LTB 198/24 – Prostate Cancer – Raising Awareness and Campaigning for a National Screening Programme

No. 198/24

Dear Colleagues,

Prostate Cancer – Raising Awareness and Campaigning for a National Screening Programme

As we approach Men’s Health Week 2024 with the UK theme “Lets Talk Prostate” this is an update report on the research, campaigning and raising awareness work undertaken by the Health, Safety and Environment Department and in particular the call for a national screening programme.

As CWU Branches, Regions and health and safety reps will well know Prostate Cancer is an important subject matter that the Health, Safety & Environment Department has done a huge amount of work and campaigning on over the years to raise awareness amongst our Regions, Branches and members.

Prostate Cancer is a subject which is also personally dear to our heart as two former CWU National Official colleagues and long-standing friends died of Prostate Cancer; Dave Ward former CWU Education and Training Officer lost his battle against prostate cancer and passed away on 1 February 2020. Former CWU National Romec/RMP&FS Rep and Chair of our London Postal Engineering Branch, Cyril Onyejekwe, passed away on Sunday 10 March 2019 after a long battle with Prostate Cancer and myelofibrosis.

Prostate cancer is the second most common cancer in men, and rates are on the rise. By 2030 its forecast that there’ll be 1.7 million men living with prostate cancer in the UK. It’s already killing hundreds of thousands of men each year, and those who survive face serious side effects.

The Health, Safety & Environment department has worked hard on awareness raising, producing LTBs, Fact Sheets, Posters and a Black Workers Fact Sheet/Leaflet/Flyer has been produced, as requested by the Black Workers Conference which was very well received indeed – Black Workers being higher risk etc. (See copies attached).

The first Prostate Cancer Campaign we in the Health, Safety & Environment Department ran was our “Water Works” Campaign with Posters and Leaflets in 2003.

We ran our first ‘Movember’ Help Save Men’s’ Lives Campaign in 2016 Highlighting Prostate Cancer, Testicular Cancer and Suicide Prevention with posters, leaflets and pocket cards.

In 2017 we published LTB 165/17 – launching a CWU ‘Prostate Cancer Awareness Campaign’ in conjunction with ‘Prostate Cancer UK’. (Copy attached).

This included;

Five pages of general information plus,
Diet and physical activity for men with prostate cancer,
Know your prostate – A guide to common prostate problems,
Prostate cancer – A guide for men who’ve just been diagnosed,
What is my risk of prostate cancer? Guide.

In 2017 we repeated the ‘Movember’ Prostate Cancer campaign with an extensive, detailed report and Guidance in LTB 597/17.

The Guidance on Prostate cancer links in the LTB are;

Also in 2017 we ran our “Seven Health Checks Men Must Do” Campaign which focused on Prostate Cancer.

In 2019 we ran the CWU ‘Prostate Cancer and Your Risk’ campaign with a New CWU Leaflet & Information for Black Men following CWU Conference Motion 47(2018), launched at the CWU Black Workers Conference which was exceptionally well received. Figures state that black, Caribbean and mixed-race men are more likely to die from prostate cancer than any other group of men. (See Leaflet pdf copy attached).

Branches and Regions will be aware that ‘Calling on the UK Government to introduce ‘Prostate Cancer Screening’. As well as raising awareness amongst members of Prostate Cancer, its signs, symptoms and to encourage members to get checked and PSA tested where appropriate is already CWU Conference Policy through the carriage of Composite Motion 36(2022) and Composite Motion 68(2016), Motion 47(2018) and this year Motion 12(2014) was carried.

The Health, Safety and Environment Department has pursued and investigated the issue of Prostate Cancer Screening with national subject matter experts and in fact we had correspondence and discussions with Laura Kerby CEO, Jonathon Waxman OBE President and Jonathan Kay Health Information Team Lead of ‘Prostate Cancer UK’, the main Charity in this area, to seek their expert advice and check on the up to date medical and research situation regarding Prostate Cancer Screening and in particular the suitability of using the PSA test for this purpose.

A copy of the detailed written advice and response from ‘Prostate Cancer UK’ dated April 2022 is attached. This has been previously shared with Branches and Regions involved in past Conference Motions to update them.

See also attached the Gov.UK – ‘UK National Screening Committee’ advice and recommendation which is supported by all the main Cancer charities and Royal Colleges

In short ‘Prostate Cancer UK’ along with the ‘UK National Screening Committee’ and other medical experts and stakeholder organisations do not currently recommend screening for prostate cancer.

This we are informed, is because the PSA test is not accurate enough to detect prostate cancer that needs treatment and the potential harm from PSA-based screening programmes. PSA testing in the UK is only recommended in people suspected of having prostate cancer and symptoms. In terms of a national screening programme for prostate cancer, they confirmed that the PSA test is not a suitable screening tool, due to its low specificity and sensitivity. A man’s PSA can be high when he does not have cancer (false positive), conversely he can have a low PSA when he has clinically significant cancer (false negative). The PSA test can’t differentiate between low-risk cancer that may

never cause any harm, and aggressive disease that requires immediate treatment.

Although, clinical trials have shown that using the PSA test to identify prostate cancer within a population can save lives, screening using the PSA tests also increases over diagnosis, overtreatment and invasive biopsies.

(Note: The UK National Screening Committee (UK NSC) in part of Public Health England and advises ministers and the NHS in the 4 UK countries about all aspects of population screening and supports implementation of screening programmes).

At 2022 CWU Conference, the above information was presented to CWU Conference and after the debate on Composite Motion 36, which the NEC supported with the qualified support, representatives of the two Regions and four Branches (Midland Regional Committee, Eastern Regional Committee, South Midlands Postal, Scotland No.2 and South Central Postal) were invited to meet outside Conference to be briefed on the Prostate Cancer UK advice with copies distributed to those delegates who attended.

There is no screening programme for prostate cancer currently because unfortunately we don’t have a reliable enough test to use, and the PSA test available at the moment, referred to in the motion 36(2022) has significant risks, so the experts tell us. We’re informed by the experts that the PSA test can help doctors to work out how likely a man is to have prostate cancer but this test is not reliable enough to use as part of a national screening programme. Ongoing research is seeking to find a reliable test suitable for screening.

UK National Screening Committee:

The UK National Screening Committee has decided that the disadvantages of regularly screening men using the PSA test outweighs the possible advantages as it could lead to over-diagnosis and over treatment of ‘harmless’ Conditions. The Charities (Prostate Cancer UK and Cancer Research UK) supports this position on screening but the charities also both support and monitor developing research into screening for prostate cancer.

The UK National Screening Committee was established in 1996 and since April 2013 it has been part of Public Health England. It consists of a number of eminent medical experts and advises Government Ministers and the NHS across the four UK countries on all aspects of screening policy and it supports implementation by co-ordinating the screening of people for medical conditions within the United Kingdom. It assesses the evidence for programmes against internationally recognised criteria, using research evidence, economic evaluation and pilot programmes.

The “Stockholm-3” model for Prostate Cancer detection:

In a widely publicised development (see attached Daily Mirror News Clip), the “Stockholm-3” model for Prostate Cancer detection has been claimed to offer a solution with potential to improve the accuracy of prostate cancer diagnosis for men across Europe and around the world. Professor Henrik Grönberg a Swedish doctor, cancer researcher and professor of cancer epidemiology developed the new diagnostic blood test process because he said the major problem with PSA screening is too many unnecessary biopsies and inaccurate diagnosis. Stockholm 3 is available in Sweden, Finland, Norway and Denmark, with plans to launch across the rest of Europe and the world. The technology is not currently used in the NHS.

The UK National Institute for Health and Care Excellence (NICE) have considered the “Stockholm-3” model for prostate cancer screening and subsequently published a Medtech innovation briefing [MIB303] on 9 August 2022 (copy attached).

Four experts were drafted in to look at “Stockholm-3” and contributed to the development of the briefing along with Prostate Cancer UK. They were; Dr John Bolodeoku, consultant chemical pathologist, Mr Aniruddha Chakravarti, consultant urological surgeon, Mr Freddie Banks, consultant urologist and Prof Sanjeev Madaan, consultant urological surgeon, along with Prostate Cancer UK. The experts concluded that there were advantages and potential disadvantages with the “Stockholm-3” model and All experts recommended additional research.

One expert felt that there was a need for long term (over 15 years) longitudinal follow-up data in people who had testing with the ‘Stockholm 3’ technology and who did not have an MRI or biopsy. Another expert noted the need for research to see how the technology works in Black, Asian and minority ethnic populations. The expert also acknowledged there is an ongoing study in the US which might address this issue. One other expert recommended that additional research in the UK setting was needed and stated that the issue which would prevent adoption of the technology would be the additional cost of it and the unclear benefits in the NHS setting.

Prostate Cancer UK saw some benefits of Stockholm 3 in respect of resulting in quick or accurate care provision also preventing harm from unnecessary biopsies but noted the potential disadvantages of the technology which may include possible side effects and practical difficulties, for users or carers. Regular use of this technology within the NHS could create delays within pathology which could delay a person’s diagnosis. The cost of the Stockholm 3 test is also significant and would be an issue for mass use within the NHS.

‘The REIMAGINE study’ and ‘The LIMIT study’

I attach for your interest and information two recent reports on two interesting and promising ‘Prostate Cancer screening studies’, the ‘The REIMAGINE study’ and ‘The LIMIT study’. Both involve top expert Consultants, Doctors, medical imaging experts. These reports explain well the current situation and problems with existing screening and diagnosis and of course the need to develop more reliable and consistent diagnosis methods on which to base a ‘National Screening Programme.’

Luminal Index MRI Identification of Prostate Cancer (LIMIT Study) Supported by Cancer Research UK the team involved have developed a new MRI technique that can allow prostate cancer to be detected using a 5-minute scan as opposed to the current 35–40-minute MRI scan. As this novel scan is simple, cheap and has good performance, it can be delivered within the community setting even using an MRI scanner located in a travelling van. We believe that providing scans in the community setting could allow men, who would otherwise not be scanned, the opportunity to have their cancer detected earlier.

This research is being done on the basis that MRI is the best available test for the detection of prostate cancer, but at present this can only be provided in a hospital setting.

Whilst MRI is being used, there are still many men (about 16%) that are being diagnosed with late-stage disease and almost 12,000 men dying per year from prostate cancer in the UK. Clearly, these men are not being scanned early enough in the time-course of their disease for treatment to make a difference. If we can detect their cancer earlier, we think we might be able to reduce deaths from prostate cancer. If LIMIT is successful, a national-level trial would also be required before prostate cancer screening becomes standard clinical practice.

Professor Mark Emberton (UCL Surgical & Interventional Science and consultant urologist at UCLH), senior author of the study, said: “The UK prostate cancer mortality rate is twice as high as in countries like the US or Spain because our levels of testing are much lower than other countries. Given how treatable prostate cancer is when caught early, I’m confident that a national screening programme will reduce the UK’s prostate cancer mortality rate significantly.

There is a lot of work to be done to get us to that point, but I believe this will be possible within the next five to ten years.”

Conclusion:

In respect of the CWU’s support for a fit for purpose, universally recognised, accurate and effective screening programme, we are ‘pushing at an open door’ right now. What we need is a medical and scientific breakthrough by those working hard to find one. Hopefully, it will come sooner rather than later. In the meantime the advice available from the NHS and the Charities, ‘Cancer Research UK’, ‘Prostate Cancer UK’, ‘Tackle Prostate Cancer’, ‘Orchid’ etc. we are all looking forward to the day of a breakthrough and an effective, accurate test, fit for purpose and a UK wide national screening programme.

The HS&E Department fully supports the need for a national screening programme and will continue working on this, supporting the call for continued and increased investment and support to find and deploy an effective reliable screening test which the scientists are still searching for and which the charities are supporting.

In the meantime the CWU will continue working with the Prostate Cancer Charities, NHS and the employers to raise awareness of Prostate Cancer amongst our Branches and members, encouraging members to be aware of the signs and symptoms of Prostate Cancer and not to delay going to their GP to get checked out and PSA tested as necessary and if recommended by specialist urologist consultants and doctors in order to diagnose conditions requiring treatment in order to catch it early and in doing so successfully treat the condition at an early stage when the cure success rate is at its highest.

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