Much was made last Friday in the BBC news of updated statistics about prostate cancer. Prostate cancer has now overtaken breast cancer as the third most fatal in the UK, after lung and bowel cancer. In addition, the mortality rate for prostate cancer is dropping less quickly than that for breast cancer. The difference is, experts seem to agree, that while there is a reasonably reliable screening procedure for breast cancer, no such thing is available for prostate cancer. And yet, it was stated quite clearly in bulletins that the best explanation for these changes in prostate cancer data is a rising population and increasing longevity among men.
According to the BBC website:
Michael Chapman, director of information and involvement at Cancer Research UK, said: “The number of men getting and dying from prostate cancer is increasing mostly because of population growth and because we are living longer.”
Nevertheless, the spin given to the news reports refers to the lack of any reliable, single test for prostate cancer, and on the need therefore for research to be funded in order to develop one, thereby improving survival rates for men with prostate cancer. Which is a good thing. This is a familiar narrative. It is how disease in general is presented in our societies. As a technical problem that can be solved by funded scientific research. More importantly in this discourse though is the notion that prostate cancer has overtaken breast cancer, with the implication that there is some sort of competition between them.
The logic at work within this pernicious elision of media campaigning and news reporting takes for granted that the mammogram has a crucial function in breast cancer diagnosis that is nowhere available for prostate cancer, and that this lack in some way explains the change in rank in a couple of statistical measurements of the diseases, and/or justifies efforts to intervene in some way. In spite of the actual logic of statistics asserting that the actual statistical update in question is due to there being more men living longer, this subtle misuse of statistics underpins more overt lobbying for research money dressed up as news, which appears to engender a kind of diffuse male resentment, a feeling among men that women are getting a better deal, that what women already have for their cancer, men should surely have too.
I believe I put the matter quite succinctly in my, in this context, prescient piece about Prostate Cancer Warriors, posted after I climbed Braeriach last year:
In spite of the existence of many support and campaigning organisations and charities – Prostate Cancer UK, Prostate Scotland, Maggie’s Centres, Macmillan – it remains much easier for women to discover and discuss the first symptoms of breast cancer than for men to find out about what may or may not be developing in a gland they probably do not realise they have. Without wishing to be vulgar, breasts are more prominent than prostates and are more frequently examined. Anomalous tissue growth in breasts is consequently more quickly identified than in prostates.
It boils down to this: in the course of ordinary life, more breasts are squeezed than prostates massaged.
I remember my first digital prostate examination as if it were yesterday. Even though the doctor’s gloved finger was liberally lubricated, its brief penetration of my anus was not pleasant. The crusty, ridged surface of my prostate was palpable beneath the doctor’s finger through the wall of my rectum. An unfamiliar sickly feeling spread through my lower body, lingering as I made myself respectable again and for a while after the examination. This was a short and inexpensive procedure that left no doubt that there was something anomalous about my prostate. And from this began the process of tests and scans, which taken together led to diagnosis.
There was one element of the diagnostic process – the biopsy – that clinched it. Only by comparing actual tissue from an actual prostate with library samples is it possible to diagnose cells as cancerous. The procedure of sampling prostate tissue is extremely unpleasant – squeamish readers are invited to skip to the next paragraph. The anus is held open with a speculum as an apparently blunt instrument is pushed through the wall of the rectum, and then through the surface and into the tissue of the prostate. In order to get as broad a view as possible, samples are taken in this way at as many as ten different locations within the gland. This means up to ten separate penetrations of rectum with biopsy needle. Readers who do not know what a biopsy needle looks like, should imagine a tiny version of the jaws of the monster in the Alien film franchise. At the moment of sampling there is an immediate, intense pain that sends surrounding nervous tissue into spasm and shoots outwards into other parts of the body.
This diagnostic trajectory is labour intensive, demanding the time and expertise of pathologists, clinical nurse specialists, urologists and assorted ancillary staff. There is an obvious financial incentive to develop a less expensive and time consuming method of diagnosing prostate cancer – quite apart from the general unpleasantness of it all. Although quite what test or procedure would function in the same way as the mammogram does in breast cancer screening remains to be seen. Presumably it is to be hoped that by funding biochemical research within the usual mechanistic paradigms, something useful will spin off.
In the meantime, I can’t help thinking that learning, as a culture, that being able digitally to examine prostates without embarrassment or shame would surely be a serious contribution to public health. For the fact of the matter is that although there is no direct equivalent to the mammogram that can screen for prostate cancer, the mammogram remains only one stage of a diagnostic process – similar to the one described here, with tissue biopsy at its pinnacle. The issue nevertheless persists: it is not easy to detect or notice the first symptoms of prostate cancer and so the disease is generally discovered after it has developed too extensively for surgery or radiotherapy. For this reason too, comparison between prostate and breast cancer data is not strictly like for like. The solution however remains simple.
If we want to become more adept at nipping prostate cancer in the bud, we need to start talking about prostate massage, and to develop scanning devices that can be easily and comfortably inserted into a postion from which they are able then more and more closely to display what is going on in a prostate.
I look forward to the day when I hear on the news a report about the latest breakthrough in medically scanning butt plugs. It would make for much more entertaining fare than the usual bollocks about throwing money at science to make disease go away.