Health inequality - Chris Hoy and prostate cancer

[Pebbles16]

I work in healthcare and realise there is enormous health inequality which often disadvantages women. However, Sir Chris Hoy is highlighting a very important deficit in screening for health conditions amongst men. As women, we "enjoy" screening for cervical and breast cancer but prostate screening is woeful.
It's a simple blood test for PSA levels which should be offered from 40+ as a minimum. Men are notoriously tricky when it comes to seeking health advice, so simple monitoring (not qualified enough to suggest a frequency) rather than an invasive procedure really might help them to come forward for monitoring.
My Dad had prostate cancer in his early 60s which was - thankfully - spotted early and he received an experimental treatment which eliminated those cancerous cells.
I want to protect the men we love from this insidious disease which often gets to stage 4 without notice.

CRUK have already said that more PSA testing is unlikely to save more lives.

It isn’t a great diagnostic blood test though. It’s great it’s being highlighted, but there will be a rush of men wanting the blood test, many who will be falsely reassured they don’t have prostate cancer when they actually do.

1 in 50 men with a normal PSA level have a fast growing prostate cancer. Because of this, the PSA test on its own is not recommended as a screening test for prostate cancer. But men over 50 can usually ask their GP for a PSA blood test if they want.
www.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/screening#:~:text=And%20that%201%20in%2050,blood%20test%20if%20they%20want.

The test costs around £20, £10 for the test and £10 ish for the staff/admin time.

Around 4 million people aged 44-49 so about 2 million men.

This testing would cost around £40 million. Worth it? Probably not unless you're the extra person it picks up

Chris Hoy has a really devastating story and a prominent platform, but celebrities shouldn't have a place in health care policy

I heard Chris Hoy on R4 this morning advocating for more PSA testing, but it’s not really helpful as PP’s have said. I am sure it would already be standard practice if it detected a meaningful number of cases, but I suspect rolling out PSA testing causes both false reassurance and unnecessary alarm.

The health inequality you mention exists because a) men are generally very bad at getting help for their health and b) Their health is less valued by society than women's which means it's more likely to be neglected against other considerations.

Celebrities frequently have an influence in healthcare take up. I applaud celebrities and their families who highlight health problems such as MND and - back in the day - bowel and breast cancer.
I know the test isn't great, it should be improved and we should campaign to create a better test

PSA testing is very complex as having a high result doesn't necessarily mean you have cancer, and having cancer doesn't mean it will kill you.

What hasn't been highlighted as much in the press is that Chris Hoy was very high risk having had a father and grandfather having prostate cancer at a young age.

So potentially there is benefit for those with high risk family histories. But that is a much much smaller group of men.

FFS A man who has heart disease health is not valued less in society.

Hoy is being more nuanced than that. His grandfather and father both had it. It’s people with that kind of genetic history he says should be screened younger, not everybody.

What about an awareness campaign highlighting other symptoms, even less common ones aimed at men?

Empowering them to be more vigilant, aware and proactive about seeking further testing - further testing of the most appropriate sort.

So prostate equivalent of a breast check monthly.

I googled and discovered this:

•	A painful or burning sensation during urination or ejaculation.
•	Frequent urination, particularly at night.
•	Difficulty stopping or starting urination.
•	Sudden erectile dysfunction.
•	Blood in urine or semen.

So a campaign like "are you passing the piss test?"

Or "talking about erections isn't just for architects - how's yours?"

This actually really pisses me off. As he’s someone in the public eye he gets listened to when he calls for more testing. It was the same with Tessa Jowell the one time brain tumour research got more money from the government was because she died from it- one of their won. Where was the money when my husband died from it and all the other men in that hospital I witnessed suffering. We don’t need celebrities calling this out they just need to look in hospitals up and down the country.

My husband has had a lot of interventions because of a very high PSA test reading. He does not have cancer at this point, so it is not cut and dried
I think Chris Hoy is spot on - his father and grandfather meant a higher risk to him that was not detected because he wasn't asked to have a test.

Wes Streeting should be ashamed of himself asking the NHS to review this, based on the opinion of a cyclist (who is btw a brilliant man, but not a doctor or scientist). We actually have a national screening committee, made up of scientists, and they consider the question of prostate screening on a regular basis. It’s not done as a screening programme because the benefits don’t outweigh the costs (both financial cost and costs to men in terms of over diagnosis). Chris Hoy is welcome to his opinion but Wes Streeting should be saying, “well actually we have a committee that already considers this every few years”, not just producing stupid sound bites.

I think we should leave it to medics to study the evidence to determine when / who to test.

Clearly Chris was at higher risk due to family history.

My own father's prostate cancer did not show up on a PSA test.

And men with a strong family history can get seen by a specialist clinic anyway.

Yep Womens is so valued that we arent even worthy of a decent pain free option during a hysteroscopy. Apparently a paracetamol or ibuprofen is enough.

What hasn't been highlighted as much in the press is that Chris Hoy was very high risk having had a father and grandfather having prostate cancer at a young age

I was coming on to say this. Honestly, bless him, with his family history he should have requested an earlier test. In the same way women with a history of breast cancer in their family can access regular screening.

Campaigning for all men to have access from an earlier age isn't cost effective, but for those with a family history, definitely.

@Itsnotallaboutyoulikeyouthink My dad had prostate cancer He was sent home from hospital on 16th September and died on 6th October in a fall on the stairs because he was so weak.

@KnittedCardi yes I'm surprised with his background in sports, plus level of wealth, he wasn't having private medicals. In that setting people would have fallen over themselves to give him a PSA test.

A wish for better tests surely applies to any cancer. Why not pancreatic or ovarian or leukaemia etc? Research is ongoing into better tests for all sorts of cancers, including prostate. People are campaigning, researchers are working on this.

And the evidence is that screening using current tests is not useful for prostate (or ovarian for that matter).

Celebrities do have huge impact - Jade Goody’s death massively increased smear test uptake, but that was uptake of an existing screening that was offered, not a campaign to start screening.

PSA tests are unreliable which is why you only get one if you show other symptoms

With his strong family history I can't understand why he hadn't requested a test?

I have strong family history of a particular cancer and have already sort early screening. Nobody asked he I had to go to the GP and ask

The evidence shows that those who are high risk should have more screening much like with breast cancer and the current approach does not factor in that slime men have an increased risk - but all men have the same - simply those at high risk like breast cancer / stroke / blood pressure should have more monitoring than those at standard risk

Using articulate kind well respected celebrities who have chosen freely to highlight their case helps shift the narrative and helps uncover and challenge assumptions to improve patient care for all

Hmm, I do find something not quite right about the "celeb stands up... government instantly reacts" scenario. Also there are some studies (but not all, I accept) that seem to show that (intensive) cyclists are more prone to prostate cancer. That and Chris Hoy's family history seems to make him more susceptible regardless. As said by PP above, PSA testing is not black and white, so as always its a question of where and how should the limited resources be spent? Not sure if the call for early PSA and the governemnt reponse is correct. Happy to be proven wrong.

This is laughable. Try telling the thousands of women who suffer with gynae problems for years on end without being taken seriously that their health is valued more than men's.