Sunday, 12 January 2014

Dr, I've a problem, erm, you know ‘down there’…

I was poorly last Monday and I spent almost the entire day in bed nursing an extreme cough/cold/flu episode. Over the Christmas and New Year break I had one cold or cough after another, and the last one, just before returning to work, knocked me off my feet completely. So unusually for me, I did the sensible thing and stayed off work for the day.  

Actually, it’s fairly unusual for men in general to do the sensible thing when it comes too their health. Susan Hale and colleagues publishing in the British Journal of Health Psychology, report that unlike women, men are less likely to consult their GP with health problems, make less use of general health checks and screening than women and often seek help for symptoms late in an illness episode, sometimes with fatal consequences. 

Interestingly whilst women still have a higher life expectancy than men, they are more likely to have an illness for which they received medical treatment than men. This doesn't mean that women are not as healthy as men – there is no evidence to suggest this is the case. However, for all kinds of reasons women tend to recognise symptoms much earlier than men and then act more quickly in seeking help in dealing with these and the illness that might have generated the symptoms. Men either don’t recognise changes in bodily sensations as being symptoms or ignore the symptoms until such time as they become publicly revealed.

So I was interested to read of the new guidance released last week by the National Institute for Health and Care Excellence (NICE) for prostate cancer Each year, over 37000 men are diagnosed with prostate cancer and a further 10000 will die from the disease. The new treatment protocol recommends a monitoring approach (‘watchful waiting’ as it’s described in the US) for everything apart from high risk localised prostate cancers. Now don’t get me wrong, I am the first to advocate reducing medical intervention. I'm with Illich in that regard. But is this advice going to work? I doubt it.

There is nothing pleasant whatsoever about the treatment or diagnosis of prostate cancer. Treatments can often result in urinary incontinence and erectile dysfunction. Diagnosis involves a digital rectal examination (DRE) a biopsy and a blood test (PSA). In a study published in Oct 2013, 60% of men over the age of 50 hadn't heard of a PSA test. Although the number of female GPs is growing, it’s still the case that 57% of GPs are men. And as Susan Hale noted there are issues for many men of another man performing a DRE on them. Biopsy’s are painful and can lead to long term complications, and the jury is out on the benefits of PSA.

Indeed in the latest study (2012) which looked at the two major international studies (the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, and the European Randomised Study of Screening for Prostate Cancer) concluded that for every 1000 men aged 55-69 who are screened every 1-4 years for a decade: 0-1 deaths from prostate cancer would be avoided; 100-120 men would have a false positive test result that leads to a biopsy, and about one third of the men who get a biopsy would experience problems from the biopsy; 110 men would be diagnosed with prostate cancer. 50 of these men would have a complication from treatment including erectile dysfunction (29 men) urinary incontinence (18 men), serious cardiovascular event (2 men) deep vein thrombosis or pulmonary embolism (1 man), and death due to treatment (1 man).

I can’t see the NICE advice appealing to many men – however there is an alternative. An MRI scan can establish with 95% accuracy when a man has got prostate cancer. Scans are cheap to do (£200) compared to a biopsy (£600). Extensive research has found no evidence that the magnetic fields and radio waves use during MRI scan pose a risk to the human body. As a diagnostic procedure it’s no more unpleasant or painful than spending a day in bed with an extreme cold/cough/flu.episode.