The latest figures on prostate cancer are shocking: it has officially overtaken breast cancer as the most commonly diagnosed cancer in England, according to NHS figures.
These show a massive 25 per cent increase in the number of men with the disease in just four years (2019 to 2023).
Every year, more than 50,000 UK men are diagnosed with prostate cancer. It affects the doughnut-shaped gland that sits around the urethra and which produces semen. Some 12,000 lives are lost to the disease annually.
There is little doubt that the willingness of men such as Olympic gold medal-winning cyclist Sir Chris Hoy, actor Sir Stephen Fry and restaurant critic Giles Coren to speak out about their diagnoses has encouraged more men to be checked.
When Sir Chris went public, the news led to a 672 per cent increase in hits on the prostate cancer symptoms section of the NHS website (signs include an increased need to pee, poor flow and blood in the urine).
'More men than ever are learning about their risk, speaking to their GP about the PSA [prostate-specific antigen, more on this later], having a blood test and then taking the best next steps,' says Chiara De Biase, director of health services at Prostate Cancer UK.
Another reason for the increase is that men are living longer, according to Nick James, a professor of prostate and bladder cancer research at the Institute of Cancer Research and The Royal Marsden Hospital in London, who led a commission examining the worldwide rise of prostate cancer.
'Prostate cancer is primarily a disease of ageing – the older you get, the more likely you are to develop it,' he told Good Health.
It is most commonly diagnosed in men aged 75 to 79, according to Cancer Research UK. And about 80 per cent of men in their 80s have it, although most will never need treatment.
But there other alarming factors propelling the recent dramatic increase in cases, say experts. For one thing, the number of younger men being diagnosed with prostate cancer – those in their 50s and even younger – is also increasing. Sir Chris is 48.
It reflects a more general trend in cancer diagnosis, says Karol Sikora, a leading oncologist and a former director of the World Health Organisation Cancer Programme, who points out that more younger patients are also being diagnosed with colon cancer, for instance, than previously.
One theory he is quick to dispel is that it relates to Covid infection – the suggestion being that infection-induced inflammation triggers it. He says: 'Inflammation may be associated with prostate cancer development or progression, but the rise started before Covid happened.
'It's also nothing to do with Covid vaccinations [which have been associated with a slight increase in PSA levels], so it must be something in the environment that is changing.'
One major change in recent decades has been the ever-expanding size of our national waistline. Obesity is known to play an important role in driving prostate cancer aggressiveness and increased risk of dying from it, says Professor Mike Kirby, president of the British Society for Sexual Medicine.
'There are different theories about why obesity makes prostate cancer more deadly,' he told Good Health. 'One is that excess fat tissue can trigger chronic inflammation, creating an environment that promotes cancer cell development.'
Fat cells secrete proteins (such as leptin and IGF), which have been linked to increased cell growth and cancer. Two-thirds of men in England (67 per cent) are classed as 'overweight' (BMI over 25) or obese (BMI over 30) – in 2010 it was 41 per cent.
And it's not just how much we eat but also what we eat that is fuelling the steep rise in prostate cancer deaths, according to Professor Chris Eden, a consultant urologist at London Bridge Hospital in London.
'Multiple studies have shown the clear link between eating a diet high in saturated fat and an increased risk of dying from prostate cancer,' he says. 'We don't yet understand the exact mechanism for why this triggers cancerous changes in the prostate.'
Cancer Research UK (CRUK) says regular consumption of dairy and animal products is linked to higher levels of IGF-1, a growth hormone linked to cancer cell development and progression.
While ultra-processed foods should be avoided because they contain high levels of salt, sugar and saturated fat – contributing to obesity – the evidence that they cause cancer themselves is 'still very weak', says CRUK.
Research also suggests that eating a Mediterranean-style diet rich in fruit, nuts and vegetables can have a protective effect against prostate cancer. It's thought that the antioxidants they contain may help to mop up harmful free radicals (unstable molecules that damage cell DNA).
Specifically, the antioxidant lycopene – cooked or processed tomatoes are a rich source – has been shown in some studies to slow the growth of prostate cancer cells.
Yet most British men fail to get their five a day: a study published in the journal Nutrients in 2020 found that half of the Englishmen surveyed ate less than three portions of fruit and veg a day, with young men (aged 18 to 24), consuming the least.
Air pollution has also been linked to increased risk of prostate cancer. A new study to be published in the journal Environmental Research, which tracked 200,000 healthy men for ten years, found those who were exposed to greater levels of air pollution were significantly more likely to develop the disease.
Exposure to certain pollutants – including nitrogen oxide, benzene and particulate matter from exhausts – was the most hazardous, according to the study, which looked at data from the UK Biobank (a research resource of samples from 500,000 Britons).
'We know that air pollution is a carcinogen for many different types of cancer especially lung and prostate cancers,' says Professor Kirby. 'This study makes it more imperative that we continue to assess and control air pollutants.'
He adds that you can reduce your risk by using an indoor air filtration system and avoiding walking beside busy roads where possible.
Pesticides could play a role – research published last November in the journal Cancer found that 22 different pesticides, including phthalates, which mimic human hormones, were linked to an increase in prostate cancer.
But as Professor Kirby points out, only eight of these 22 chemicals are still legal in the UK, including the agricultural weed killer 2,4-dichlorophenoxyacetic acid, known as 2,4-D.
Experts say the NHS needs to urgently prepare for a rising tide of prostate cancer cases – 'we know this surge is coming, so we need to start planning and take action now,' says Professor James.
Early detection and education programmes are key to saving future lives, he says, along with reliable tests and effective treatment. There are now calls to introduce more PSA testing for men. High levels of PSA in the blood can be an indicator of prostate cancer.
The charity Prostate Cancer UK has launched a campaign for GPs to be allowed to talk proactively about the option of PSA testing to men who might count as at risk.
Under current NICE guidelines, men aged 50 or over have to approach their GP for the test, which can be done on the NHS even if they do not have symptoms. Men under 50 don't qualify for testing on the NHS unless they are classed as being at high risk.
But earlier screening – in your 40s – can also flag a risk of developing prostate cancer later in life, according to Professor James.
'From various studies, we know that if your PSA score is very low [under 0.5] when you are in your mid-40s, you are very unlikely to die from prostate cancer,' he says.
'But if it is at the higher end of the PSA range at this age – i.e. one or more – then there is a higher chance it will increase and you will have to be treated for the disease later on. Being forewarned of your risk can ensure you have regular PSA tests and adopt lifestyle changes that minimise your risk.'
However, the concern has been that PSA tests aren't accurate enough, leading to false positive results and men undergoing needless investigations and even invasive procedures they don't require – with potential complications including urinary incontinence and erectile dysfunction.
High PSA levels don't necessarily always indicate cancer is present.
PSA is made in the prostate, which naturally enlarges with age, so PSA levels naturally increase with age, anyway.
However, in 2019 a major trial – the European Randomised Screening study for Prostate Cancer (ERSPC) – found that men who were screened with PSA tests were less likely to die than those who were not screened.
Researchers tracked 180,000 men for 16 years. Professor James says there's a clear link between reduced deaths from prostate cancer and using PSA tests – and believes they should be used as a screening tool in the same way as mammograms are used to detect breast cancer.
Professor Sikora is less convinced. 'PSA tests are not great screening tools but they can be the first step towards a diagnosis,' he says.
Yet there is more hope on the horizon. Yesterday it was announced that Cambridge researchers have developed a 'game-changing' test that can detect not only if cancer is present but also how aggressive it is.
The 'super' test works by checking a blood and urine sample for 100 biological markers of prostate cancer and will be far more accurate than the current PSA test, the maker said. If approved, it is hoped it will be rolled out later this year, privately at first.
About one in five men dies within five years of a diagnosis because the disease is so far advanced at the time of diagnosis. Three in five will undergo surgery or radiotherapy and be cured. One in five will be diagnosed but be monitored, according to the National Prostate Cancer Audit.
Men who are referred to NHS clinics for tests after an elevated PSA test are now routinely offered MRI scans to show if a tumour is present and determine the likely grade of it. These scans are highly accurate, which means a patient with a normal result usually won't need a biopsy as well, says Professor James.
He adds that artificial intelligence, which is already used to help assess breast cancer mammograms, could also be used in future to improve accuracy of MRI scans for prostate cancer.
Men diagnosed with low-risk prostate cancer that hasn't spread or who have cancer that isn't causing symptoms can choose two monitoring options: watchful waiting – keeping an eye on the cancer, often recommended for older men; and active surveillance, involving regular PSA tests and MRI scans.
Professor Kirby says that active monitoring generally involves PSA tests every six months. He adds: 'A significant reading is generally considered an increase of more than 25 per cent a year; a PSA that doubles in less than three years; or a total PSA greater than ten.'
Treatment is started only if the cancer shows signs of progressing. Active surveillance is safe. 'Two-thirds of the men we monitor [in this way] never need treatment,' says Professor James.
However, a minority of men do opt for immediate treatment, says Professor Eden. He adds: 'Treatments for prostate cancer can have side-effects so we aim to target men with treatment who actually need it.'
The 2023 ProtecT Trial found that death rates for men in the UK who opted for active surveillance and to defer treatment were about the same as men who opted to have treatment immediately – about a 1 per cent death rate after 15 years.
Treatment has become far more targeted and effective, particularly for advanced disease, according to Professor Kirby.
He says: 'When I first started a prostate cancer screening project in the early 1990s, life expectancy of men with advanced disease which had spread around the body was about 18 months.
'Now, men with this diagnosis can live for a decade or longer with new treatments, including drugs such as abiraterone, enzalutamide, apalutamide and darolutamide that block androgen receptors in prostate tumour cells, inhibiting their growth.'
