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Contents
Introduction
The past two decades have seen much
progress in the diagnosis and treatment of women’s disorders
such as breast and cervical cancer, which have attracted high-profile
publicity. As a result of the efforts of the pharmaceutical
industry and the medical profession, there have been significant
improvements in treatment and a reduction in deaths. By contrast,
‘men’s disorders’ such as impotence, benign prostatic hyperplasia
(BPH), and cancer of the testis and prostate gland have attracted
less attention. Public understanding of them is low and they
are under-recognised and under-discussed.
This situation has started to change: medicines for impotence
have received enormous publicity, while advances in the treatment
of testicular cancer have reduced death rates by 75 per cent
in 20 years, despite a large increase in the number of new
cases. However, BPH and especially prostate cancer remain
poor relations in terms of diagnosis, treatment and public
awareness.
Nevertheless, data issued in summer 2000 by the Office of
National Statistics show that the five-year survival rate
in prostate cancer improved by seven per cent (to 49 per cent)
in men diagnosed from 1991 to 1993 compared with those diagnosed
from 1986 to 1990. This should improve further with the Government’s
pledge to reduce deaths from all cancers by at least 20 per
cent by the year 2010, specifically recognising the unsatisfactory
situation regarding prostate cancer. To achieve this aim,
there will need to be earlier detection, more accurate diagnosis
of early disease and improved treatment. Until further information
has become available, the Government does not support the
introduction of a screening programme based on the measurement
of prostate specific antigen (PSA), although the test is widely
used in the USA.
In the light of this background, the statement in September
2000 by the Secretary of State for Health was especially welcome.
In it, he recognised the seriousness of prostate cancer and
promised to introduce screening as soon as a technique is
sufficiently developed; a large-scale trial of the existing
PSA test could be initiated shortly. He also pledged increased
funding for prostate cancer research, rising to £4.2 million
per year by 2003/4, thus more than matching the £3.5 million
allocated to breast cancer. These commitments are in addition
to those made in June 2000 by the Minister for Public Health,
who pledged an extra £1 million for prostate cancer research.
In terms of treatment, the cost of prostate cancer to the
NHS was estimated to be about £100 million in 1999. Of this,
hospital costs account for 70 per cent, owing to the high
use of radiological and surgical methods. By contrast, medicines
expenditure was less than 20 per cent of the total. By offering
patients real and effective treatment alternatives, medicines
can save money and allow the reallocation of scarce resources.
It is hoped that this booklet will help maintain the new impetus
and raise the profile of prostate disorders, give some account
of recent and likely future developments in medicines research,
and provide a message of hope and encouragement to men and
their families who are living under the cloud of prostate
disease.
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