Cambridge researchers say we may be looking for the wrong prostate cancer symptoms

  • Watch a report by ITV News Anglia's Sophie Wiggins

Public health messages about prostate cancer may be giving people a "false sense of security" and hampering efforts of early detection by placing a misleading focus on problems with peeing, say researchers.

University of Cambridge say there is “no evidence of a causal link between prostate cancer and either prostate size or troublesome male urinary symptoms”.

However, much public health guidance promotes this link – with an increased need to urinate high on the list of symptoms for prostate cancer given on the NHS website.

Sky football commentator and former ITV Anglia sport reporter Tony Jones, 63, from Norfolk, was diagnosed with with prostate cancer in 2020 and said he had had no problems with peeing.

His cancer was picked up after a blood test.

  • Sports broadcaster Tony Jones spoke to ITV News Anglia about recovering from prostate cancer

He told ITV News Anglia: "Urinary problems don’t always present themselves - I never had an issue but I was aware that once I reached the age of 50 that I needed to be tested. 

"I went for a PSA blood test. The first one was fine, five years later I went for another one and it flagged up that I had a problem."

After the second PSA test, Mr Jones had an MRI scan, a biopsy and then surgery all within the two months.

Vincent Gnanapragasam, professor of urology at Cambridge University, said: "We urgently need to recognise that the information currently given to the public risks giving men a false sense of security if they don’t have any urinary symptoms."

In a review published in the journal BMC Medicine, the Cambridge researchers argue the “strong public perception” that male urinary symptoms are a key indicator of prostate cancer “may be seriously hampering efforts to encourage early presentation”.

“If rates of earlier diagnosis are to improve, we call for strong clear messaging that prostate cancer is a silent disease especially in the curable stages and men should come forward for testing regardless of whether or not they have symptoms,” the paper says.

“This should be done in parallel with other ongoing efforts to raise awareness including targeting men at highest risk due to racial ancestry or family history.”

More than 52,000 men are diagnosed with prostate cancer every year in the UK Credit: ITV News

How common is prostate cancer?

Prostate cancer is the most common type of cancer in men.

According to Cancer Research UK, more than 52,000 men are diagnosed with prostate cancer each year and there are more than 12,000 deaths.

More than three-quarters (78%) of men diagnosed with the disease survive for more than 10 years, but this proportion has barely changed over the past decade in the UK, largely because the disease is detected at a relatively late stage.

In England, for example, nearly half of all prostate cancers are picked up at stage three of four - stage four being the latest stage.

Symptoms of prostate cancer according to the NHS

Prostate cancer

The NHS website says prostate cancer usually develops slowly, so there may be no signs for many years.

Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis (urethra).

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What symptoms may be associated with prostate cancer?

  • needing to pee more frequently, often during the night

  • needing to rush to the toilet

  • difficulty in starting to pee (hesitancy)

  • straining or taking a long time while peeing

  • weak flow

  • feeling that your bladder has not emptied fully

  • blood in urine or in semen

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Are these the only symptoms of prostate cancer?

The NHS website says that these symptoms do not always mean you have prostate cancer. Many men's prostates get larger as they get older because of a non-cancerous condition called benign prostate enlargement.

Signs that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unintentional weight loss.

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What are the causes of prostate cancer?

The NHS says it's not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.

These include:

  • Age – the risk rises as you get older, and most cases are diagnosed in men over 50 years of age

  • Ethnic group – prostate cancer is more common in black men than in Asian men

  • Family history – having a brother or father who developed prostate cancer before age 60 seems to increase your risk of developing it; research also shows that having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer

  • Obesity – recent research suggests there may be a link between obesity and prostate cancer, and a balanced diet and regular exercise may lower your risk of developing prostate cancer

  • Diet – research is ongoing into the links between diet and prostate cancer, and there is some evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer

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What you should do if you're worried about prostate cancer

If you have symptoms that could be caused by prostate cancer, you should visit a GP.

There's no single, definitive test for prostate cancer. The GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

The GP is likely to:

  • ask for a urine sample to check for infection

  • take a blood sample to test your level of prostate-specific antigen (PSA) – called PSA testing

  • examine your prostate by inserting a gloved finger into your bottom – called digital rectal examination

The GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels and the results of your prostate examination, as well as your age, family history and ethnic group.

If you're at risk, you should be referred to hospital to discuss the options of further tests.

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Tony Jones said it was key to get an early diagnosis of prostate cancer and a PSA blood test could make all the difference.

He said: "So often it can undiagnosed, it can be in the system and you wouldn't know.

"Certainly if there's a family history of prostate cancer, black men, anyone over the age of 50. Those are the key [groups] which Prostate Cancer UK are trying to target now and to make aware that at PSA blood test can make all the difference."

"I feel as though it gave me a second chance. I feel relieved, I feel grateful, acutely aware that there are a lot of people in a far worse position than me but it has given me an opportunity to get on with my life."

Prof Gnanapragasam said: “When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night.

“This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”

There are various tests that can be done for prostate cancer but sometimes there are no symptoms. Credit: ITV News Anglia

'A false sense of security'

Prostate enlargement can cause the urinary problems often included in public health messaging, but evidence suggests that this is rarely due to malignant prostate tumours, according to the researchers.

Rather, research suggests that the prostate is smaller in cases of prostate cancer.

Prof Gnanapragasam said more nuanced public messaging was required to improve detection rates.

“We need to emphasise that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages," he said.

“Waiting out for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable.

“Men shouldn’t be afraid to speak to their GP about getting tested, and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors such as being of black or mixed black ethnicity.”

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