BBC Doctor says one in three have prostate cancer over certain age and don't know it after Chris Hoy diagnosis
A prominent TV doctor and practicing GP has spoken out in the wake of the shocking news that cycling legend Sir Chris Hoy is suffering from terminal cancer. The 48-year-old has revealed that he has been given between two and four years to live due to prostate cancer.
Writing in The Times, Dr Mark Porter who has appeared on BBC Breakfast and Good Morning Britain, said many patients would be very concerned if ‘one of the fittest people on the planet has been given such an awful prognosis in his late forties’.
Dr Porter said that at the age of 61 he personally has a 1 in three chance he already has that type of cancer, based on the results of a review in 2015 of autopsy results on men of different ages - who died of all causes. He explained the study found 1 in 30 white American and European men in their twenties in the studies already had cancerous changes in their prostates, rising to 1 in 15 among black African and Caribbean men. And in those in their sixties it rose to 1 in 3 (29 per cent) and 1 in 2 (46.9 per cent) respectively. The risk in Asian men was much lower at every age.
He added: “However, most of the men studied, had they gone on to live full lives, would probably never have known about theirs. And herein lies the challenge when it comes to diagnosing and treating the disease: which cancers are going to cause problems, and which of the men are going to die with theirs, rather than from it?” Dr Porter explained: “The more we screen for prostate cancer using prostate-specific antigen (PSA) blood tests, the greater the number of cases we will pick up and the more deaths from the disease we will prevent. However, this comes at a cost in the form of over-treatment of many other men whose cancers might never have posed a serious threat. The trouble is, we are still not very good at differentiating the tigers from the more common pussycats.”
Dr Porter said the main issue was being able to predict the long term outcome of the disease and if it should be treated or not. He described symptoms as a ‘grey area’ but explained which ones people should get in touch with their doctor over. He said: “While men should always report prostate-related symptoms such as needing to get up frequently during the night, a weakening stream and difficulty getting started, these are generally caused by benign, age-related enlargement of the prostate rather than cancer.
“Indeed, if cancer is causing them there is a fair chance it is already at a stage that means it cannot be cured. Fortunately, many cases are picked up incidentally and at a relatively early stage, when age-related prostate symptoms prompt men to seek help.”
On the first signs of trouble he said: “Little wonder that for some men the first sign of trouble is pain caused by secondary spread to the pelvis, spine and other bones (Hoy’s cancer was picked up when he had a scan for a painful shoulder). By which time it is too late to cure the disease, although it can be held in check for a few years using palliative therapies, and there have been some welcome advances in this field recently.”
He said that doctors were ‘wary’ of PSA blood tests for middle aged men as the treatment could ‘ruin’ more lives than are saved. He added: “If your PSA result does come back as high, it is important that you have the right investigations to confirm whether you have cancer and what treatment approach — surgery, radiotherapy or “watch and wait” with close monitoring — you require. And there have been some useful advances here too, which are now becoming routine across the NHS.
“Suffice to say that if my PSA result came back high, I would expect the next step to be an MRI scan to double check for worrying changes and identify exactly where they are in my prostate. And if the scan confirmed I had a suspicious lesion I would want a biopsy done through the skin between my legs (transperineal) rather than through my backside (transrectal). As would every doctor, I suspect.”