Prostate cancer is one of the most common cancers that are specific to men. It is often poorly understood, yet it is also often very treatable, especially if it is caught at an early stage.
Indeed, the UK government chose the occasion of International Men’s Day (November 19th) to announce the launch of the biggest prostate screening trial in Britain for decades, named TRANSFORM. It is the only cancer in the UK that does not have a national screening programme and 12,000 patients die from it every year, while 52,000 are diagnosed with the disease.
The screening will use new scanning techniques like MRI scanning to detect prostate cancer. This is expected to deliver much more accurate and reliable results than the current standard method of blood tests, which can often fail to diagnose cancer and also give false positives.
Commenting on the trial, secretary of state for health and social care Victoria Atkins said: “Our hope is that this funding will help to save the lives of thousands more men through advanced screening methods that can catch prostate cancer as early as possible.”
As with other cancers, failure to catch the disease early means eliminating it is harder and in some cases impossible. The government announcement of the trial featured the case of 58-year-old patient Daniel Burkey, who was unfortunate enough to have been diagnosed late.
He said: “Men need prostate cancer screening so that if we’ve got it, we can find out early enough to treat it and get rid of it. I got my diagnosis in my fifties, and the doctor told me the horrible news that it can’t be cured.”
Mr Burkey is receiving a range of treatments to slow the cancer and extend his life, which includes radiotherapy. But for some patients in Europe and across the world, even getting this treatment can be hard. Not everywhere has a radiotherapy centre, let alone one that offers outstanding treatment using the best-in-class equipment and clinical expertise.
The way radiotherapy commonly works in treating prostate cancer is by using external beam radiotherapy, rather than a gamma knife. This can be used either on localised prostate cancer (where it has not spread beyond the prostate) or non-localised cancer (where it has spread).
It involves killing the cancer cells through direct beams of radiation, although this can also damage other cells. However, other cells can repair themselves after. During the process, however, this can bring various side effects, ranging from hair loss and fatigue to urinary problems and a loss of sexual function.
The aim of radiotherapy in the case of a localised infection or a recurrent one is the elimination of the cancer. Early diagnosis that captures the disease before it spreads gives the best chance of achieving a complete cure.
It can also be used in a wider area. This can include the seminal vesicles, the semen-producing glands next to the prostate, while the treatment can also cover the area just around the prostate, including the nearby lymph nodes.
As ever with cancer, lymph nodes can be critical to the eventual outcome. Once any cancer reaches the lymph nodes, it can spread more rapidly, so localised radiotherapy can extend to nearby pelvic lymph nodes.
Once it has spread further, the purpose of radiotherapy is to control the cancer or its symptoms, limiting its spread and effects. By this point, however, it is too late to have a chance of eliminating the cancer.
Other forms of radiotherapy include adjuvant and salvage radiotherapy, which are carried out on the area after surgery to remove the prostate.
The risks of getting cancer do vary, with a clear racial distinction; in particular, black men are the most at risk with one in four set to contract the disease in their lifetime, twice the risk level for other men.
As a result, the TRANSFORM screening trail, while generally focused on volunteers aged from 50 to 75, will start examining black men aged 45 and over.
However, it is not just racial factors that determine both incidences and outcomes. Writing about the topic in 2022, Science Direct highlighted the fact that variability in access to high-quality treatment can have a significant impact on outcomes.
Quoting statistics from Eurocare-5, it noted the average five-year survival rate for sufferers was 83 per cent overall. However, this varied between 92.8 per cent in northern Europe and 80.1 per cent in eastern Europe, with Poland standing out as the only country with a worsening mortality rate.
Another notable fact is where Europe stands among global statistics for incidences of prostate cancer. In 2017, World Atlas published a list of the countries with the highest incidences of prostate cancer and found that European countries tended to be among the highest.
However, the worst rate among all countries was on the French Caribbean island of Martinique, at 227 per 100,000. This was one of several countries or territories in the Caribbean with high incidence rates. Others include Trinidad & Tobago in fourth, Barbados in sixth, another French territory, Guadeloupe, in 13th and Puerto Rico in 17th.
Racial demographics are an obvious factor in these locations as the populations are largely black, but that is far from the whole picture. Metropolitan (i.e. European) France is third overall and while it has an ethnically diverse population, eight other European countries make the top 20.
Of these, many are nations with very low non-white populations, including the Nordic nations – Norway (second), Sweden (sixth), Iceland (12th), Finland in 15th and Denmark in 19th. Non-European countries standing high on the list include ones historically colonised by predominantly white populations, like the US, Canada and New Zealand.
What these countries have in common is not just mostly white populations that are less prone to contracting the disease than nations with black populations, but the fact they are first world nations with advanced healthcare and therefore a greater capacity to diagnose cases.
This does mean there is likely to be a statistical bias in this regard, although it should be noted that the lower life expectancies in developing countries mean fewer men live to the age when they would be most vulnerable to getting prostate cancer.
Either way, for countries where diagnosis levels are high, for whatever reason, access to radiotherapy can make a crucial difference in either beating the disease or at least surviving it for longer.