative treatment options to that which they were first offered, and 43% did not seek any additional information. With 51% of patients discussing their treatment options within a week of diagnosis, the survey indicates that many men might be making choices very quickly without considering all the options and a poor understanding of potential side effects and how these might affect their lifestyle and quality of life.

Within this article, we would like to champion the PSA test as screening for prostate cancer that all men should automatically receive, as per official guidance from the European Association of Urology; outline the major warning flags of prostate cancer that patients may raise in a general consultation with their GP; an overview of the treatment options available; and how GPs can support patients with a potential diagnosis – including, for example, consulting both a Urologist and an Oncologist – when deciding on the right treatment for them.

The recently released 2021 European Association of Urology Guidelines recommend that the transperineal route should be used for prostate biopsy based on the weight of clinical evidence, supporting the shift from traditional transrectal (TRUS) biopsies. Additionally, there is a growing clinical evidence-base which suggests certain standard-practice treatment options and doses may not be as effective, and / or have significant long-term clinical side effects that clinicians and patients alike should be aware of. Yet, many men remain unaware and uneducated about their available options, as well as the potential side effects of treatments – emphasising the importance of researching and discussing available options with their consultant.