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A blog following a recent study which has revealed that Prostate cancer tests, which predict how aggressive a tumour is, underestimated the severity of the disease in half of cases.
By Ben Lees
I read recently about a study published in the British Journal of Cancer  which involved a prospective study of 847 men with prostate cancer. Tumour volume was assessed by pathological examination, and 415 members of the study group were informed that their cancer was slow-growing. Of the 415, 209 were subsequently found to have a more aggressive form of the disease, and in a third of the cases, the disease had actually spread beyond the prostate, which therefore casts doubt on the reliability of prostate cancer testing and the advice being given to patients with prostate cancer.
Talking to the BBC, Dr Iain Frame, director of research at Prostate Cancer UK said:
“Accurate prostate cancer diagnosis continues to be one of the biggest challenges facing the disease today.”
“The results of this study highlight yet again that existing tests cannot provide a precise picture of the aggressiveness of a man’s cancer, often leaving men and their doctors to make difficult decisions about treatment without all the facts.”
The author of the study, Mr Greg Shaw, a urological surgeon based at the University of Cambridge, also commented on the findings. He is of the view that a “surprising” number of men were not diagnosed appropriately the first time around.
Mr Shaw added that, based on the study, if men are informed their cancer is slow-growing and opt for active surveillance (rather than surgery to remove the prostate), 30% of them would be likely to need “radical treatment”, such as surgery and radiotherapy, five years later. In his view, this demonstrates that there is “room for improvement”, which I would agree certainly seems to be the case.
Prostate cancer is the most common male cancer in the UK and is reported to result in approximately 10,800 deaths per year. It is therefore essential that as thorough testing as possible is undertaken from the outset to avoid more aggressive forms of the disease being misdiagnosed.
Mr Shaw has suggested that a template biopsy, which looks at more tissue samples than the usual prostate biopsy, should be included on the basis that more samples may give a clearer picture of the extent of the disease. He also indicated that MRI scans should be improved to identify how aggressive the prostate cancer was from the outset.
Talking to the BBC, Prof David Dearnaley, at the Institute of Cancer Research, London, said that targeted biopsies would be better than the random ones which are currently used.
One thing is clear; the current tests are imprecise and make it difficult for patients to come to informed decisions about their treatment.
As a clinical negligence lawyer I and my colleagues have acted for patients who have suffered due to a delayed or misdiagnosis of prostate cancer and have seen how this has negatively impacted on the outcome and treatment required, causing further injury and losses to the patient.
Whilst this is a different scenario, as clinical negligence claims usually arise from misinterpretation of results or delayed investigations, rather than the testing being unreliable, the outcomes are similar for the patients in that the disease may have spread further and more radical treatment is required. It is hoped that the study will prompt improvements in the way that the staging and severity of prostate cancer is tested and to reduce the number of patients affected by this.
If you have any concerns about your treatment for prostate cancer, please contact me or another member of the Clinical Negligence Team for further advice.
 British Journal of Cancer (10 April 2014) | doi:10.1038/bjc.2014.192