BBC Focus - 03.2020

COMMENT

fewyearsago,I madea filmabout
healthtestsforBBC’sHorizon.
I putmyselfthrougha battery
ofhealthteststoseewhich,if
any,wereworthdoing.Thesetests
includedthingslikehavingmyblood
pressuretested,a CTheartscan(only
availableprivately),theprostate
specificantigen(PSA)testforprostate
cancer,andbowelscopescreening
(theysticka cameraupyourbackside
to detectearlysignsof bowelcancer).
I concludedthathavingmyblood
pressure tested and my bowels
screenedwerea reallygoodidea,
butthatmanyof theothertestsI did
weremorelikelytoinduceanxiety
thanfindoutanythingworthwhile.
ThePSAtestforprostatecancer
is a primeexampleofa testthatcan
domoreharmthangood.Thereason
fordoingit is thatprostatecanceris
a majorkiller.Whilebreastcancer
deathshavereducedbya fifthover
thepast 10 years,thenumberof
mendyingfromprostatecancerhas
increasedby 18 percent.Withinthe
next 10 years,prostateis predicted
to become the most commonly
diagnosedcancerintheUK.
Soyoucanseethepressureto
detectit early.Yetnotonlydoes
thePSAtestthrowuplotsof‘false
positives’(tellingyouthatthere
mightbesomethingtherewhenthere
probablyisn’t),butit alsowarnsyou
aboutthepresenceofcancersthat
wouldneveractuallyimpactyour
life. Autopsies show that something

like 70 percentofmenovertheage

of 80 haveprostatecancer,but most

willdieofsomethingelse.

Myfatheris a primeexample.He

hada PSAtestinhisearly70sand

wastoldhehadprostatecancer.He

hadinvasivesurgerytogetridofit.

Theimpactofthesurgeryblighted

thelastyearsofhislife.It’spossible

thetreatmentslowedthedisease,but

it is alsopossiblethatit wasa slow-

growingtumourandhewould’vedied

neverknowinghehadit.Infact,he

diedof unrelatedheartfailure a few

years after the operation.

MICHAEL

MOSLEY

Michaelis a writer

andbroadcaster,

whopresentsTrust

Me,I’mA Doctor.

Youcanwatch

clipsatbit.ly/trust_

me_clips

Healthtestsmaybeuseful,

buttheycanalsoleadto

anxiety and false positives

PROBING THE

PROSTATE

COMMENT

Severalrandomisedcontrolled

trialshaveshownthatif youhave

a slow-growingtumourthenit is

betterto watchandwaitthanto have

surgery,radiationor hormonetherapy.

Buthowdoyouknowif your tumour

is growingslowly?

Thegoodnewsis thattestswhichcan

discriminaterapidlygrowingcancers

frommorebenignformsarebecoming

available.Theseincludesomething

calleda ‘multi-parametricmagnetic

resonanceimaging’(mpMRI)scan,

whichcreatesmoredetailedpictures

oftheprostatethana standardMRI

scan.TheseareavailableontheNHS,

andrecenttrialshaveshownthat

havinganmpMRIscanreducesthe

chanceofunnecessarybiopsies and

aggressivetreatments.

Sincebiopsiesandover-treatment

oftenleadtoimpotenceandurinary

incontinence,I willbebookingmyself

inforanmpMRI should the need

arise.

“ThePSAtestfor

prostatecanceris a

primeexampleofa

testthatcandomore

harm than good”

PORTRAIT: KATE COPELAND ILLUSTRATION: JASON RAISH

A