Prostate Cancer (Hansard, 9 April 2001)

§ Lord Hunt of Kings Heath
My Lords, we are committed to introducing a screening programme if and when screening and treatment techniques are sufficiently well developed. We recently announced that, working with our partners, we shall be providing £6 million over the next five years to develop two centres of excellence for prostate cancer research, developing better screening and diagnostics for 993 prostate cancer. I can today announce that the department has agreed to fund a large-scale randomised control trial of treatment for localised prostate cancer at a total cost of about £13 million.

§ Lord Ezra
My Lords, bearing in mind that 10,000 men a year die from this condition in Britain, which represents one of the highest mortality rates in Europe, it is satisfactory to note that the Government are now—after some delay—taking stronger measures, including the introduction of greater funding, to deal with the matter. Can the noble Lord tell the House whether the NHS will have adequate services to deal with the increased PSA testing that is now likely to be carried out? Further, can he indicate what is the delay between diagnosis and treatment, and tell us what measures are being taken to reduce that delay?

§ Lord Hunt of Kings Heath
My Lords, we are aware of delays in referral from GPs to consultants. That is why the two-week-wait target has been set. That target was set for breast cancer for the year 1999, while the target for all other cancers was the end of the year 2000. We shall monitor the results of that process to ensure that those waiting times in relation to prostate cancer are radically reduced. I agree with the implication behind the Question; namely, that in many places people have had to wait far too long.
As for the issue of PSA testing, we expect the health service to be able to respond to any additional demands that are made upon it in that respect. However, it is important for me to inform the House that we shall be launching what is called an "informed choice programme" to ensure that men who come forward and ask for a PSA test are absolutely clear of the consequences of such testing. Experience in the United States shows that whereas 80 per cent of people offered a PSA test without careful counselling elected to take the test, only 38 per cent opted to have such a test when they were given information on which to base their preferences. It is important that informed choice should be the basis upon which such decisions are made.

§ Lord Marsh
My Lords, does the Minister have any Figure available to him that demonstrates the level of inaccuracy of PSA testing, and the number of false results?

§ Lord Hunt of Kings Heath
My Lords, as far as I am aware, false positives as a result of PSA testing are as high as 50 per cent. That is the reason why a great deal of caution has been exercised about the extent to which screening and PSA testing should take place in this country. If, as a result of having a PSA test and a biopsy, a patient is diagnosed as having cancer, it is worth pointing out that there is no telling what the outcome of that cancer will be because it is known that half of men over the age of 80 have prostate cancer but that only one in 25 will die of it. That is why it is so important that there should be informed choice for individual men who decide to go down the testing route.

§ Baroness Howells of St Davids
My Lords, I am most grateful to the Minister for meeting me and my noble friend Lord Morris of Manchester to discuss with Gordon Muir of the King's College and Lister Hospitals his findings in the Camberwell area; namely, that there is a significantly higher incidence of inoperable prostate cancer among men in the Afro-Caribbean community. As those findings have been borne out by United States statistics, can my noble friend the Minister tell the House whether that will be given due consideration in deciding the guidance and the priorities for screening?

§ Lord Hunt of Kings Heath
My Lords, my noble friend is right to draw attention to differences in the incidents of prostate cancer among different ethnic groups. That is certainly suggested by research in the United States. Along with my noble friend, I met Mr Muir who is a researcher in this area. We are extremely keen to pursue this important area of work. We have invited detailed proposals from researchers in both Bristol and London who are looking at the incidence and nature of prostate cancer in UK ethnic sub-groups. If we were able to fund such research, it would inform the development of policy in relation to screening, testing or treatment.

§ Lord Clement-Jones
My Lords, the Minister recently announced a set of pilots for pre-retirement health checks. Will the PSA test be included in the pilots and should not the informed choice programme be included in the tests?

§ Lord Hunt of Kings Heath
My Lords, I am certainly happy to consider that. However, it is important that we make sure that the informed choice programme is fully rooted in the National Health Service and is seen to be working effectively. While we would consider sympathetically screening in itself, we must have evidence that it will be effective. It is important that the informed choice programme is a component of any such programme.

§ Baroness Sharples
My Lords, what is the average wait or delay between seeing one's GP and seeing a consultant?

§ Lord Hunt of Kings Heath
My Lords, the average time between seeing a GP and a consultant is about 13 weeks.

§ Baroness Thomas of Walliswood
My Lords, bearing in mind that there is an equality issue here in that unequal treatment for cancers as between men and women has been suggested, what plans do the Government have for greater information to be given to men through all the various media on symptoms and when one needs to self-refer, as such information was given years ago, and continues to be given, to women?

§ Lord Hunt of Kings Heath
My Lords, the whole purpose of the informed choice programme is to make 995 that kind of information available to men who approach their GP, ask about prostate cancer and ask for a PSA test. The more information we provide, the more likely an individual is to make an informed choice.