Prostate Cancer

Steve Brine Excerpts

Wednesday 6th February 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is always a pleasure to see you in the Chair, Madam Deputy Speaker. Here we are again and for once we are not in a rush. It will be dark outside before we finish. I congratulate my hon. Friend the Member for North Dorset (Simon Hoare) on securing today’s important debate. He entertained us and educated us, and he set out his stall very well.

Let us start with a positive: cancer survival in this country has never been better. Survival rates are at their best ever, having improved every year since 2010. That is a hard-fought success, and we should celebrate it. Among men, prostate cancer is the most common cancer in the UK and the second most common cause of cancer deaths. However, prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five or more years.

It is worth stating at the outset—some people who are watching may not be familiar with this subject—that the prostate is found only in men. It produces some of the fluid in semen and is found below the bladder. It is about the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder. The causes of prostate cancer are not that well known. The strongest risk factor is age, but about 5% to 10% of prostate cancer is thought to be due to family history. Black men, whether of black African or black Caribbean origin, are more likely to develop prostate cancer than white men. One in four will get the disease, as opposed to one in eight of all men. Asian and oriental men have the lowest chance of developing prostate cancer, which is interesting—we should always look at this sort of data when looking at prevention. I will come on to that point.

The way that prostate cancer develops is not fully understood. It is not a single disease, but a spectrum of diseases ranging from slow-growing tumours that may not cause any symptoms and may not shorten life at all to very aggressive tumours that can kill. We should remember that. As I said, the strongest risk factor is age, but younger people get it, too. I have a school friend who has recently contracted and beaten—I will come on to the use of language in a moment—prostate cancer. He may even be watching today’s debate; he may be mowing the lawn, who knows? We wish him well.

My hon. Friend raised some very good points in his speech, and I should be able to touch on them all. This is a timely debate for all the reasons he set out, but also because it was World Cancer Day on Monday. It was great to see Cancer Research UK light up the Palace of Westminster in pink and blue.

My hon. Friend’s point about language was very interesting. He may have seen a poll by Macmillan that came out last month. It showed how many people with cancer are fed up with the language of war. We often say “cancer stricken” or “victim”. We often call a person’s cancer diagnosis a “war” or a “battle”. We say that they “lost their battle” or “lost their fight” when they pass away. It is no surprise that articles in the media and posts on social networks were found to be the worst offenders. My advice is to be real and honest. Macmillan has launched the “Right there with you” campaign to highlight the challenges posed by a cancer diagnosis and the support that is available. As we all know, Macmillan does fantastic work, including in this House. I urge people to take a look at its campaign.

My hon. Friend also touched on the all-party group on male cancers, formed by my hon. Friend the Member for Lewes (Maria Caulfield) who is a former nurse. It had one of its first gatherings this week. Orchid, the male cancer charity, will provide the secretariat for the group. It is not that well known as a charity, but it is growing fast. I met the charity at Britain against Cancer a couple of years ago, and it is now part of my cancer roundtable work here in the House every quarter. I pay tribute to its works and to the all-party group. I had a good conversation in the Lobby with my hon. Friend last night. We are going to do an awful lot together. The group is very important. If it did not exist, it would need to be invented, and I congratulate her on inventing it.

My hon. Friend the Member for North Dorset raised early diagnosis, so let us deal with that. The biggest weapon we have in successfully treating cancer is early diagnosis. I have said many times, as did the former chair of the all-party group on cancer, that it is the magic key or magic bullet. That is true, but there are many cancers where early diagnosis is all but impossible. We do not see presentation of symptoms until it is very late and then it becomes incredibly difficult. They will be a big challenge for the cancer ambition that I will come on to talk about in a moment.

As my hon. Friend and others said, we men are notorious for not visiting the doctor at the first sign of a concerning symptom. I think that that is changing, but anything that can raise awareness of prostate cancer, where early diagnosis is indeed the magic key, is to be welcomed. I pay tribute to public figures such as Stephen Fry and Bill Turnbull from “BBC News” for speaking out so honestly about their own prostate cancer diagnosis. They provided an invaluable public service in raising the profile and awareness of the disease, giving some men the vital nudge they need to see their GP if they think something is not right. For some men, it can be a quick burst of symptoms that come on very quickly. They can go to a doctor, are seen and treated and have surgery in a very short space of time. For others, it can be a very slow burn.

I hope that the work that Stephen Fry, Bill Turnbull and others have done will have an impact similar to 10 years ago when the TV personality Jade Goody, following her cervical cancer diagnosis from which tragically she died, spoke out about how vital it was for women to attend their smear tests. We had an excellent debate in Westminster Hall last week on Natasha’s Army—there is that word again. Natasha was a 31-year-old mother from Newton Abbott who died of cervical cancer, leaving four young children just before Christmas. Natasha’s Army are her friends and family who campaign on awareness and smear tests. That is so important. The work Jade Goody did led to a huge uptake in screening, enabling the NHS to detect and treat more cancers early. I hope that, as more people talk about prostate cancer, something similar can happen.

[Nick Smith]

I join the Minister in congratulating people like Stephen Fry and the grassroots movements on doing such a good job in talking about the importance of early diagnosis. The hon. Member for North Dorset talked about the important PSA test. The Minister may not have the figures available, but if he does could he let us know the proportion of men over 50 who have had the test? That would be an interesting indicator as to what is going on.

[Steve Brine]

I do not have that figure with me today, but I will write to Members attending the debate and I will tweet it @BrineMinister—but enough of the advert.

Early diagnosis and the NHS long-term plan is where I want to turn next. Straight after the Christmas recess, we launched the NHS long-term plan, which is a seismic piece of work. I would be the first to say, along with many other people working clinically in the field, that we cannot rely solely on the celebrity cases that I mentioned to improve early diagnosis. The long-term plan included a comprehensive package of measures that will be rolled out across the country, with the aim of securing the Prime Minister’s promise, which my hon. Friend the Member for North Dorset spoke about, from party conference back in the autumn: that three quarters of all cancers will be detected at an early stage—stage 1 and stage 2, when they are most beatable—by 2028. The plan will provide new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation, with the aim of ensuring that 55,000 more people are surviving cancer for five years in England every year from 2028.

That ambition refers to all cancers, including prostate. When we came out with that ambition, a number of people, in the breast cancer community, for instance, said, “But what about us? We are already above 75%”, and some said, in relation to the rarer and less survivable cancers, “What about us?” It is very important for me to restate at the Dispatch Box that this ambition does refer to all cancers—not just those that afflict men or women, old or young, or that are easily treatable or more difficult and less survivable. We are clear that to achieve the five-year survival ambition, we have to improve outcomes for all cancers, and we will.

As I said, early diagnosis is key. Early diagnosis of prostate cancer is challenging, in truth, because the symptoms are similar to those of an enlarged prostate and very often, there can be no symptoms at all. As has been said, the most common method of identifying an increased risk of localised prostate cancer is the prostate specific antigen test. However, that is not perfect. The House will have seen press reports a year or so ago stating that a raised PSA level is not necessarily a sign of prostate cancer, and that a low PSA level is not necessarily a sign of it not being there either. That is not entirely helpful, but we must always remember in these debates—and I am not a doctor, as is clear—that medicine is not an exact science. I thought that story was a good example of that.

A raised PSA level can indicate prostate cancer, but in some cases it can miss indicating a cancer. It can also suggest a cancer when there is not one, or identify slow-growing tumours that may never cause any symptoms for a man or shorten his natural lifespan. This can all be very difficult in primary care. My hon. Friend talked about GPs, and there is a clue in the name. I sometimes get a lot of flak for saying this, but general practitioners are so called for a reason—they are general practitioners—and we should remember the devilish job that general practitioners have, given the huge variety in what comes through their door.

The prostate cancer risk management programme—the PCRMP; we love our acronyms in the health service—was established so that men considering a PSA test are given information about the benefits, limitations, which I have touched on, and associated risks. It supports GPs in giving and discussing information with their male patients. A pack of materials is available for primary care to help men to make an informed choice about the PSA test, which includes a leaflet that they can take away to discuss with partners. There is also an evidence booklet and summary sheet for GPs. These are all widely available online.

As I said, there are pros and cons of having a PSA test, but it is so important that men arm themselves with as much information as they can and speak to their GP or practice nurse, including when they go for their NHS health checks—I will be going for one of those at the end of this month. I know that it is hard to believe that I am old enough to be called for one, but they phoned me yesterday, so I have been booked in.

As has been said, men over 50 have the right to be given a PSA test free on the NHS once they have discussed the advantages and disadvantages with their GP. The PCRMP makes that very clear to GPs, and, having discussed the pros and cons, no one over 50 should be told “No”, as we have heard today. I will find those figures—I agree that they will be very interesting.

[Simon Hoare]

I am very grateful that the Minister is setting this out in his customary detail. In a circumstance in which all those conversations have taken place, if the patient says, “Thank you doctor, I hear what you say, but I am entitled to have this test, and I want to have this test done,” will the Minister confirm that GPs are obliged to make the referral, rather than saying, “Well, I’ve heard what you said, but I am your doctor and I am not going to let you have it done”?

[Steve Brine]

We do not often use the term, “No decision about me, without me” any more, but I always remember the former Health Secretary—now Lord Lansley—using that a lot, and that is still very true. A patient over that age has every right to request a PSA test, and certainly even more so if they believe that they have symptoms. I would be very concerned about a GP refusing it—I think it would be extremely unlikely for one to do so in such instances—but any patient has the right of travel. Every patient has the right to change GP if they are not satisfied with the relationship that they have. If my hon. Friend did know of an instance of that, I would be very interested to hear about it—as, I suspect, would the Royal College of General Practitioners —but I would be very surprised.

I want to touch on screening, which we talk about a lot at the moment, and I will come on to why. Because of the limitations of the PSA test, there is currently no national screening programme for prostate cancer. In 2016, Prostate Cancer UK, which has been rightly lauded this afternoon, began work to help to develop tests that could form part of a national screening programme. This would potentially involve better blood tests, which are currently in development, combined with more advanced scanning. It is hoping to make that happen in the next five years—nothing happens quickly in this space unfortunately—and I am sure that we all welcome their efforts.

Members will be aware—I have spoken about this quite a lot in the House recently; we have had a number of cancer debates since Christmas—that Sir Mike Richards is leading a review for the Secretary of State of our current screening programmes. As part of that—I met Sir Mike last month—we will consider how we can make screening smarter, targeting those most at risk. We expect that Sir Mike’s work will have positive implications for future programmes. He is an incredibly experienced and respected figure in this space, and I hope that his work will enable us to roll screening out faster when the evidence base is there to support it. I am very hopeful and ambitious about that work, as I know Sir Mike is.

Let us talk about public awareness campaigns, which my hon. Friend mentioned in opening the debate. The Government have to do all that they can to raise awareness of prostate cancer and target high-risk groups, while recognising that there are limitations on how much the public will listen to public health messages from Ministers at the Dispatch Box—I know that it is hard to believe that people do not take this all to heart, but they do not, so we work with our partners.

In 2014, along with Public Health England, we worked on the phenomenally successful “Be Clear on Cancer” campaign, which has had a number of iterations, on prostate cancer in black men. The campaign messaging included:

“1 in 4 black men will get prostate cancer”,

which was one of its tag lines. It urged black men over 45 who were concerned about their risk of prostate cancer to visit their GPs. The campaign evaluation showed that it had stimulated new conversations about prostate cancer among families and the black community. Public Health England has made all the materials developed for the campaign available online, so that groups and other organisations can use them locally if they wish. They are very striking and powerful, and we believe that they were very successful.

We also welcome the work that Prostate Cancer UK is doing with the Football Association to raise awareness through their “relegate prostate cancer” campaign. It is fronted by high-profile celebrity football figures, including the England football manager, Gareth Southgate, and includes the slogan:

“One man dies every 45 minutes of prostate cancer”.

Anyone who can stay awake for “Match of the Day” on a Saturday night—thank goodness for the repeat on a Sunday morning—will see very many people, including the pundits and the managers interviewed afterwards, wearing the badge that I am wearing today. Members will be very familiar with that badge, which demonstrates the widespread support that Prostate Cancer UK has in continuing to raise awareness of this disease.

Let me turn to research, as I come to a conclusion. Research has played a crucial part in the advances that we have made in cancer survival over the past four decades. More than 15 years ago, the Department identified the need for further research into prostate cancer, and we have since worked closely with Cancer Research UK—it was here this morning; I was pleased to pop into its drop-in—Prostate Cancer UK, the Medical Research Council and others, through the National Cancer Research Institute, which is a strategic partnership of the major UK funders of cancer research. NCRI spend specifically on prostate cancer research increased from £17.1 million in 2011-12 to £26.5 million in 2015-16.

[Mary Glindon]

On research, does the Minister think that those who are diagnosed with cancer should be encouraged to take part in clinical trials that aid research and help us to find ways to halt or even cure these horrendous diseases? I think this is underplayed and that we should encourage as many people as possible to help with research by themselves getting involved in trials.

[Steve Brine]

I am happy to agree with the hon. Lady. In her work on brain cancer, the late Baroness Jowell made the point about stimulating new research projects, and that work has been incredibly successful, including subsequent to her death. She also spoke a lot about clinical trials. Anybody diagnosed with a cancer for which there is no significant treatment would want to load the gun with the trial bullet, but there are challenges there. There is only so much that one can do, and there is a toxicity issue with moving from trial to trial that patients do not always fully appreciate, but in consultation with one’s oncologist and physician absolutely it has a critical role to play. Without trials, we would not have any of the treatments we have today, so I thank the hon. Lady for raising that point.

My hon. Friend the Member for North Dorset said that women’s cancers, such as breast cancer and the gynaecological cancers, perhaps get more Government attention. I have to disagree. Last April, the Prime Minister pledged £75 million towards clinical trials for prostate cancer, which will focus on improving early diagnosis and survival rates as well as exploring options for different treatments for men affected by the disease. We expect 40,000 men to be recruited to new research projects with this cash boost. I hope this demonstrates our ongoing commitment to male cancers as well as female cancers.

I am the first guy to hold the post of Public Health Minister in a long time, possibly ever, and it is true that there is a lot of focus on female cancers, but I am determined to raise the bar for men’s health generally, but for male cancers in particular, which is why I was pleased to mention the all-party group earlier.

Alongside the £75 million for research, in 2016-17 the NIHR clinical research network recruited patients to over 90 trials—the hon. Member for North Tyneside (Mary Glindon) raised the point about trials—and other studies on prostate cancer, so there are a lot of trials in this area. The NIHR biomedical research centre at The Royal Marsden here in London and the Institute of Cancer Research also have a five-year £3.1 million prostate cancer research theme.

I started by saying that we do not know everything about prostate cancer. We hope to see these projects deliver more personalised diagnosis, treatment and care of men with prostate cancer through better understanding of the molecular and genetic pathways that determine the non-uniform nature of prostate cancer. The prostate testing for cancer and treatment—ProtecT—trial was the largest publicly funded clinical trial ever to take place in the UK. NIHR funding to date is £40million, which is quite a significant sum.

I agree with what my hon. Friend said about the workforce. The NHS is nothing without the 1.3 million staff on whom patients depend day and night, and for no group is that more true than for cancer patients. We will not achieve our cancer ambitions without an increased cancer workforce, which is why the Secretary of State has commissioned Baroness Dido Harding, working closely with Sir David Behan, who used to lead the Care Quality Commission, to lead a number of programmes to engage with key NHS stakeholders to develop a detailed workforce implementation plan. Baroness Harding and Sir David will present initial recommendations to the Department in March, and these will consider detailed proposals for growing the workforce rapidly alongside the implementation of the NHS long-term plan, including that early diagnosis of cancer target I mentioned.

In connection with that, my hon. Friend mentioned cancer nurse specialists. Health Education England is working to expand the number of cancer nurse specialists and to develop their competencies and routes into training. This will mean every cancer patient having access to a CNS or other support worker by 2021, which I think he will agree is a very good thing.

I have covered today just some of the many initiatives the Government are undertaking in our significant efforts to tackle prostate cancer for many of our constituents, including my friend. I hope I have given the House some information today and a promise of some more. The Government remain totally committed to maintaining and improving cancer survival rates. Prostate cancer is the second-biggest cancer killer among men and is right at the top of our list of priorities.

Finally, I could not close without paying tribute to Prostate Cancer UK, led by Angela Culhane, and the work it does on research and early diagnosis and in supporting men with prostate cancer and reassuring them that they are not alone and that there is often a way out. As cancer Minister, I have been told many times by cancer patients that the cliff edge of an all clear is every bit as bad as the original diagnosis. Owing to our successes, people are living much longer and perfectly normal and full lives after cancer, but we need to support them better, so I pay tribute to the work of Prostate Cancer UK. Its work is invaluable, as is that of all those members of staff who make the NHS what it is. I thank everybody for taking part in today’s debate.

Question put and agreed to.