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.