Today sees the publication of Sir Chris Hoy’s memoir, All That Matters, where one of Great Britain’s greatest Olympians charts his life living with cancer, which he recently disclosed was terminal.
There was a nearly eight-fold increase in NHS searches for prostate cancer symptoms in the days following the six-time Olympic champion’s announcement and has even led to the NHS reviewing whether to change its advice on testing for prostate cancer.
Prostate cancer affects one in eight men during their lifetime and claims the lives of more than 12,000 men each year.
Following Hoy's diagnosis and bravery in discussing the disease, we've taken a look at the risks and why early testing is so important, with input from cyclist and urologist Dan Magrill, of West Sussex Urology, and Chiara De Biase, director of health services, equity and improvement at Prostate Cancer UK.
What is prostate cancer?
“Prostate cancer’s a malignant growth in the prostate, which is usually a small gland that surrounds a man’s urethra and sits in the pelvis next to the bladder,” says Magrill.
“The term covers a wide range of cancers, some of which can be slow growing and not cause any symptoms, and some of which (like Sir Chris Hoy’s) can be aggressive.”
Are there any symptoms?
Sir Chris Hoy revealed his shock at his terminal illness because there were “no symptoms, no warnings, nothing”.
“All I had was a pain in my shoulder and a little bit of pain in my ribs,” he said. He presumed it was tendonitis and he’d be told to lay off the weights.
The fact is most men with early prostate cancer don’t have symptoms, though the NHS states that the need to pee more frequently, often during the night, may be a sign. See your GP if that’s you but don’t be alarmed unnecessarily.
“For most of us the prostate gland will enlarge as we age,” says Magrill. “This is known as Benign Prostatic Hypertrophy, which is a non-cancerous growth but can cause symptoms with urination such as slow flow or difficulty initiating a urinary stream.
“Most prostate cancers grow in the outside area of the prostate, and don’t actually present with symptoms, but if you do have any urinary symptoms – and especially if you’re in a higher risk group or have prostate cancer in your family – you should see a doctor and get checked out. Similarly, if you see any blood in the urine, or have noticed trouble with erections, it’s worth seeing a doctor.”
Higher risk groups include men over the age of 50 and, as Magrill said, if you have a strong family history of the disease.
“You’re twice as likely to suffer from prostate cancer if you’re a Black man and this increased risk carries through to people with a mixed ethnic background,” adds Magrill. “On the positive, there are some interesting studies from Sweden indicating that having a very low PSA [Prostate-Specific Antigen] when you’re as young as 40 is a good sign that you’re unlikely to develop the disease later in life.”
What is the testing procedure?
Testing for prostate cancer requires a PSA blood test. PSA is produced by all prostate cells, but usually cancerous prostate cells produce more PSA, so it’s often used to help with initial testing.
“If you’re concerned about your risk of prostate cancer, then you can speak to your doctor about the role of getting tested with a PSA blood test,” says Magrill. “Most doctors would also perform an examination of the prostate (which involves a finger in the back passage to feel the gland for irregularities).”
The problem, says De Biase, is that there’s currently no screening programme. Instead, there are private tests, or men aged 50-plus can ask their GP for a PSA test, even if they don’t have symptoms.
“Right now, you need to be aware of this and bring it up with a GP yourself,” says Prostate Cancer UK’s De Biase. “As prostate cancer often has no symptoms in its earlier stages, this is leading to too many men getting a late, incurable diagnosis, like Sir Chris.”
According to the NHS, a PSA test may help detect early prostate cancer but it's not routinely used to screen for the disease, “as the results can be unreliable”. The NHS website states: “If you have a raised PSA level, you may be offered an MRI scan of the prostate to help doctors decide if you need further tests and treatment.”
De Biase says: “The system needs to change. That’s why we’re calling on the government to overhaul outdated NHS guidelines, so that GPs can start conversations with these men about their higher risk and the option to have a PSA blood test. This move will save thousands of lives every year. The earlier you find prostate cancer, the easier it is to treat.”
You can find out your own risk, and what you can do about it, using Prostate Cancer UK’s quick online Risk Checker.
Are there any links between prostate cancer and cycling?
As cyclists, we spend hours upon hours clamped to rather firm saddles. Thankfully, the evidence suggests this doesn’t lead to a higher risk of prostate cancer.
“There have been a number of studies looking into whether cycling causes prostate cancer and the urology community doesn’t think that there’s a causal risk,” says Magrill.
“There are studies suggesting that repeat trauma from long hours in the saddle causes inflammation of the prostate gland, which can lead to men seeking medical advice,” he adds.
Evidence suggests that this results in an increased diagnosis rate of prostate cancer because the cyclist has sought a test and not caused by cycling itself.
“Just note this same prostatic inflammation from hours in the saddle can artificially increase your PSA blood test,” says Magrill. “That’s why most urologists recommend avoiding long cycles for a few days before a PSA blood test to avoid a falsely elevated level.”
What can a cyclist do to maintain prostate health?
Cycling’s actually good for prostate health with studies suggesting that physical activity could lower your risk of prostate cancer, especially of aggressive and advanced prostate cancer.
“Beyond regular cycling and exercise, we’d also suggest reducing fat intake, eating more fruit and vegetables (including leafy greens, cooked tomatoes, broccoli and cauliflower),” says Magrill. “There might be help from green tea and soy, too.”
There are also studies suggesting that remaining sexually active might help prevent prostate cancer, Magrill adds. “We think that a higher frequency of ejaculation helps prevent inflammation in the prostate, and as well as other benefits this seems to reduce the chance of being diagnosed with prostate cancer.”
All in all, prostate cancer is a scary disease given its commonality. “Saying that, we’re getting better and better at working out who is at risk,” says Magrill.
“If you’re concerned you can speak to your doctor or look at some of the excellent websites out there.
“Most urologists are also happy to discuss the risks and tests with you, and indeed we spend much of our time going through this with patients in person or over the telephone,” adds Magrill, who says people can get in touch directly with West Sussex Urology.
Visit prostatecanceruk.org for more information and support. You can also call Prostate Cancer UK's specialist helpline on 0800 074 8383. West Sussex Urology can be contacted by telephone on 01243 682111 or via westsussexurology.co.uk.
Sir Chris Hoy's new book, All That Matters, is published by Hodder & Stoughton.
