Prostate Cancer (Hansard, 23 May 2000)

§ Baroness Gardner of Parkes
asked Her Majesty's Government:
What research into prostate cancer they are supporting.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the Government give high priority to cancer research and already support a wide range of research into prostate cancer. We actively seek to support further studies.

§ Baroness Gardner of Parkes
My Lords, I thank the Minister for that reply. Will the noble Lord consider the comparison between prostate cancer and breast cancer, which is a condition that largely affects females? I hear someone say that breast cancer affects only women, which is not correct. The campaign in the case of breast cancer has been so successful that whereas in the 30 years up to 1987 there was a 26 per cent rise in the death rate, in the past 10 years there has been a one-third reduction. Does the noble Lord agree that it is not only a question of finding the right cure, which is very important, but of obtaining an early diagnosis? Further, does the Minister agree that, as a result of public policy, women are more aware than men of the need for examination and screening? Finally, can the Minister tell the House of research which will increase the awareness of the male population into the possibilities of early diagnosis of prostate cancer?

§ Lord Hunt of Kings Heath
My Lords, the noble Baroness raises an important point: more generally, the issue of men's interest in their own health. There is no doubt that we need to do everything we can to encourage men to take an active interest. That is why the Government announced a series of measures on 1st March. We need to do as much as we can to encourage men to use our health services and to look closely at matters that affect their own health.
One problem is that the current test which can help to identify prostate cancer is not totally accurate. That is an inhibition in relation to detecting the disease at an early stage.

Lord Acton
My Lords, at what age should men start taking these inaccurate tests?

§ Lord Hunt of Kings Heath
My Lords, men can take the test at whatever age they choose. The disease affects men mainly over the age of 65.

§ Lord Walton of Detchant
My Lords, as regards the Minister's last statement in answer to the noble 639 Baroness, does he accept that while many urologists in this country and abroad believe that estimation of the prostate-specific antigen in blood is a mechanism useful in screening, others are very concerned that the test produces a good many false positives which give rise to needless anxiety? Is the noble Lord aware of recent research strongly suggesting that lycopene, an important constituent of tomatoes, has a powerful, protective effect against prostate cancer?

§ Lord Hunt of Kings Heath
My Lords, I am most grateful to the noble Lord for that information. He is absolutely right: PSA levels in blood can be raised by several other conditions which affect the prostate gland. I understand that of every three healthy men who have a high PSA level, only one has prostate cancer. We also have to bear in mind the side effects of treatment: for instance, of 1,000 men having surgical treatment, between three and 20 will die of that treatment; between 200 and 850 will experience impotence; and between 10 and 70 will develop urinary incontinence. That puts into perspective the issue over detection.

§ Lord Ezra
My Lords, despite the Minister's remarks about the PSA test, does he agree that the procedure is widely recommended by medical practitioners and widely practised by a large number of men including to my certain knowledge Members of your Lordships' House, including myself? Is that advice wrong? If so, it is a very serious matter. Prostate cancer is one of the most serious diseases from which men suffer. When will the Government be in a position to make clear where the PSA test stands? If they feel that it is deficient, what alternative is recommended?

§ Lord Hunt of Kings Heath
My Lords, the heart of the issue is that individual men have the relevant information on which they can decide whether to take the test and, subsequently, treatment. I recommend the information leaflet produced by York University in an effectiveness bulletin of two years ago which sets out clearly the choices, options and effects of the test and treatment. In addition, we are committed to spending considerable resources in relation to research and encouraging more research projects to come forward. At present we have a programme of research amounting to £1.5 million. Recently the Government announced another £1 million for further research.

§ Baroness Knight of Collingtree
My Lords, on 3rd May the Minister told this House that an action plan was to be developed. He has not mentioned it although he promised the House that the action plan would be available. Can he give us further news?

§ Lord Hunt of Kings Heath
My Lords, I am happy to provide information. The action plan is not complete. It is currently being prepared. As soon as it is prepared, we shall wish to publish it.

§ Baroness Masham of Ilton
My Lords, apart from eating tomatoes, can men take any other action to help to prevent prostate cancer?

§ Lord Hunt of Kings Heath
My Lords, I am not aware of any specific preventive "tips", along the lines 640 of the suggestion of the noble Lord, Lord Walton. It is clear that we need to undertake further research in order to have an effective test for early detection. We are funding in this country a number of research programmes to help to achieve that. At present we do not know enough about the impact of testing and detection. We do know that treatment programmes can have many adverse side effects. We also know that although prostate cancer is an extremely serious disease and can be a killer, many men who have it do not die from it and are not affected by it. That is what makes the treatment position so difficult.

§ Lord McColl of Dulwich
My Lords, will the Minister make it clear that although the PSA test has its problems, the medical profession would never dream of treating somebody for cancer of the prostate unless there had been a biopsy? The PSA test may be unreliable, but not the biopsies.

§ Lord Hunt of Kings Heath
My Lords, I understand that point. If a man had a high PSA test, he would probably be offered further investigations including a biopsy. The question then is whether or not treatment should take place. As the noble Lord will know, there are various options ranging from what one might describe as careful watching to surgical or radiation therapy. But at the stage when the disease is diagnosed it is important that the individual concerned is fully aware of the side effects of some of the treatments on offer.

§ Lord Clement-Jones
My Lords, the Minister will have noted the disquiet over his statements on the PSA, test. Will the noble Lord undertake that the National Screening Committee will publish a full report on the PSA test and its reasons for not recommending that it should be introduced into a national screening programme? Furthermore, will he undertake that the new urine test being developed in Philadelphia will be reviewed by the National Screening Committee?

§ Lord Hunt of Kings Heath
My Lords, I can give the assurance that any new tests which are being developed anywhere in the world will be kept under close review. The noble Lord is right to remind the House, as I did in our debate three weeks ago, that the National Screening Committee (which advises the health department) has said that, on existing evidence, a national screening programme for prostate cancer would not be justified. I am happy to place in the Library as much information as we can about the reasons for that advice.