Prostate Cancer Risk Management Programme (PCRMP): Q&A
Prostate Cancer Risk Management Programme (PCRMP): Q&A |
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What is the Prostate Cancer Risk Management Programme? What is the Prostate Cancer Risk Management Programme?One of the main aims of the programme is to ensure that men who are concerned about prostate cancer and considering a PSA test are given clear and balanced information about the benefits, limitations and risks associated with the test. Evidence based materials have therefore been produced by the NHS Cancer Screening Programmes and Cancer Research UK to help GPs provide patients with an informed choice about whether or not to have the test. The PCRMP was initially announced by the Secretary of State for Health as part of the NHS Prostate Cancer Programme in September 2000. What does the pack contain?The GP packs consist of:
The leaflet for men takes the form of a tear-off pad at the back of the pack which GPs can give to men to take home following consultation. If a man wants a PSA test after the consultation and consideration of the leaflet, he will be tested. How was the information pack developed?We wanted to ensure that the information contained in the pack responded to the needs of GPs and primary care staff and would assist them in providing men with information on the benefits and limitations of the PSA test for prostate cancer. A wide consultation exercise was undertaken. The packs were developed following consultation with over 100 GPs and practice nurses. In addition, an expert, multi-disciplinary group set up by the Department of Health advised on all aspects of the Prostate Cancer Risk Management Programme. The materials were developed by a specially commissioned GP, Dr Graham Easton, before going out to consultation via the National electronic Library for Health (NeLH) website. The Cancer Research UK Primary Care Education Research Group finalised the materials, taking into account this consultation, work with primary focus groups and the specially established Scientific Reference Group (including urologists, representatives of primary care, scientific staff and lay membership). The Royal College of General Practitioners has endorsed the approach of the Prostate Cancer Risk Management Programme, and is represented on the Scientific Reference Group for the project, as are several other GPs. How will this impact on the GP's work load?The pack is designed to aid and relieve GPs' workload by providing comprehensive information to share with patients. The packs provide consistent and standardised information for primary care clinicians across the country, thus cutting inequalities. Is this initiative UK wide?At present, the initiative is operational in England alone. However, the national screening programmes in Scotland, Wales and Northern Ireland have been kept informed of the work done by the English programme and Scotland and Wales are planning to issue similar information. What about men who require further information?Men requiring further information about PSA testing and prostate cancer can contact Cancerbackup (helpline 0808 800 1234) who have produced a booklet - Understanding the PSA Test. Further information is also available from Cancer Research UK and The Prostate Cancer Charity. Why isn't there a national screening programme for prostate cancer in England?Until there is clear evidence to show that a national screening programme brings more benefit than harm, we will not be offering prostate cancer screening for asymptomatic men. When considering population screening programmes the benefits and harms should be assessed and the benefits should always outweigh the harms. In 1968, Wilson and Junger of the World Health Organisation developed 10 principles which a national screening programme should meet. To date, we are only able to identify the first principle for prostate cancer screening:
For these reasons, the National Screening Committee has recommended that a prostate cancer screening programme should not be introduced in England at this time. Will a national screening programme be introduced?A national screening programme will only be introduced if and when screening and treatment techniques are sufficiently developed and the 10 principles of screening have been met. Is the Department of Health funding any research into prostate cancer?Yes. These include:
Prostate CancerWhat do we know about prostate cancer?It is the second most common cause of cancer deaths in men. Each year in the UK about 22,000 men are diagnosed with prostate cancer and 9,500 die from the disease. Prostate cancer is rare in men below the age of 50 years, and the average age of diagnosis is 75 years. Are some men more at risk of developing prostate cancer?The biggest risk factor is age. However, other factors may also play a part. Risk is greater in those with a family history and is also known to be greater in African American men. A diet high in animal fats and proteins may increase the risk of developing prostate cancer. There is often increased anxiety amongst men with risk factors. It is important that these men receive the best available information and support to assist them in deciding whether or not to have a PSA test. What are the symptoms of Prostate Cancer?Men with early prostate cancer are unlikely to have any symptoms as these only occur when the cancer is large enough to put pressure on the urethra or disturb bladder function. Many older men have enlargement of the prostate due to non-cancerous benign prostate hypertrophy. PSA TestWhat is the PSA test?The PSA test is a blood test that measures the level of PSA in the blood. PSA (Prostate Specific Antigen) is a substance made by the prostate gland, which naturally leaks out into the blood stream. A raised PSA can be an early indication of prostate cancer. However, other conditions which are not cancer (e.g. enlargement of the prostate, prostatitis, and urinary infection) can also cause a rise in PSA. The PSA test is currently the best method of identifying localised prostate cancer. There are two further recognised methods; digital rectal examination (DRE) and transrectal ultrasound (TRUS). What are the limitations of the test?The PSA test is not diagnostic. PSA is tissue specific but not tumour specific in the prostate. Therefore, other conditions such as benign enlargement of the prostate, prostatitis and lower urinary tract infections can also cause an elevated PSA. Approximately 2 out of 3 men with a raised PSA level will not have prostate cancer. The higher the level of PSA the more likely it is to be cancer. The PSA test can miss cancer, and provide false reassurance. It can lead to unnecessary anxiety and medical tests when no cancer is present. And the benefits?It may provide reassurance if the test result is normal and may find cancer before symptoms develop. If prostate cancer is detected at an early stage, treatment could be beneficial. If treatment is successful, the consequences of more advanced cancer are avoided. What are the Prostate Cancer Risk Management Programme's referral guidelines?The Programme recognises that currently there is a wide range of practice around the country, with laboratories in some areas using a single cut-off value and others providing age-related reference ranges. Further work is being done to consider the evidence in this area with the aim of standardising the test itself and the cut-off values used. As interim guidance, the Programme recommends the following cut-off values are used for the PSA test:
TreatmentIf early prostate cancer is detected, what treatments are used?Approximately two out of every three men who have a prostate biopsy will not have prostate cancer. There are three main options for treating early prostate cancer:
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 Prostate Cancer Aim of Prostate Cancer Prostate Specific Antigen Information pack for |
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