With Movember Mo’s starting to appear throughout November, pharmacists are optimally placed to take the opportunity to use the Mo-grow movement, to take a Mo-Ment and start a conversation about the signs and symptoms of prostate cancer.
Prostate cancer is the second most common cause of cancer in men, after non-malignant skin cancer. Each year 17,000 men will be diagnosed with prostate cancer and approximately 3000 men will die from it, making it the third most common cause of cancer deaths. Men tend to have general concerns and beliefs that prevent them from seeking advice about prostate cancer. These include believing that seeking information about health is not masculine and being embarrassed about being diagnosed with a male-specific disease. They may also have a fear of examinations and tests.
These attitudes and beliefs – together with the fact that many men have no symptoms in the early stages of disease, poor awareness of the symptoms and risks, along with lack of knowledge of the benefits of treatment – all impact the likelihood of men seeking advice from healthcare professionals. It is therefore vital for men to be educated on the signs and symptoms to allow early detection and treatment.
Early signs and symptoms may include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
Symptoms associated with advanced prostate cancer include:
- blood in urine
- pain during urination
- lower back or pelvic pain.
There is no single test to detect prostate cancer. The two most commonly used tests are the prostate specific antigen (PSA) blood test and the digital rectal examination (DRE). Recommendations made in the Clinical practice guidelines for PSA Testing and early management of test-detected prostate cancer, suggest while some studies indicate PSA testing reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm to the patient. This can lead to over-diagnosis and unnecessary treatments that have potential side effects such as sexual impotence, urinary incontinence and bowel problems. A PSA test is therefore not used as a cancer screening test.
It is important for patients to consider their risks as to whether they have a PSA test. A patient may like to consider testing if:
- they are over 50
- they have any symptoms such as difficulty urinating or blood in the urine or semen,
- you are over 40 with a father, brother or son who have been diagnosed with prostate cancer, particularly if they were diagnosed young,
- or there is a family history of other cancers such as breast or ovarian cancer.
If the patient has no symptoms the current guidelines recommend that:
- Men should be offered to discuss the risks and benefits of a PSA test with their doctor.
- Men at average risk of prostate cancer who decide to be tested should be offered a PSA test every 2 years from ages 50-69.
- The harm of testing may outweigh the benefits for men over 70.
- Men with a family history who decide to be tested should be offered a PSA test every 2 years from 40-45 years up to 69 years, with the starting age depending on the strength of their family history.
- A DRE is not recommended as a routine test with a PSA test by your GP but is important if they are referred to a urologist or specialist.
Prostate cancer is usually a slow growing disease and compared to other cancers it has one of the highest 5 year survival rates with early detection. So this November take an ‘Mo-ment’ and start a conversation to raise awareness and improve the education of your patients.