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Lord Mott
To ask His Majesty’s Government what steps they are taking to ensure that GPs proactively discuss prostate cancer with men at the highest risk; and inform them of their right to a free prostate specific antigen test.
Lord Mott (Con)
My Lords, around one in eight men will be diagnosed with prostate cancer at some point in their lives. In the UK, it is the most commonly diagnosed cancer in men and, sadly, it causes around 12,000 deaths a year. Even more tragically, this number includes many men who are dying needlessly due to late diagnosis. Around one in five of those diagnosed are diagnosed too late. When caught early, there is nearly a 100% survival rate—a remarkable reflection of advances in treatment—but survivability plummets to around 50% when the cancer has progressed to stage 4. Our current approach to testing and screening is falling short. That is why I have secured this debate today, and I welcome Members from across the House who have indicated that they wish to take part.
I support calls for a targeted screening programme for high-risk men. I believe that over 135 Members in the other place have expressed their support, as have many noble Lords. Importantly, so have the vast majority of GPs when surveyed, as well as many patient and campaign groups, including Prostate Cancer Research and Prostate Cancer UK, which I must thank for their support. It is also important to thank the Daily Telegraph and Daily Mail for raising awareness by taking up the campaign.
The National Screening Committee is currently carrying out its review, but it seems clear to me that the introduction of MRI and new biopsy techniques, alongside the traditional PSA test, goes a long way to addressing concerns about the accuracy of a PSA test alone and the risks of the diagnostic process. The All-Party Parliamentary Group on Prostate Cancer published a report yesterday to that effect, highlighting the progress that has been made in reducing the risk of overdiagnosis and overtreatment. I hope the noble Baroness, Lady Merron, can offer an update on when this is expected to conclude and on what the Government are doing to ensure there is no further delay.
I also want to note the longer-term work, including the £42 million TRANSFORM trial, announced under the previous Government, that can further add to the evidence base and is a huge step forward; yet I have not chosen to make this the focus of today’s debate, because the issue is too urgent to wait. I want to focus on what we can do immediately to stop men dying needlessly.
Whatever the outcome of the National Screening Committee’s review, we need to change the guidance we give to GPs. At the moment, we leave it to men to proactively request a PSA test from their doctor and we actually prevent GPs from raising the issue, even with men who are at the highest risk. Men are already more likely to put off a visit to the doctor. I must admit I know this from personal experience. How realistic is it to have a system that means a man must proactively find out his risk and then chase his doctor for a prostate cancer test? It means only those who have sharp elbows or who are highly skilled at navigating the health system are getting the tests they need. It is bad enough across the board, but such an approach also entrenches health inequalities, leaving high-risk groups, particularly black men, those with family history and men in deprived areas, seriously disadvantaged.
This guidance was well intentioned when drafted, but it is now out of date. Previously, the test used could cause pain and bleeding and came with a risk of serious infection, but the introduction of MRI and new biopsy techniques has been transformational. Diagnosing prostate cancer has never been safer or more accurate. When combined with the serious consequences of late diagnosis, an update to the guidance is justified. Allowing GPs to have proactive discussions with high-risk men about their right to a free PSA test does not mean that everyone will choose to have a test; indeed, allowing doctors to have proactive conversations could help to reduce the overall proportion of over- diagnosis and overtreatment. GPs would only be proactively raising the point with those most likely to be diagnosed with aggressive cancers.
If we want to say we have a policy of informed choice, then let us make that a reality. Do not leave men to have to do their own research. Let their GPs talk them through it, let GPs guide men on the risks and benefits, and let us make the system one that does not entrench health inequalities. Will the Minister give a commitment today to revisit the guidance given to GPs through the prostate cancer risk management programme to allow them to have proactive conversations with high-risk men?
In conclusion, there is much more to do to stop men dying needlessly of prostate cancer that goes well beyond the scope of this debate, from supporting research and investing in our diagnostic infrastructure to outreach through efforts like the “Man Van” model, which recently made an appearance in Westminster, and the excellent work that has been carried out by Professor Stephen Langley at the NHS Royal Surrey cancer centre and hospital in Guildford, with a trial run by Surrey and Sussex NHS cancer alliance. I certainly hope that we have a targeted national prostate cancer screening programme once the National Screening Committee completes its review. Irrespective of the committee’s decision, we can take action today to end the absurd practice of GPs being prevented from raising prostate cancer checks with men at the highest risk. I urge the Government to take this forward without delay and I look forward to the debate and to hearing from the Minister.
Lord Patel (CB)
My Lords, I thank the noble Lord, Lord Mott, for initiating this debate. Some of my comments are shared by the noble Lord, Lord Winston, on whose behalf I also make them, as he is in hospital with a broken leg—but he is doing okay.
I agree with the comments that the noble Lord, Lord Mott, made about identifying and offering the PSA test for higher-risk patients. My comments are therefore not about GPs’ role in offering the test to men at higher risk of prostate cancer. My comment is mostly based on the use of PSA as a test for screening purposes. It is a test which has a fairly high degree of sensitivity but a very low degree of specificity, which means that the rate of false positives and false negatives is very high for a screening test.
I agree that some of the trials being carried out—the noble Lord, Lord Mott, mentioned one in Royal Surrey hospital, and there are others in Europe and the United Kingdom—may help us modify the guidance that could be given based on the results of the study and therefore could be targeted at a wider group of people. But we need a test that is much more reliable, easily carried out and much more accurate. Such a test as a preliminary study was developed by the Institute of Cancer Research and the Royal Marsden Hospital. It uses a spit test, which recognises 130 different modifications or mutations of DNA with a high degree of specificity, much higher than the PSA, and a high degree of sensitivity. In a model trial, it would have identified nearly 13,000 patients, the same number of deaths that occur per year, with low-grade prostate cancer. It is a test that requires further trials, because it is easily administered and may become part of a wider screening programme. So we need to be much more aware of innovations that may occur.
Lord Patten (Con)
My Lords, first, the key word in my noble friend’s very important question is “proactively”. Axiomatically, it is Ministers who must decide to be proactive in the end, not national screening committees. This is a time when worried men face a blizzard of news and views about their prostate risk. These are sometimes very hard to decide on; they are conflicting or indeed confusing, even within some GP practices on the front line. PSA tests are valuable, but they have some limitations, not producing infallible results every time. We must be honest about the upsides and downsides, and they must be made clear in order to get realistic buy-in from men on the need to get started on being checked from age 45, or indeed even earlier.
Secondly, surely the messages should be the same in all four parts of the United Kingdom. They are not at the moment: they are different, which strikes me as bizarre, despite the fact that men do and can freely move across borders, just as the condition moves across borders. So I say to the Minister only that in the end it is national Ministers in the four different regions who must be got together to give one national message, lest the tragic death toll climbs further and faster.
Lord Taylor of Warwick (Non-Afl)
My Lords, I thank the noble Lord, Lord Mott, for securing this important debate. One of the lessons of history is that we do not learn lessons from history, and we must not ignore the historical facts. First, prostate cancer is the most diagnosed cancer in men aged over 45 in England. Secondly, there are higher risks of prostate cancer linked to ageing, black men and family history. Thirdly, early diagnosis is critical. Survival is nearly 100% when detected early but drops to around 50% at stage 4. Yet one in five men—that is 10,000 annually—is still diagnosed too late. Fourthly, despite these facts and earlier warning signs, there is still no UK-wide screening programme. So my first question of the Minister is: what analysis of other nations’ prostate cancer treatment is the Government carrying out, and have they come to any conclusions as to the way forward for the UK?
Next, will the Minister set out what action the Government will take to ensure that higher-risk men who request a PSA test are never refused, in line with current policy? What conclusions have the Government reached as to the most effective method of PSA screening as a result of the TRANSFORM trial launched in May of last year? Bearing in mind the reluctance of some men to submit themselves to rectal examinations, what assessment have the Government made of the BARCODE 1 study on the early detection of prostate cancer using saliva samples to identify high-risk patients? Lastly, when will the UK National Screening Committee announce the conclusions and recommendations of the TRANSFORM trial? A national screening programme for men at high risk of prostate cancer is long overdue. National screening will radically improve the fate of prostate before it is too late.
Lord Dobbs (Con)
The biopsy was not much fun. Stuck in those stirrups, my dignity dangling in the breeze, a charming lady nurse asked me if I was comfortable. We both agreed that that was a profoundly stupid question and laughed our way through the prodding and the poking.
Prostates raise many questions. I got through it thanks to my GP, Dr James Banfield, and support from others, particularly my noble and very dear friend Lord Kirkham.
Too often, men shy away and leave things too late. We need more encouragement, and perhaps more courage, like that of Sir Chris Hoy. When I was a guest editor of the “Today” programme and devoted it to prostate cancer, I interviewed Bill Turnbull, so full of regrets. He had tried to ignore it. He had only a few months to live. We know it does not need to be that way.
When my turn came, I chose radiotherapy. On day one, I gave the young technicians a large box of House of Lords chocolates. “What’s that for?”, they asked. I told them it was to encourage them to aim straight. That was five years ago. I caught it early, which is the key, not only to an extended life but to one without the mucky, yucky side effects, which is not possible without supportive GPs and timely testing. Testing may not be foolproof, but it is better than being a fool. So I am grateful to my noble friend for this short debate. We are helping save lives.
Lord Watson of Wyre Forest (Lab)
The Lord is absolutely correct. It was not much fun, was it? I speak as someone who is recovering from prostate cancer. Nearly two years on—so far, so good—I am under active surveillance. I was treated early because of my wise and gentle GP, Dr Nazeer, who has just entered his 60th year in the National Health Service. He gave me his time and his patience, and he cajoled me to rid myself of type 2 diabetes, and after that insisted on giving me an annual blood test. That is how I was diagnosed early.
It is obvious to me that in a civilised society we should allow our GPs to have a conversation with men about what the testing regime should be, particularly those high-risk groups. So I thank the noble Lord for bringing up an important subject that means a great deal to tens of thousands of men and their families in this country, and I know the Minister will have heard very deeply what he had to say today.
Lord Bethell (Con)
My Lords, I give huge thanks to my noble friend Lord Mott for this important debate, and thanks also to the noble Lord, Lord Patel, for pointing out that we need better diagnostics with better specificity and sensitivity. We all aspire to a new generation of diagnostics, but we have to live with what we have today. My noble friend Lord Dobbs pointed out that timely assessment is the most urgent thing if you are developing prostate cancer. That is why I would like to address the question of risk aversion: a culture that, I am afraid to say, holds back timely intervention.
The evidence suggests that, too often, doctors’ intolerance of uncertainty is directly associated with diagnostic delays and errors, sidelining informed choices for patients and instead favouring the psychological comfort of clinicians. The NHS culture too often infantilises patients. In modern life, we are used to making 35,000 decisions a day, so the suggestion that patients cannot handle the complexity of modern tests, the idea that diagnoses may be reversed, or the pressure of diagnosis is, frankly, absurd. Yet studies reveal wild variations in PSA testing between GP surgeries, driven often by individual bias, not by science. This lottery is completely unacceptable.
This is a system-wide problem involving not just prostate cancer. Early detection of disease is vital if we are to turn around our national health disaster. We need risk-based screening, mandatory GP engagement and accountability for delays. Therapeutic privilege should be dead and buried; patients deserve informed choices and agency.
Baroness Murphy (CB)
My Lords, as a doctor, I have witnessed many men living with prostate cancer and cared for them. It has been heartening over the last 30 years to see the dramatic improvement in survival—good survival—of prostate cancer. My own husband was treated successfully for an aggressive prostate tumour 17 years ago, following an entirely fortuitous PSA test. But as we have heard and as the noble Lord, Lord Patel, has reminded us, PSA testing is not perfect; surely it will be superseded soon by something better. The 20% reduction in mortality through PSA screening has surely been won very well, but at a very high price in the side-effects of treatment by surgery and radiology, and in urinary incontinence and erectile dysfunction, which very few urological services in the UK take seriously enough to treat, even though they can be successfully treated.
Going back to the PSA test, there are now risk calculators to help GPs and patients assess whether the test is worth it. As has already been mentioned by the noble Lord, Lord Mott, male patients do not go to the GP unless they are forced to and they have symptoms. They do not like to go through the 8 o’clock scramble—how many of us do? We are light-years away, therefore, from the discussions that we need between patients and GPs, even though, theoretically, we have universal registration with GPs, which should be the perfect concept for developing the system. GPs will not do it unless there is money in it, and if we could include proper screening with risk calculators with GPs in the QOF points, we could solve the problem.
Lord Kirkham (Con)
My Lords, I am able to speak today only because of a chance discussion 18 years ago during a general health check-up in the USA. This led to a positive prostate cancer test back here in the UK, which gave me the opportunity to radically improve my health and extend the length and quality of my life. That is why I fervently believe in early intervention via simple, non-invasive testing to provide others with the same opportunity.
Prostate cancer is now the most commonly diagnosed cancer in England. That is actually good news, as it shows that awareness campaigns are working, and more men have been diagnosed while the disease is still treatable. But 17% of those positively diagnosed in 2023 have stage 4 cancer that has spread, becoming incurable and life-shortening. As we have already heard, those at the highest risk are well-defined. They may have a strong family history of the disease, be of Afro-Caribbean heritage or with a genetic predisposition, and they can be simply targeted by GPs.
Men are reluctant to get tested because it hits right at the centre of what it means to be a man, involving deep personal issues such as incontinence, fertility, libido and sexual function. The fact that early-stage localised prostate cancer rarely gives rise to any symptoms makes proactive discussion with a GP vital, and it is why it should become part of routine health awareness and NHS care.
PSA is a simple blood test that costs only a few pounds. It is not perfect, but it is a good starting point to detect men who need secondary testing. It is blatantly obvious that GPs should proactively discuss PSA testing with higher-risk men and inform them of their right to a test. It could save many, many lives.
Baroness Royall of Blaisdon (Lab)
My Lords, I am grateful for this debate, understanding that when men have prostate cancer and when they die, their loved ones also suffer. I welcome the review by the national screening committee, and I look forward to its conclusions. But in parallel, there must be change in the guidance given to GPs to ensure that men at the highest risk are informed of the risk and offered a PSA test.
If the screening committee decides to recommend targeted screening, which I fervently hope that it will, it will take years to implement. It is crazy that current NHS guidelines prevent GPs discussing the disease with those who are most likely to have it, and late diagnosis of incurable cancer. The system benefits men who are aware of the issue and able to interact with doctors, entrenching biological and societal inequalities. It cannot be right that it is awareness, not risk, that determines who gets tested. This exacerbates inequality and leads to death. Surely, if a GP is in front of a black man or a man with a family history of the disease, they should say, “Have you thought about a test for prostate cancer?” The noble Lord, Lord Patel, and others rightly say that PSA tests are not always accurate. Yes, we need better tests, but, in the meantime, we have PSA tests, so let us use them, because targeted testing saves lives.
Raising awareness is critical. and I pay tribute to the wonderful work of charities such as Prostate Cancer UK, with its great campaigns and whose badge I usually wear. I urge the Minister to work closely with those charities and to embrace the research they are undertaking all the time. I look forward to a positive response from her.
Lord Rogan (UUP)
My Lords, I, too, thank the noble Lord, Lord Mott, for initiating this timely debate. Prostate cancer is now Northern Ireland’s most common cancer, and yet is the only major cancer without a national screening programme. According to the latest statistics, more than 1,300 men are diagnosed with prostate cancer every year in Northern Ireland, with almost 300 men in the Province dying annually from the disease. At present, more than 12,000 men are living with and after prostate cancer in Northern Ireland. I am one of them, as well as having several other medical conditions.
I am extremely grateful to the National Health Service in Belfast for the treatment I have received, and I pay particular tribute to the consultants, Mr Benson, Miss McBride and Miss Shum, for enabling me to be with you here this evening. While we do not have a national PSA screening programme, it must be pointed out that that exists in some countries, including Lithuania and the Czech Republic, with many other nations, including the Republic of Ireland, conducting pilot schemes. That said, men living in the UK aged 50 and over can request a PSA test through their GP.
In recent weeks, former news presenter Dermot Murnaghan, who was educated in Northern Ireland, went public with his own stage 4 prostate cancer diagnosis. He said that, in the continued absence of a screening programme, he would advise men of a certain age to “go and demand it”. I fully endorse that call.
Mr Murnaghan is planning to join six-time Olympic cycling gold medallist Sir Chris Hoy, who was diagnosed with stage 4 prostate cancer two years ago, on a charity bike ride to raise money for the cancer charities and raise awareness. I wish both men well with their heroic endeavours and with their treatment.
Lord Bailey of Paddington (Con)
My Lords, prostate cancer is the most common cancer among men, but the risk is not shared equally. Black men face a one in four lifetime risk, compared with a one in eight risk for white men. They are also most likely to be diagnosed at a late stage, when treatment is less effective. Men with a family history of BRCA mutations or who live in more deprived areas are also at greater risk. Yet the current guidelines treat all men the same. GPs are told not to raise the issue unless the man has symptoms, but prostate cancer often has no symptoms until it is advanced.
Prostate Cancer UK argues that this is outdated and dangerous. It is calling for GPs to be allowed to proactively speak to black men aged 45 about PSA testing. This small change could save lives by enabling diagnosis and treatment. Previous trials have not included enough black men to show the full benefits of screening, but this gap in evidence should not justify inaction. Updating guidelines to reflect this risk is a matter of public health and fairness. I urge the Government to act so that this inequity and this postcode lottery no longer dictate a man’s chances of surviving prostate cancer.
I had to badger my GP to have it done. I had to point out that I am of West Indian descent and that my family has had this happen before. That was the only point at which it became relevant to my GP. If you did not have my tenacity, that could be a death sentence. You would not be willing, would not be able and would not even know that you need to take on this system. There are many poor communities, black and white, that need this change if our men are to survive.
Lord Berkeley of Knighton (CB)
My Lords, my story is slightly different from that of the noble Lord, Lord Bailey. A few months ago, I had an elevated PSA. Within 36 hours, the surgery to which I go, run by the excellent Dr Sheldon, had put me on a cancer pathway and offered me an MRI. I was absolutely amazed by this efficiency. The news, I am glad to say, was good, but it was the third time that I had had an MRI. My prostate is obviously a rather energetic creature and my PSA levels seem to be quite high. We have now had to adjust what should take me for another MRI.
However, as the noble Lord, Lord Patel, and the noble Baroness, Lady Murphy, said, there are concerns here. Perhaps I might make a constructive suggestion for the Minister to take back to her department. I do not know whether the two GPs would agree with this, but I have found that men are often not told to desist from energetic exercise prior to this test—sport, tennis, running, and indeed and especially sexual activity. They also give a false reading and this needs to be accented a bit more. People coming away from a PSA test should be told that these things could raise the prostate-specific antigen.
I will finish by saying how amazed I was to be given this MRI, although it was the third one that I have had. I more or less had to say, “Do you really want to do this? Do you want to spend NHS money on somebody who has been told twice that, thank God, there is no real problem?” Having said that, I am profoundly grateful.
Lord Beamish (Lab)
My Lords, I congratulate the noble Lord, Lord Mott, on securing this very important debate. I was diagnosed with prostate cancer last February. I had no symptoms. I was going as normal for my yearly health check at my local GP surgery when a nurse suggested that the PSA test might be appropriate because of my age. It came back positive and, as the noble Lord, Lord Dobbs, and my noble friend Lord Watson of Wyre Forest said, it is not a dignified process—although when you get the diagnosis, frankly you do not care.
Let us go through the reasons why this is not being offered. One, as the noble Lord, Lord Patel, said, is the PSA test. I accept that, but I am sure that the three of us who have just talked about our experiences would rather have had a chance of that test than nothing, which was the alternative. There are moves forward with PSA tests, saliva tests and other things, but we must have a screening programme that targets high-risk groups. Education is also going to be important. We need we need a national education programme on this.
Also, from the NHS’s point of view, there is the UK National Screening Committee. I campaigned with my noble friend Lord Watson in the other place around cardiac risk in the young, asking for screening of young people in active sports. The same excuses were used to resist that as are being used now for prostate cancer: false positives and raising anxiety. Yes, it is very stressful point when you get that diagnosis. Thankfully, my treatment is going well, which is down to the incredible people that we have in our NHS, who work very hard on our behalf. I am eternally grateful to them.
Let us look at the economics of this. If we are to reduce costs in the NHS, we must put more money and effort into prevention. This is about prevention. Put very crudely, early diagnosis and treatment is not only saving the NHS money but helping people have a positive and active life.
Lord Kempsell (Con)
My Lords, I join with noble Lords in paying tribute to the noble Lord, Lord Mott, for convening this business and discussing an issue that is absolutely vital in order to save the lives of men across the UK. We are blessed in this House to have eloquent noble Lords who have shared their own experiences of diagnosis and treatment. Men advocating the importance of diagnosis, testing and the fight against prostate cancer is such an important part of advocacy across treatments and will definitely help to raise awareness. We are blessed to have those advocates share their experiences in this debate.
Before Front-Bench contributions and the Minister’s response, I will limit myself to one point, which is to give a voice to younger men in this debate. All too often, prostate cancer is thought of as an issue that affects only older men. As the youngest serving Member of your Lordships’ House, on behalf of younger men everywhere I point out that those young men are ordering private PSA tests at a higher rate than ever. That is all very well for younger men who have the means and awareness to do so, but it is not the case universally. So we need to revisit the guidance that doctors should not raise the issue of prostate cancer with men under 50 if they are non-symptomatic.
I echo the incredulity that has been expressed across all sides of the Lordships’ House about the other aspect of that guidance. Even for men over 50, there needs to be a proactive effort to engage in a conversation about the risk of prostate cancer. Let doctors be doctors. Let them treat their patients. They know their patients better than those who write healthcare guidance. I urge the Minister to visit that question in her response.
Lord Rennard (LD)
My Lords, many men and their families should be grateful to the noble Lord, Lord Mott, for this debate, which will increase the profile of prostate cancer and illustrates the need for screening.
We have heard moving stories about prostate cancer. I have very strong and close relationships with friends from my university days some 45 years ago. Several male members of this group now have personal experience of prostate cancer. Thanks to screening, early diagnosis and the latest treatments, most of them are okay. But one close friend, who is my age, has advanced stage 4 prostate cancer. The very latest and experimental treatments are helping to keep him going for a few more years than we dared hope. He was unlucky, because he had screening but the disease developed rapidly in between screenings.
The experience of my male friends means that I ask for a PSA test now when I can, sometimes when I have other blood tests concerned with diabetes. But we have heard how some GPs are discouraged from discussing this threat with some of those at highest risk. The risks are highest with black men and those with a family history of the disease. Those from the most deprived backgrounds are almost a third more likely to be diagnosed with late-stage incurable prostate cancer.
The PSA screening test is not perfect by any means. We need, as and when we can, to move to saliva/spit tests. We need to use AI with blood and urine tests and use multi-parametric MRI. But in the meantime, it seems that we should get GPs to proactively offer PSA testing to men at high risk. It will save lives, and I hope that people are listening.
Lord Kamall (Con)
I thank my noble friend Lord Mott for securing this important debate and for sharing some of those startling statistics. I also thank other noble Lords who contributed today and shared their personal experience. Time constraints and a Paddington Bear stare from the noble Baroness, Lady Anderson, prevent me naming them all.
I hope noble Lords will forgive me if they have heard this before but, when I worked in Belgium, a urologist advised me that men over 45 should seek an annual prostate cancer test. So, when I came back to the UK, I asked my GP about this and he was dismissive, suggesting that I ask for a PSA test at my next blood test. When I did so, the nurse asked me if I was sure that I wanted one and said, “They’re not very reliable”. Given that attitude from some medical staff—not all, it has to be said—it is not surprising that the data I looked up today shows prostate cancer incidence in Belgium to be below the UK’s.
I understand concerns about overdiagnosis of what is termed slow-growing, localised, or benign prostate cancer, which, when unnecessarily treated, may lead to incontinence, erectile dysfunction or bowel issues. I also understand concerns about misinterpreting data from enlarged prostates. These are important points to bear in mind, but surely this should not be an excuse for reluctance or inaction by some clinicians, especially given the alarming racial disparities mentioned by a number of noble Lords.
I welcome the Minister back to her place after her recent absence. In doing so, I will ask her some questions. Given the emphasis on “from sickness to prevention”, how do the Government intend to raise awareness of checking for prostate cancer, particularly in those disproportionately affected communities?
Some noble Lords mentioned trials—some introduced under the last Government. There are also reports of tests. I know we have to be very careful about what we read in the media and some of the claims, but some suggest that these tests are up to 96% accurate in detecting prostate cancer. Can the Minister say any more at this stage about these trials, the ongoing evaluation, and whether there is a rough timescale for a definitive test we can all have confidence in?
Given the concerns that have been raised, what guidance is available now for medical practitioners on prostate cancer tests such as the PSA, then later the PCA and others? How do we ensure that patients can be encouraged to come forward? How can we be assured that prostate cancer is given the attention it deserves?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, this has been an extremely valuable debate on what is a very important matter. I find much to commend in the points noble Lords have made. I am very grateful to the noble Lord, Lord Mott, for bringing this debate forward, for his work in raising awareness of prostate cancer and for his continuing campaign. Let me say at the outset that we are committed to finding a solution and working at pace on research, testing and treatment.
I thank the noble Lord, Lord Kamall, for welcoming me back to the Dispatch Box. I have missed his questions and all the questions in your Lordships’ House, so it is genuinely a pleasure to be back. This is a very important debate for my return.
I thank noble Lords for sharing their experiences, whether personal experiences such as those shared by the noble Lord, Lord Dobbs, my noble friend Lord Watson and others, or the experiences of those close to those directly affected, such as my noble friend Lady Royall. I thank her for raising that issue.
Too many men are dying of prostate cancer. Indeed, as many have said, any death from cancer is a tragedy. So, let me speak first to our Government publishing a national cancer plan later this year that will have patients at its heart, and our goal to reduce the number of lives lost to cancer. I assure my noble friend Lord Beamish that it will provide a specific focus on prevention and early diagnosis, very much in line with the Government’s health mission to shift from sickness to prevention.
We have been listening to and codesigning the plan with members of the public, the health workforce, charities, academics and other partners. I express my thanks to the cancer community for working tirelessly to advocate change. I say to my noble friend Lady Royall that we work very closely with charities, including on research, which I will come to shortly.
I thank everybody who contributed to our call for evidence on the national cancer plan. It received over 11,000 responses, which are now being analysed.
We continue to invest in all-important research through the research delivery network of the National Institute for Health and Care Research. The noble Lord, Lord Mott, referred to investment by former Governments as well as this Government. The most recent available data shows that in 2023-24, the Government invested over £133 million in cancer research. Having heard the very real concerns about prostate cancer screening, that is why this Government rode in behind Prostate Cancer UK’s £42 million TRANSFORM trial, which, again, was referred to by the noble Lord and others. This Government have invested £16 million into finding better ways to detect prostate cancer in men without symptoms, which has been the substance of this debate, and I have listened very closely.
I can say to noble Lords, including the noble Lords, Lord Patel and Lord Rennard, that the TRANSFORM trial will compare different screening test options. That will include MRI scanning, genetic testing through the spit—or saliva—test, and PSA testing. They are all part of that trial.
I am grateful to the noble Lord, Lord Bailey, for reminding us of a point that should never be forgotten: that black men have double the risk of being diagnosed with prostate cancer. Therefore, I assure your Lordships’ House that the TRANSFORM trial will ensure that at least one in 10 of those invited to participate in the trial are black men. This will establish an evidence base to reduce the increased and unacceptable risk of black men dying from the disease.
The UK National Screening Committee, about which there has been much discussion today, works closely with TRANSFORM, assessing new evidence as it becomes available. This ensures that prostate cancer policy and action is at the forefront. Prostate Cancer UK anticipates that the initial findings will be available within the next three years, while the trial will run for over a decade.
To respond to some of the points made by the noble Lord, Lord Taylor, I have referred to when TRANSFORM will deliver results. The noble Lord, Lord Patten, asked about the devolved Administrations. Health policy officials keep in extremely close contact on this very important issue. But, as noble Lords will be aware, health policy is a devolved matter and no nation within the United Kingdom currently offers a prostate screening programme. However, it is important to say that NICE and the Scottish equivalent have detailed guidance which is being used across the UK. I say to the noble Lord, Lord Taylor, that the BARCODE test is part of TRANSFORM. It may be a good test indeed, but we have to be sure that it is a good predictor of disease before going forward.
The PSA test absolutely has a place in men’s healthcare. The test works best in men with symptoms of prostate cancer. It also works in men who have had prostate cancer treatment to assess whether the treatment has been effective and in surveillance of men who have been successfully treated for prostate cancer.
The core issue of today’s debate has been GPs, although we have also talked about screening, and I will come on to that. Many GPs want to, and indeed do, inform men, particularly those at the highest risk, about prostate cancer. Health awareness is crucial in making informed decisions about one’s own health and I absolutely hear the point. This will be part of the consideration of the men’s health strategy which we will see in due course, following the consultation call for evidence. I think the reluctance men may have to come forward on health matters is understood and cannot be ignored.
There have been quite a few comments about GPs not being able to raise matters, not being able to offer tests, et cetera. The noble Lord, Lord Mott, raised the prostate cancer risk management programme in respect of allowing GPs to have proactive conversations with high-risk men. A number of noble Lords raised this, including my noble friends Lord Watson and Lord Beamish, and the noble Lords, Lord Dobbs, Lord Patel and Lord Kirkham, among others. This management programme is only guidance; it is aimed at GPs and their dealings with men. GPs—and I emphasise this to all noble Lords—are not prevented from taking relevant clinical actions that are in the best interests of patients or from having proactive conversations with patients. The Government will consider revising the management programme in line with the outcome of the UK National Screening Committee evidence review. The balance of benefit and harm, even in asymptomatic high-risk men, is unknown and under review.
The noble Lord, Lord Bethell, raised risk aversion among medics. In this case it is sensible to be cautious about offering PSA tests to men without symptoms because the current evidence, as we have heard in the debate, suggests that the test is unreliable when men are asymptomatic. I have heard noble Lords speak tonight and previously about their very positive experiences of the PSA test, and I absolutely have regard to that but there are issues to which it is important to refer. Even if there is a cancer present, the diagnostic tests—which include biopsy and MRI following a raised PSA result—cannot reliably differentiate between cancers that grow slowly and aggressive disease that requires treatment. Some slow-growing cancers may never progress to causing any harm in a man’s lifetime and by detecting non-aggressive cancers there is a risk of leading men into treatments they do not need. As the noble Baroness, Lady Murphy, said, this exposes men to significant harmful side-effects, including bowel and bladder incontinence and erectile dysfunction. We expect GPs to use their clinical knowledge expertly in discussing prostate cancer and sharing the pros and cons of a PSA so that men can make an informed choice.
I want briefly to refer to the national screening programme. We know that it would improve equity so that all eligible men would have equal access, regardless of who they are or where they are. With this in mind, we are seeking a solution. We have asked the National Screening Committee to prioritise looking again at the evidence for a population screening programme and one targeted at specific high-risk groups. I assure your Lordships’ House that the work of the committee is on track. Scientific reports were received in August. They are currently receiving expert consideration, following which there will be a public consultation to allow the committee to make a recommendation on prostate cancer screening, focusing on the essential question of whether the balance of good versus harm is met. The noble Lord, Lord Mott, and other noble Lords inquired about timelines. Consultation is expected to start in this calendar year and will last, as usual, for three months.
This has been an extremely important debate. I hope noble Lords get a sense of progress, commitment and delivery and I look forward to returning to this point in order that we can save lives.