‘Postcode lottery’ in prostate cancer care costs thousands of lives a year

By Liam On Jul 9, 2023

A ‘zip code lottery’ in prostate cancer care costs thousands of lives every year, warns a charity.

Men living in parts of the Northeast are nearly six times more likely to be diagnosed after their cancer has spread than in the country’s top-performing trusts.

Patients in the northern provinces are also significantly less likely to have access to advanced diagnostics and treatment compared to the South, an analysis by Prostate Cancer Research found.

The charity said it was a “national tragedy” that survival rates for the most common cancer in men depend on where they live. It estimates that around 3,000 lives could be saved each year by reducing disparities in late diagnosis – and called for more men to come forward to get tested.

The call comes as the UK’s National Screening Committee is reviewing evidence on whether or not to roll out a full screening program for men over 50 or high-risk men.

Experts believe improvements in testing — including better scans and safer biopsies — mean the benefits now finally outweigh the negatives, with a decision expected by the end of the year.

While the UK is still without it, more needs to be done to improve access to the best available care.

Nick Fletcher, 58, from Malton, North Yorkshire, who traveled 100 miles each day for prostate cancer treatment

Today the Daily Mail is re-launching the ‘End Unnecessary Prostate Deaths’ campaign in an effort to improve the diagnosis and treatment of prostate cancer.

Oliver Kemp, chief executive of Prostate Cancer Research, said: ‘It is a national tragedy that you are much more likely to die from prostate cancer just because you live a hundred miles further north.

“While some people will languish on chemo, others will receive groundbreaking targeted drugs that extend the quality and quantity of life.

It’s time to end the zip code lottery and improve access to the latest diagnostic technology and treatments.

‘A man living in County Durham should have the same chance of surviving this terrible disease as a man living in Berkshire.

“Awareness is the first step, which is why this is an absolutely necessary campaign by the Daily Mail.

“Your readers can really make a difference.”

Early diagnosis is key to survival, as only one-third of men live five years or more if the cancer has spread beyond the prostate.

Oliver Kemp, chief executive of Prostate Cancer Research, said: ‘It is a national tragedy that you are much more likely to die from prostate cancer just because you happen to live a hundred miles or more further north’

Early diagnosis is key to survival, as only a third of men live five years or more if the cancer has spread beyond the prostate

However, data from the National Prostate Cancer Audit shows widespread disparities in the likelihood of men being diagnosed when it’s too late for a cure. In London’s best-performing hospitals, only one in 20 prostate cancer cases was diagnosed too late for life-saving treatment, compared with one in four in parts of the North East and the Midlands.

Patients at the Royal Free London, University College London Hospitals and Whittington Health NHS Trust fared best, with only 5 per cent diagnosed with stage 4 cancer.

Yet this rises to 29 per cent in the North Tees and Hartlepool NHS Foundation Trust and South Tees, while a quarter of men in Derby and Burton NHS Foundation Trust were not diagnosed until the cancer was already elsewhere.

Those living in more remote coastal areas were also more likely to be diagnosed with advanced stage cancer, with 24 per cent in parts of Cornwall and Devon and 23 per cent in Norfolk.

Meanwhile, those closer to London, such as Brighton and East Sussex, as well as the Royal Berkshire NHS Foundation Trust, fared much better: only 7 per cent learned too late.

In fact, 13 of the 20 best-performing trusts were in the South — and 16 of the worst 20 were in the North.

Greg Smith, Tory MP for Buckingham and Vice-President of the APPG on Cancer, said: ‘Early diagnosis is critical and the disparities we are seeing here across the country are putting lives at risk’

The warning signs to watch out for

Warning signs of prostate cancer include going to the toilet more often, especially at night.

Other symptoms include going to the toilet longer, starting and stopping, pain, a burning sensation and blood in the urine.

Men over age 50 can request a free PSA test, which measures the level of prostate-specific antigen in the blood.

A high reading may be a sign of cancer, but the test is not entirely accurate. Your GP will do other tests before you decide whether you need to see a specialist.

Most men with high levels will then have an MRI scan to give a better indication of whether it is cancer before confirming it with a biopsy.

For many men with prostate cancer, no treatment is needed and it is monitored instead.

But for those who need treatment – for example, if the disease has already spread – this often consists of hormone therapy, radiation and chemotherapy, depending on a person’s diagnosis.

Prostate cancer mainly affects men over the age of 50. Those whose fathers or brothers have had it are two and a half times more likely to be diagnosed.

Men are also at risk if their mother or sister has had breast cancer under the age of 60, because it is caused by the same genes.

Black men are more likely to develop prostate cancer, as are overweight or obese men.

Men in more underserved areas are also more likely to be diagnosed too late for a cure. Meanwhile, as many as a third (35 percent) of men in Scotland and a fifth (19 percent) of men in Wales were diagnosed with stage 4 last year.

The Daily Mail has been fighting for nearly 25 years to highlight prostate cancer, a disease that kills a man every 45 minutes in Britain.

More than 52,000 men are diagnosed with the disease each year – 1,000 a week – making it the second most common cancer in men and the second most common.

In 10,000 of these, the cancer is in stage 4, meaning the cancer has already spread throughout the body, often making the cancer incurable.

Care has made significant progress since the Mail’s campaign launched in 1999, but progress has been slow compared to breast cancer progress.

This is despite the fact that one in eight men are likely to be diagnosed in their lifetime and approximately 475,000 men live with and after prostate cancer. Not all men who are found to have prostate cancer need treatment, but if they are identified early, they can be better monitored.

Greg Smith, Tory MP for Buckingham and Deputy Chairman of the APPG on Cancer, said: ‘Early diagnosis is critical and the disparities we are seeing here across the country are putting lives at risk.

“When it comes to treatment, zip code lotteries will continue, not only for existing treatments, but also for new, innovative, minimally invasive technologies becoming available for all cancers.

‘It is vital that all UK patients have equal access to the best diagnostics and treatments.’

As well as the huge differences in the stage of diagnosis, the way men are diagnosed with cancer also varies, according to the charity.

In total, there is access to 15 percent fewer diagnostic options in the North.

Men in the Midlands and above generally have less access to a growing number of non-invasive procedures, such as PET scans and non-invasive biopsies.

Similarly, they have 29 percent fewer treatment options within close proximity and may face significant challenges when it comes to accessing care.

An NHS spokesperson said a record number of people are getting cancer checkups, with local services now diagnosing more cancers, including prostate cancer, at an early stage than ever before. They added: ‘We know it can be daunting to come forward for prostate checks but it could save your life so we recommend men use the simple 30 second online risk checker developed by NHS and Prostate Cancer UK experts, or consult the advice on prostate cancer symptoms available on NHS.uk, and to see their GP as soon as possible if they are concerned.’

A spokesman for the Department of Health and Social Care said: ‘Early diagnosis of cancer can help save lives, so if you notice anything that is not normal for you, have any health problems or symptoms, you should contact your GP.’