Understanding PSA Tests (Part II)

Season 3 Episode 12 (Part II)

Professor Chris Booth MBBS, FRCS – Consultant Urologist

In this second episode we are once again joined by Professor Chris Booth, MBBS, FRCS — a leading Consultant Urologist and one of the UK’s most respected voices in men’s health. Professor Booth is the founder of CHAPS, a dedicated men’s health charity established to improve awareness, early diagnosis, and access to better health services for men across the country.

With a distinguished career in urology, Professor Booth has become a national expert in urological service redesign, championing modern, integrated care pathways that deliver faster, more effective, and more affordable treatment. His work is especially transformative in rural communities, where access to specialist services can be limited, and where his innovative approach has helped bridge the gap between primary and specialist care.

Driven by a passion for prevention, early detection, and patient-focused care, Professor Booth continues to lead the conversation about how we can improve men’s health outcomes and reduce avoidable deaths from diseases such as prostate cancer.

We’re thrilled to have him with us today to share his insights, experience, and vision for the future of men’s health.

https://chaps-uk.org

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Transcript

SPEAKER_00: 0:04

You're the point of your code on the weekly podcast with your host, Martin Mortimer, fighting state or lack of work. Why don't grab yourself a cup of coffee? Tip back and enjoy the chatter as we discuss and share information, talking about top subjects, and offering help, support, and motivation with a positive middle attitude.

SPEAKER_04: 0:28

Morning Martin. Morning. Well, we find ourselves in your car headed back to Dedham in Essex. I know, Martin. We'll see uh Professor Chris Booth. And he's going to talk today on his specialist subject, which is a prostate captain.

SPEAKER_01: 0:45

Yeah, something really, really important in life, and uh something some people ignore, which I think, you know, once you start f feeling the symptoms, and Chris will certainly talk about that, I'm sure, um, you get into contact with someone and uh get sorted. So uh please listen, guys.

SPEAKER_04: 1:04

So without further ado, Chris, if you'd be kind enough to start why you left off. Thank you. So the PS PSA test you think should be mand mandatory, really?

SPEAKER_05: 1:16

This uh this gets us into the very checkered history of PSA and the arguments around screening. At the moment, PSA is the only cheap blood test that we have for, if you like, getting into uh a diagnosis of either benign enlargement of the prostate, because that puts the PSA up, or prostate cancer. Whether you can use it for mass screening is of course the subject of hot debate at the moment. I mean, since I retired, I've maintained an interest in this area, screening particular. CHAPS is an acronym, it originally stood for Colchester Has Active Prostate Support. Fiona thought of that one. But it started off as a prostate cancer charity in 2000 to raise money for our department. But when I left the department in 2006 when I retired from the NHS, I took chaps with me, amalgamated it with a research company that we'd set up in the urology department called Urology Research in North Essex, which spells urine. We amalgamated them and we started raising awareness of men's health issues, we produced booklets on it, men's health passports. So we were looking at all as all the things that sort of afflict men and cause them to die prematurely. I mean, one man in five dies before the age of sixty-five. Male mortality is far worse than female mortality.

SPEAKER_02: 2:59

Right.

SPEAKER_05: 3:00

And most of these deaths are due to preventable causes. In young men, suicide is the commonest cause of death, be premature death below the age of forty. Over the age of forty, it's cardiovascular disease, so that's uh heart attacks, strokes, etc. Ruptured aortic aneurysms, it's all down to your blood vessels. So when we were doing our men's health bit, we were screening men for aortic aneurysms with ultrasound, we were doing cardiovascular checks, we were checking for diabetes, and we were also doing PSA blood tests looking for prostate cancer. By 2014, it seemed obvious to me that the big remaining problem was prostate cancer. So for the last ten years, we've been looking and campaigning for an effective screening program.

SPEAKER_01: 3:56

At this point, can I just tell our listeners you are the clinical director of all this, aren't you?

SPEAKER_05: 4:01

Yes, I founded CHAPS and I've maintained role as clinical director. Yeah. And because we've been doing a lot of screening as a charity, and because I'm continuing to work with urologists who are doing the doing the urological surgery and have been going to the academic meetings, etc., I then got co-opted onto the Scientific Advisory Board, which is overseeing prostate cancer screening pilot studies that are running in Europe. They're miles ahead of us in in Europe. We we've known since 2014, which is when I really started concentrating on prostate cancer. We've known since 2014 that if you're having PSA tests on a regular regularly, really between the risk ages of about 40 and 70, you can halve your risk of dying from prostate cancer. I mean, one in eight white men will get prostate cancer, one in four black men, one in forty will actually die from prostate cancer. That's why we've got thirteen thousand deaths a year in the UK. Yeah. Sixty-three thousand new cases every year. And these numbers are going up all the time. Well, from the studies that have gone on, mainly in Europe, where these academic studies have been done properly, of trialing men having regular PSAs versus men not having PSAs, as I say, since 2014, we know that we can substantially reduce the death rate. The penny has finally dropped in this country. Screening in this country all come comes under the control, advice, if you like, of an organization called the National Screening Committee. This is where it gets political. The National Screening Committee is comprised of a lot of academics, a lot of epidemiologists, and I looked through two days ago, I actually looked at the constitution and membership of the National Screening Committee and the Advisory Research Group that advises uh the screening committee on prostate cancer. And there are no frontline urologists or radiotherapists or oncologists in that committee. They're looking at it in a very academic way that doesn't take into account current clinical practice. So we make advances in clinical practice almost every six months, something new will come out. Very often these are just small modifications but minor improvements. Well if the National Screening Committee is only looking at so-called randomized clinical trials, where you compare one group who are having the treatment with a group who are not having the treatment, i.e. having PSA tests, not having PSA tests, or only having PSA tests in a random manner, then you're limiting your view down to these trials. And these trials are extremely difficult to run. If you run them for prostate cancer, you only start seeing a significant change in the death rate after at least ten years, if not fifteen years, of study. Because if you start checking men in their 40s or say fifties, how many men are dying in their forties and fifties? Very few. So there are going to be very few deaths. So you're not going to get any convergence of the trial group versus the control group until you get into your 60s, and then you start seeing it. And then it continues to diverge. By the end of 15 years of screening, then you will see a really significant difference. And up to now, our benighted national screening committee has not taken regard of this evidence. And they've been saying things, well, we want to run our own trials, or well, you can't compare Swedes with Brits, for instance. Um there aren't any black men in Sweden, whereas lots of black men here, and you haven't got them in the equation. So they think of all sorts of what I would call academic reasons for not accepting the work that's been done elsewhere. And that figure of 50% reduction came from the Rotterdam arm of the European study on screening, which has been going on all over Europe for a long time, and our National Screening Committee has not accepted this type of work. There was a similar paper came out in 2019 from Northern California in a trial of involving over 400,000 men, which showed a 64% reduction in the arm that had been having PSA tests on a regular basis compared with those who are having it only on a random basis. But they're not accepting that type of work. I know because I've I've submitted submissions to the National Screening Committee. In fact, we have a a submission in at the moment that's been sitting on their desk for three years. I mean, they request submissions for new screening programs. That's been sitting on their desk for three years, recommending a comprehensive screening program for all men from the age of 50 up to 70.

SPEAKER_01: 9:55

Well, women women have screening for breast you know, cancer, don't they, and things like that. So And you see these vans parked up in car parks, don't you? Is that a thing that you you'd want for men to have that they can walk in, is it possible?

SPEAKER_05: 10:11

Yes. I mean, effectively we're doing that by running events mainly in Essex, Suffolk, London and the home counties. But uh last week, for instance, we were trialling in uh or screening, I should say, for caterpillar tractors in Belfast and have done the year before. The week before that we were in Glasgow. We do every second year we go up to Glasgow, do screening for Siemens rail automation. So we're all over the country now. We we essentially have a network of phlebotomists who do the blood tests, a network of laboratories, top laboratories who do the blood sampling, and our own computerized record, so we can see what men's PSAs are doing over the years. We've demonstrated quite clearly in Essex that if you go to say Colchester, Chelmsford and Upminster and screen there, you find that one and a half percent of the men that we screen have got prostate cancer, and 1.2% have got aggressive prostate cancer that needs immediate treatment. If you go to Harrich, Clacton, and Grays down in Southwest Essex, these are all poor socioeconomic regions, that rate is up to 3%. Wow. It's double.

SPEAKER_03: 11:37

Yeah.

SPEAKER_05: 11:38

So taking a man van to somewhere like Harrich or Clacton or Gray's is a very good way of getting to these more deprived populations. The problem is men are at work. So you really want to get men in their forties and fifties. I mean, look at Chris Hoy, he's got advanced prostate cancer at the age of 47. The youngest man we've picked up who's had a radical prostatectomy was 41. And we're picking up more and more men in their forties. Whether the disease is getting commoner or whether it's just because we're screening more and we're finding it, I don't know. But we are picking up a significant number of men, it's about 3% of men who are in their 40s and require treatment for prostate cancer. That goes up to about 10% in your 50s. I can't remember the percents exactly over that, but certainly late 60s and 70s is the commonest time for diagnosing prostate cancer. But in a lot of men, almost half the men that were diagnosing prostate cancer in the UK via general practice, half of these men have got advanced prostate cancer. We can't necessarily cure it. We can get the ones that are just beginning to leak outside the prostate, but when they're all spread around, when they're spread around the body, as in Chris Hoy's case, you can't cure it. You can only provide drugs that will keep chaps going for a number of years. Five years, about 20% of men with advanced prostate cancer will be dead within five years. A lot are living much longer, but the side effects from the drugs that we are using, the quality of life of these men, because of the side effects, is worse than the quality of life of men who've had early prostate cancer.

SPEAKER_02: 13:29

Yeah.

SPEAKER_05: 13:30

Picked up and treated with either radical surgery or radical radiotherapy or one of these new treatments. So there's a quality of life issue there. If you get advanced disease, your quality of life is worse. Also, the cost to the NHS of treating advanced disease is huge.

SPEAKER_02: 13:48

Yeah.

SPEAKER_05: 13:48

The European stats is it costs about 15, this is a figure from a couple of years ago, but nevertheless it does perfectly well. 15,000 euros to provide radical treatment for early prostate cancer versus uh over 200,000 euros for long-term treatment of advanced prostate cancer. So if you move the money from treating advanced disease and put it into screening, you will actually save the exchequer quite a bit. And this is an argument that the politicians are now have now woken up to. And another group that I'm on is the All-Party Parliamentary Group, which was set up at the beginning of this year. It was set up jointly by a charity called Prostate Cancer Research and Prostate Cancer UK. Now these are two interesting charities. Prostate Cancer Research does really what it says. It uh does a lot of really valuable research on epidemiology and treatment of prostate cancer. Prostate Cancer UK, if I have to be critical, sweeps up enormous amounts of money and in my opinion, does not use that money very wide wisely. In fact, until three years ago, Prostate Cancer UK were opposed to having a national screening program. I got them on board. They had a change of management about three years ago, and I got them on board with the National Federation of Prostate Cancer Support Groups and a charity called Orchid, which is a men's cancer charity, with chaps. And I wrote the submission that has been sitting on the table uh for three years with the National Screening Committee, and it was a joint proposal for a comprehensive national screening program similar to what we have breast cancer for the women. Yeah. That went in a week before the closing date, and guess what? On the day before the closing date, Prostate Cancer UK rang me up and said, by the way, Chris, we're going to put in two more proposals. One to screen black men and one to screen men with a family history. And I was really cross because I said, if you do that, you are completely undermining our bid for a comprehensive program. Because 70% of the men who develop prostate cancer are neither black nor have a family history. So I was really cross about that. And I still feel that this has been a very bad move. It's now progressed, or Prostate Cancer UK, with their shed loads of money, have now put it into something called the transform trial, which has got multiple arms comparing different types of MRI scanning. There's multiparametric and there's biparametric MRI. Biparametric MRI has been being developed over about the last five years. It takes about 15 minutes compared with 30 minutes. It's not half as expensive, it's much quicker, etc. And we now know that biparametric MRI is as good as multiparametric MRI in diagnosing prostate cancer. There are also genetics that comes into this. So we can do genetic screening, and we would pick up men like Chris Hoy and say, look, look, your father's had prostate cancer, your grandfathers had prostate cancer. We equally want to screen men who've got a family history of breast or ovarian cancer on the mum's side. Right. Because if you inherit the BRCA2 gene, you'd have a 50-50 chance of developing prostate cancer, aggressive prostate cancer in middle age. It's a thoroughly nasty little gene. Fortunately, it's rare. But BRCA-1 is very common. So there are these associations. So they're wanting to look at what we call polygenic risk scores now and add that in. But polygenic risk scores cost about 300 quid a go. Well they do in a they're certainly the most sophisticated one in America costs about$900. We have other biomarkers available. There's one called Stockholm 3. If you're using Stockholm 3 as an alternative to PSA, it is much more accurate, but it costs hundreds of pounds. Another one, Proclerics, costs hundreds of pounds. Randox have brought out an advanced PSA test. We're now using the Randox advanced PSA test for the first time over in Northern Ireland. Randox are based in Northern Ireland. So we work with companies to introduce this.

SPEAKER_02: 18:49

Yeah.

SPEAKER_05: 18:50

At the moment, I'm not aware of the NHS, apart from one unit in Southampton, using any of these other biomarkers on a regular basis. But we're starting to trial them. But you can see it ramps up the cost. Prostate Cancer UK have invested 30 million quid into a multi-arm screening trial, starting off with 12,000 men, that won't report any results for three years. After that, they're going to expand it up to hundreds of thousands of men, and it won't report again, they estimate until 12 years' time. Well, if you multiply 12 by 13,000 deaths, and if you reckon that these trials are going to halve that death rate, but you're only going to hit that number of men, how many men are going to die before we get the results of this wretched trial? And we're really worried, some of us are really worried, that our national screening committee will hide behind the so called transform trial and say, oh, we're not going to do anything until we've seen. Results of transform. How many years are we going to go on when we know that screening is saving multiple lives? And if you did it on a program manner, you would save thousands of lives compared with the small number that we as a charity can do. We work with a network of charities that covers the country. And if you add all of our screenings together and all of our lives saved together, since we've been doing this for about the last ten years or so, it's just, you know, it's three or four thousand men. Well, that's three or four thousand men. But it could be thirty thousand, forty thousand men, if we were doing this on a national basis.

SPEAKER_01: 20:42

Yeah. If you've had um prostate cancer and you've you get over it, you know, that you can remove, you know, can you still father children?

SPEAKER_05: 20:52

No. Because when you remove the prostate and you're interrupting the tubes that come in from the testicles with sperm, because these come into the prostate and get into the urethra, that root. So if you are a young man and you do have prostate cancer and you're recommended to have radical surgery, then you would need to bank sperm beforehand.

SPEAKER_03: 21:23

Right.

SPEAKER_05: 21:24

If you chance it and have radiotherapy, you may wind up with problems as a result, but you're more likely to be able. In fact, a friend of mine is a urologist in San Francisco, and his brother was a senior airline captain. Guess what? Second time round, married his uh chief stewardess, and of course he wanted to have children, and his prostate cancer was spotted on a prenuptial medical. But he had radiotherapy and successfully sired a child after it. So there's a different side effects with the different treatments.

SPEAKER_04: 22:05

What is a normal PSA reading?

SPEAKER_05: 22:09

Uh it depends on which guideline you look at. Right.

SPEAKER_04: 22:12

Yeah.

SPEAKER_05: 22:12

There's nothing simple in this. No, I just think it wouldn't be. This is why general practitioners, frankly, are all over the place on providing this test. You are, as a man over the age of 50, or if you're black or have got a family history, you're entitled to the test from the age of forty-five. But the GPs are frightened of using it. And they'll that's why one of the reasons they say go away till you've got symptoms. They've not been educated properly, they've not received the right advice, even though they've all received something called the prostate cancer risk management program, which was sent to all GPs. We've done surveys that show that 50% of them have never heard of it. Well, this is a few years ago, admittedly, but 50% had never heard of it. 25% had heard of it but didn't know what it did. And 25% were OFA and were operating it. And these are the ones who say, yeah, you can have a PSA, and I'll interpret your PSA. And with a bit of luck, I'll tell you what your risk is and when to come back. Because a screening program means a program over the danger years, which is 40 to 70 or 50 to 70. So uh depending on which range you use, and there are multiple ranges available in the UK, all the various cancer alliances around the country, of which are about a dozen, most of them have got variations. Nice, National Institute for Clinical Health, they've got their range that says that any man over the age of 50 with a PSA of more than 1.5, and that's very low, is entitled to have an MRI scan. Well, most GPs won't use that. Most GPs would say, oh, 1.5, that's all right, that's normal. Our charity, we use an age-weighted uh PSA range. So if you're below 50 should be uh below two, if you're below sixty, should be below three, if you're below seventy, it should be below four. And if you're over that and it's over five, then investigate it. That's what our local cancer alliance has and many others.

SPEAKER_04: 24:23

Every year with my heart disease I have a check-up which includes a blood test to assess things like cholesterol, etc. Um could that be added and and tested at the same time, or does it have to go to a different I think chemistry It should I no, I think it's a good question.

SPEAKER_05: 24:38

I think it should be added. Yeah. Um there is an NHS men's health check, which you can access from the age of forty up to 74, and my view is the simple thing would be to bolt PSA on onto that. Yeah. And then refer for an MRI if it's above one of these guideline ranges. Yeah. Pick a guideline. It doesn't matter which you pick really, so long as you do pick one and then operate it. But at the moment, half of the men who want to have PSA tests actually has a significant amount of urinary symptoms. What we call LUTS stands for lower urinary tract symptoms. So these are the typical symptoms you get when your prostate starts enlarging. So we've been studying this I say we, our charity CHAPS specifically, has been studying this recently. And half of the men coming to us have got significant urinary symptoms and have not visited their GP. So what we should be doing is setting up an event, determining which men have got LUTs and which men have not. They are the genuine screening target, and doing a PSA on the ones who have not got LUTs. The ones who have got LUTs, we should be issuing them with an entirely separate instruction which says go to your GP and get a complete assessment. And that complete assessment would involve your history. We quantify urinary tract symptoms very accurately. We've been doing it for many years. So we would do an IPSS on them. So you get a symptom score, you examine the abdomen, make sure the guy hasn't got a full bladder up to here, which some people have, not knowing it, and you put a finger up the bottom and examine the prostate because then you can get an idea of the size of the prostate. You're not going to diagnose early prostate cancer by putting a finger up your bottom, because early prostate cancers are small inside the prostate and the prostate feels normal. You will only diagnose prostate cancer as we could when I first started as a consultant in the early 1980s, because the prostate feels abnormal. You think, hmm, that doesn't feel quite right. Let's in investigate it. Well now an MRI is doing that much, much more accurately. So it will tell you how big the the prostate is, it'll tell you if there's a cancer inside, it'll tell you if there's a cancer outside it, growing outside it, etc. So that I think does that answer the question? Yeah.

SPEAKER_01: 27:24

But they don't they don't stick the bot the finger up the bottom now for the to test for it, because I when I went for it, the first time they did. The second time they didn't. They done it for a blood test.

SPEAKER_05: 27:36

Yeah. If you're just looking for prostate cancer, then you just do the blood test.

SPEAKER_01: 27:42

Right.

SPEAKER_05: 27:42

And there's no value in putting your finger up the bottom.

SPEAKER_01: 27:45

No.

SPEAKER_05: 27:46

If your PSA comes back abnormal, yes, then you put your finger up the bottom and you send the chat for an MRI scan. If on the other hand you've got lower urinary tract symptoms due to benign enlargement of the prostate, then put your finger up, and if the prostate feels enlarged and smooth, and you can say to the man, Well, I think you've got benign enlargement of the prostate.

SPEAKER_02: 28:10

Yeah.

SPEAKER_05: 28:10

Uh don't worry. We can do an MRI scan just to be sure, but here are these magic tablets which will relieve your symptoms. So that's what GPs should be doing. And they would be doing a PSA as part and parcel of that holistic examination of the whole problem. Yeah. Not just one test for one cancer.

SPEAKER_04: 28:36

When I had my review, which was only just last month, and she took the blood test and was ticking off the form, I asked if she could add the PSA test to it. And she said, no, you'll have to see a doctor for that.

SPEAKER_05: 28:48

And then the doctor will tell you, probably, oh, it's an inaccurate test. You get all these false positives. That's the three indicating benign disease. I think that's a mischaracterization of the test. It's an entry test, it's a pointer, it's nothing more.

SPEAKER_02: 29:06

Yeah.

SPEAKER_05: 29:07

If you see a signpost to Dedham, it doesn't necessarily mean you're in Dedham. Just a signpost.

SPEAKER_02: 29:12

Yeah.

SPEAKER_03: 29:13

Yeah.

SPEAKER_05: 29:14

And when we get a national screening program, which I have to say the National Screening Committee are due to report in November, I suspect we will not get a national comprehensive program. We might get targeted screening, or we might get some half-baked thing which says, no, we're not going to recommend screening yet until we've got the results of the transform trial.

SPEAKER_04: 29:40

Yeah. You have to bang on the door and almost insist for a test.

SPEAKER_05: 29:44

It is my right. That's right. Well, we're running a conference in this coming uh April at the Freemasons Hall in London. We I say we, CHAPS Charity, in collaboration with the National Federation of Prostate Cancer Support Groups and the Freemasons. I'm not a Mason, but we work with the Masons because they're male organizations. We ran the first national prostate cancer conference on screening. We did it as a charity. Right. Not the NHS, not the British Association of Urological Surgeons, not Prostate Cancer UK. In fact, the two PCUK delegates never turned up, which speaks volumes as far as I'm concerned. We ran that. We made the case for screening. The man who now, in fact, is running the transform trial, he presented the complete case for screening. But I think he's taken PCUK's money to run the transform trial. However, we're now going to run the next conference, and the next conference is going to be aimed specifically at men, and it's going to be on men's entitlements. That's going to be the emphasis of it, which is basically take a big hammer to bang on the door and bang on the desk and say, I want my PSA test, and I want my risk assessed as to whether I'm high risk or low risk. And based on that risk, I want the recommendation as to how often I should be screening. To sum up on that, really. Sorry, you got a bit more then, didn't you?

SPEAKER_04: 31:24

I did, yeah. When I want to see my doctor, I have to go online and fill in a consultation form and then wait for a response. No, you can't come to see Chris. And um wait for response. So what is a man's actual entitlement today?

SPEAKER_05: 31:42

If I was filling in the the online questionnaire to get a GP appointment, I would say that either I have got urinary symptoms and I want a full assessment, including a PSA and rectal exam. If I have no symptoms, I would say I am entitled to a PSA test according to the Prostate Cancer Risk Management Program. I have read all the pros and cons of having a PSA test, and I realize that there are benefits and harms. I consider the benefits now far to outweigh the harms and wish to have a PSA test done on a regular basis until I get to about the age of 75 when it should be obvious whether I need any further testing or none at all, because by that stage I should have gone through the risk period for developing a life-shortening prostate cancer.

SPEAKER_04: 32:47

I think the biggest problem, one of the biggest problems, and it's not just with prostate cancer, is we hear all the time, go and get checked. You must get checked. But it's actually getting past all the barriers. So I think a lot of men fall by the wayside because they just can't be bothered.

SPEAKER_05: 33:02

Yeah, that's right. And they don't talk enough, men. Don't talk enough. Uh during the critical years, 40, 50, 60, most men are working. Uh it's may not be easy to get to your GP. Even if you can get your GP, you know, you might have to take time off. If you're socioeconomically deprived, you're not going to know anything about the awareness uh or the importance of it. And then when you do get your GP, as far as I can see, half the GPs are refusing to do PSA tests. We did a survey earlier this year in Ipswich. Uh we had a hundred men who came in for PSA tests. We asked them all if they'd requested the test from the GP, and we identified seven surgeries around Ipswich, Suffolk and North East Essex that were refusing to do PSAs until symptoms arise. Seven surgeries. One, Derby Road surgery, for instance, that was cited by several men.

SPEAKER_04: 34:07

Yeah. So we are entitled to PSA 10. Okay, that's excellent.

SPEAKER_05: 34:14

It's enshrined in something called the Prostate Cancer Risk Management Program. Uh it is somewhat out of date. It was published in about 2014. I think it's been updated. And the NICE guidelines have been updated as well. And those are the ones that say if you have no symptoms and you have a PSA of more than 1.5, then you should you you are entitled to to be referred for an MRI scan. Yeah. Well, I think 1.5 is a bit on the low side. Yeah. But nevertheless, the studies that we've got, particularly from Sweden, we've had these studies for years. If you have a PSA of more than one point 1.5, we know you are at risk. Whereas if your PSA is below one, we know you're not at risk.

SPEAKER_04: 35:04

Yeah. Yeah.

SPEAKER_05: 35:06

So I we could say to probably half the population of men in that screening age, if your PSA is less than one and you've no family history, and you're not black of African or Caribbean heritage, you only need a PSA test done doing once in your forties, once in your fifties, once in your sixties, and then you could stop. Because such men, we know once they get to their 60s, their death rate from prostate cancer is 0.2%. Right. So you're virtually in the clear.

SPEAKER_03: 35:41

Yeah.

SPEAKER_05: 35:42

I would we're all living longer, so I would go a bit longer than that. So I would say now, in fact, our CHAPS protocol is that if your PSA is less than one and you're in your 70s, then we can say now you can quit. And one of the problems we have at the moment, and this has all been written up, it was in the British Medical Journal only a few weeks ago, and the girl that wrote the paper on behalf of the Nuffield Primary Care Centre in University of Oxford, the girl who wrote that paper and I had a lengthy conversation on the paper because her paper said essentially, at the moment we are using PSA in this country in an indiscriminate and potentially harmful manner. We are testing a lot of men who don't need testing. This is leading to this problem of overdiagnosis and that can lead on to over-treatment, but the over-treatment rate for prostate, non-aggressive prostate cancer in this country has been consistently below 10% for years. So as a country, we're not doing badly. The treatment in this country is is as good as anywhere.

SPEAKER_03: 36:59

Yeah.

SPEAKER_05: 37:00

It's a diagnostic process that's lousy compared with Europe, and that's why our mortality rate is low down in old footballing terms. We're in the fourth division.

SPEAKER_02: 37:10

Yeah.

SPEAKER_05: 37:10

Anyway, I had a lengthy conversation with this girl on this paper. It's a really, really important paper because it demonstrates what we're doing wrong in this country. And essentially it was reiterating another paper that was produced two years ago, which said, either screen properly or don't do it at all. Guess what? The papers picked it up and said don't do it at all. They didn't say don't do it properly. You know, or they didn't say do it properly.

SPEAKER_01: 37:41

Only hear what they want to hear.

SPEAKER_05: 37:43

Yeah, they they've gone for the headline and said, PSA, bad test, don't do it.

SPEAKER_04: 37:47

Yeah, I think. The$64 million question then is we hear of all these things saying, oh, you mustn't eat this, you mustn't drink that. Is there anything known that causes prostate cancer? Or can contribute to it?

SPEAKER_05: 38:01

There's nothing definite that contributes to it from a dietary or lifestyle point of view. If you haven't got it in your genes and you're not black, and we don't yet know why black men get prostate cancer at double the r rate that white men do, if you haven't got it in your genes or so, the answer the short answer is no, there's nothing we can do to prevent prostate cancer.

SPEAKER_04: 38:31

Right.

SPEAKER_05: 38:32

You're either going to get it or you're not going to get it, kind of thing. And we haven't worked out. If you have a a diet that is basically heart healthy, so that's fish oils, you know, fish, cut down on the fatty meats, lots of vegetables, especially the red ones and the green ones, the red ones in particular, then we know you can lower PSA levels by lifestyle changes. But we haven't been able to say for certain whether simply lowering your PSA converts into a lower risk of getting or dying from prostate cancer. Yeah. There's a hint that it does, but it's nothing more than a hint at the moment, not proven.

SPEAKER_04: 39:19

No. There's so much that revolves around diet and healthy eating, isn't it? Yeah. Oh, yeah.

SPEAKER_05: 39:24

So the rule of thumb is if it's heart healthy, it's prostate healthy.

SPEAKER_04: 39:28

Well, you try and make it healthy, don't you? Yeah. I'm going to cut this bit out because my wife will listen to it. I try to eat it healthy. Yeah. Well, it's been very interesting. It has.

SPEAKER_01: 39:39

Uh, what do you think of that, Martin? That was fantastic. Thank you very much, uh, Chris. Really kind of you to give your time up.

SPEAKER_03: 39:45

Thanks very much, Chris. Thanks for listening, everybody. We'll be back same time, same place next week. See you, folks. Have a lovely weekend. Yes.

SPEAKER_01: 39:53

And a lovely week.

SPEAKER_03: 39:54

Yep. Bye. Bye. Bye.

SPEAKER_00: 39:57

You've been listening to the Who's Tom and Dick podcast? With your hosts, Martin Weavers and Patrick Mortimer. If you enjoyed this episode, please subscribe to the show on Apple Spotify or your favorite streaming platform. New episodes are available every Friday. Thanks for tuning in.