Surge in prostate cancer referrals following Stephen Fry’s diagnosis

Matthew Swindells, deputy chief executive of NHS England, recently commented on the increase in awareness of prostate cancer following Stephen Fry’s announcement of his own diagnosis at the beginning of 2018:

‘We have seen increases in referrals into a number of the cancer specialties, particularly urology, in the sort of 15% level jump this year, which is unprecedented.’

NHS services have a target of 62 days to get a suspected prostate cancer patient initiated on treatment following an urgent referral from their GP. Figures from April – June 2018, released last month, show that this target has been missed again in the worst performance since records began.  

 Matthew Swindell said that the reason for the significant drop ‘is a complex story’ but that it was ‘largely driven by Stephen Fry getting prostate cancer and the media coverage of that.

‘I was deeply frustrated that we didn’t get back to the performance target at the end of last year for the enormous amount of work that went on around the country and then it dropped off, and when we look at the data there’s been an extraordinary spike in demand.’

He then added: ‘We now have as an NHS to be able to work out how we manage our demand and our capacity and get smarter, because there isn’t an enormous box of people to run diagnostic services… we have to get smarter about how we do this.’

In response to these comments, Heather Blake, Director of Support and Influencing at Prostate Cancer UK replied: ‘Since the beginning of 2018 we have seen an unprecedented amount of public interest in prostate cancer, following the announcement that it is now the third biggest cancer killer in the UK, and high profile individuals such as Stephen Fry and Bill Turnbull sharing their experience of the disease. It is likely that this increased awareness will have had an impact on the number of men at risk of the disease going to their doctor to discuss prostate cancer and subsequently sent for further tests.

‘It is a good thing if awareness of this killer disease is increasing, and more men are taking control by discussing it with their GP. However, this reinforces the need to find diagnostic tools that are reliable enough to be used as part of a national screening programme for prostate cancer, something we are committed to doing through our research programme. This would not only provide more certainty around diagnosis for men and save more lives, it would also make it easier for NHS providers to plan resources around it.’

What are your views? Do you believe that the increase in awareness of prostate cancer that resulted from the announcements and media coverage of Stephen Fry and Bill Turnbull was a positive or a negative development?

To watch the video of Stephen Fry candidly discussing his diagnosis of prostate cancer, click here

Comments (11) Add yours ↓
  1. Nitin Shrotri Consultant Urologist

    As a Consultant Urologist with a family history of Prostate cancer, in my opinion, this was well meant by Mr Fry. What had not been given thought to, was the workforce already under huge pressure driven to even more overwork and overuse of resources to the detriment of other groups of patients, especially those not suffering from cancer, yet life affecting. This is compounded by the confounding factor that the investigation and management of prostate cancer involves large sums of money and the use of extremely expensive robotic equipment used by a select few. I wonder if prostate cancer treatment did not bring in large sums of money to individuals and institutions, would it have been so forcefully driven? As a Stone surgeon who feels utterly neglected and disrespected, perhaps a tinge if jealousy could be considered. But all in all, though well meant, at least initially, by Mr Fry, I am not certain, if this has benefited the NHS in any way at all! And I haven’t even brought the pressure the GPS have been put under, in this equation.

    September 13, 2018 Reply
    • Sandy Tyndale-Biscoe Hon President, Tackle Prostate Cancer

      I don’t think Stephen Fry intended to help the Health Service. He was helping men at risk from PCa

      September 13, 2018 Reply
  2. Sandy Tyndale-Biscoe Hon President, Tackle Prostate Cancer

    Of course it’s a good thing. The evidence that improved awareness reduces the impact of a disease such as PCa is overwhelming. The challenge, and it’s a big one, is for the profession to find a way of dealing with that increased awareness without resorting to over-diagnosis and over-treatment. The standard response, which boils down to “don’t let them know their PSA” is fine for an over-burdened health service, but doesn’t actually improve the lives of the men at risk.

    September 13, 2018 Reply
  3. Michael Kirby Professor

    It was not the result of Stephen Fry coming out. Bill Turnbull, who presented with metastatic disease also gave a heart felt description of his untimely diagnosis around the same timewhich must have been seen by millions.
    PCUK have also been working tirelessly to raise awareness.
    We need to get better at early diagnosis:
    A Report, published to coincide with the 10th Male Cancer Awareness Week (9-15 April 2018),reveals that: 37% of prostate cancer cases are diagnosed in the late stages (stages 3 and 4)
    42% of prostate cancer patients saw their GP with symptoms twice or more before they were referred (with 6% seen 5 or more times prior to referral)
    23% of all cancer cases are diagnosed through A&E, with the majority of these cases at late stage Prostate cancer cases are set to rise dramatically over the next decade
    The report has been produced by Orchid 2018

    September 14, 2018 Reply
  4. Angela Culhane Chief Executive, Prostate Cancer UK

    There is so much talk about the inadequacies of the PSA test and it’s at the top of Prostate Cancer UK’s list to get to a better way of diagnosing ASAP.
    But surely continued ignorance can’t be the right answer for men, when this disease is now the third biggest cancer killer? It takes brave people like Stephen Fry and Bill Turnbull sharing their stories to help men become more aware about the disease.

    September 14, 2018 Reply
  5. Roger Kirby Professor of Urology

    Quite right Angela. PSA is an imperfect test because it doesn’t differentiate Prostate Cancer from BPH. An MRI can help to do that though. My PSA rose to 4.6 ng/ml, an MRI revealed a 1 cm nodule. A robotic prostatectomy confirmed Gleason 4+3=7 adenocarcinoma. My PSA nearly 6 years on is undectable. Awareness helped me dodge the bullet. Bring it on Steven and Bill I say!

    September 15, 2018 Reply
    • Nitin C Shrotri Consultant Urologist

      Sorry to hear that Roger. But the 31/62 day target is not required for many Prostate cancers. Create awareness but moderate the sense of urgency which is seriously damaging many aspects of the NHS. I am asking for a sense of responsibility here in the face of the worst manpower crisis of all time in the NHS. I see that all comments here are from proponents or those who have benefited. Could you kindly request replies/comments (as I know you do), from people with a contrary point of view. I would be very grateful.

      September 16, 2018 Reply
  6. ben challacombe conultant urologist

    I see both sides pretty clearly here. One the one hand Stephen Fry with 13 million twitter followers/worldwide impact with his amazing and very personal video story, and Bill Turnbull announcing his metastatic disease, combined with the news that prostate cancer is the third largest killer ALL arrived in April this year. But we then had an amazing spike in PSA referrals leading to a huge increase in diagnoses and treatment. As the urology cancer lead in one of the biggest NHS prostate cancer teams i then had to co-ordinate the response to this surge. Referrals were up over 50% for 2 months. No NHS system has the capacity to easily absorb this kind of rapid increase. We put on extra MRI slots, biopsy lists and weekend robotic radical prostatectomy lists.
    Stephen was shocked when he heard about this but awareness isn’t something that we can control, it doesn’t come in incremental growth, it comes in fits and starts and doesn’t obey simple rules. I think it is amazing that the message has been promoted throughout the country. More men are coming forward with hopefully more treatable situations. Awareness drives many agendas including investment and research not just service delivery. Many famous men have chosen no to speak out so perpetuating some of the lack of openness we see around prostate cancer.
    Our diagnostics in this country are improving rapidly with almost 50% having up front MRI and trans perineal biopsy rates improving. We also have the lowest international rate for treating low risk disease (<10%) so over treatment is better here than the USA, Australia and most of Europe. PROMIS and PRECISION trials have allowed us not to biopsy all men with a raised PSA and to target the biopsies. so thank you Stephen and Bill for you honesty and openness and we will use your stories to try and improve the futures for all men with prostate cancer.

    September 16, 2018 Reply
  7. Roger Kirby Professor of Urology

    Simon Stevens adds his own positive comment about Steven and Bill’s effort to raise awareness:

    October 9, 2018 Reply
  8. Roger Kirby Professor of Urology

    Latest figures show that from April to July 2018, 14,479 patients received treatment for a urological cancer – an increase of 3,929 (36%) compared to the same period in 2017.
    And there were 70,000 visits to the NHS website advice page on prostate cancer in March, a 250% increase from the monthly average of around 20,000.
    Mr Stevens said there would be £10m of additional investment for hospitals to increase their capacity to treat more patients with the disease.
    “This additional investment will help ensure the NHS can manage this jump in demand, so that all people with suspected cancer are tested and treated quickly,” he said.
    Line chart showing prostate cancer has overtaken breast cancer as a cause of death

    October 10, 2018 Reply
  9. Roger Kirby Professor of Urology

    Stephen did a great performance for us at The Royal Society of Medicine on Monday.
    Here is the Vimeo:
    Password: Heroes

    November 14, 2018 Reply

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