Chris Hoy announces terminal prostate cancer diagnosis

Sir Chris Hoy, the six-time Olympic cycling champion, has said he has been "blown away" by the number of men seeking cancer advice since he revealed his terminal cancer diagnosis. Sir Chris - who is 48 - has said that a primary cancer in his prostate has also spread to his bones, and that he has between two and four years to live. To find out more about prostate cancer, I went to meet Vincent Gnanapragasam, who is professor of urology at the University of Cambridge and a consultant at Addenbrooke's Hospital…

Vincent - It is extremely common as we get older. And prostate cancer is really a disease of the ageing male. The incidences and the chance of finding it is much higher the older men get. But there are no symptoms with prostate cancer unless it is extremely advanced or has spread. And urinary symptoms in particular are really not a sign of prostate cancer at all.

Chris - So when people complain of getting up in the night to go for a wee, for example, this is not a sign of prostate cancer. It's a sign of something happening in the prostate, but not cancer per se.

Vincent - Absolutely correct. So the prostate enlarges with age and there's other mechanisms which actually change as we get older that does cause those symptoms, but it is not prostate cancer unless it's extremely advanced, which is a fairly rare presentation, particularly for urinary symptoms. In fact, many studies have shown there's an inverse or opposite correlation between having urinary symptoms and the chance of finding prostate cancer. But of course, because men go to GPs because of the urinary symptoms, they may be found to have prostate cancer by chance. So that association has stuck in the mind of the general public, and in fact many doctors.

Chris - Given what you've just said about age being the biggest risk factor, Chris Hoy is therefore presumably very unusual to be just in his late forties and having this.

Vincent - You are right, the chance of finding prostate cancer in a man under 50 is about 1 in 500. The chance of having such a lethal or aggressive cancer, as has been reported in the media, is much, much less than that. In fact, if you look at the national statistics in the UK, actually prostate cancer only contributes about 3.8% of all male deaths. And that is across the ages of 30 to over 90. In men in Chris Hoy's age group, you're talking about less than 0.01%. And even among men in their eighties, it's about 4-4.5%. So overall, prostate cancer actually is not a major cause of male deaths in the UK or worldwide, but of course it's very common. And the complexity of prostate cancer is how to manage it so you don't overtreat things, but equally find those aggressive cancers early enough to be able to actually do something so that it doesn't cause death.

Chris - Well, let's look at the first of those things first, which is how we manage the disease. Say someone like Chris Hoy presents with prostate cancer, how is that controlled or managed or investigated?

Vincent - Prostate cancer is complex because it can have a very indolent path, as I mentioned, or an aggressive path. And actually most prostate cancers will never go on to cause death or mortality in a man. So a lot depends on getting that characterisation of disease first, and also for the doctor or the nurse seeing this patient to actually understand what are the many factors that have to be considered before you decide on treatment or in fact keep an eye on things, which is actually becoming one of the most common ways of managing prostate cancer. Now, in the case of Chris Hoy, that's a very different spectrum. As I understand it, he's been diagnosed with cancer that's already spread, and as I've mentioned, that's extremely rare. In fact, I don't think I've ever seen anyone of that age present with metastatic or cancer that spread. Now, once that happens, it is incurable. But these days there are many, many lines of, uh, treatment and things which can help to prolong life. But like I said, again, it's important that we don't overemphasise that lethal side because it is a vanishingly small part of diagnosis in a young man.

Chris - And what sorts of treatment options are there?

Vincent - Diverse. And they range from surveillance or monitoring, which is where you keep an eye on things because you know the risk from that cancer is low and a man is more than likely going to die of something else. And again, it depends on presentation because right at the other end of the scale, if you have someone who's got cancer that has spread, then you're talking about different lines of drug therapy, particularly blocking the male hormone, perhaps some radiotherapy as well. And then further down the line, perhaps chemotherapy, and then more experimental things such as a new wave of agents which are targeting mechanisms in the DNA which have changed, which are found in a proportion of these men.

Chris - In terms of picking it up, because that was the other point you highlighted, what options are available to us there?

Vincent - If you're looking for or trying to detect prostate cancer early, the primary way to do that is by the serum PSA or the blood test, the PSA test. And there are many efforts trying to do that, including looking at genetic risk scores or other markers. But all of these things, including PSA, have a big problem in that they don't pick up the lethal cancers preferentially. They do, but they'll pick up lots of cancers and a lot of those cancers will not cause problems. So the problem in prostate cancer is not so much that we haven't got tests that will pick things up. But the problem is when we do, what do we do about it? If we accept it that a raised PSA test, for example, could lead to a diagnosis, but that diagnosis doesn't necessarily mean you need to be treated, then actually that's a very practical and pragmatic way to manage prostate cancer. And that's what we do currently in the UK, which I think personally has the best rationale for how to manage prostate cancer. But it doesn't take away from the fact that there are specific high risk groups where finding things earlier may be better. And that's really the most novel modern concept is how to identify those higher risk groups.

Chris - And who are those people? Who's in the high risk category?

Vincent - So specifically I would say men with a strong family history, and the key word is strong family history. So just because you've had a father who's had prostate cancer in his seventies or eighties, that doesn't make it a strong family history. We are really talking about men who in the male lineage in particular have got fathers, brothers in particular diagnosed at a young age with aggressive disease. In some families where you have what's known as the BRCA mutation, which also can lead to breast cancer, finding that in familiar lines will put you at higher risk of developing cancer. But the complexity here is it doesn't always mean it's going to be aggressive cancer, but you should start to look earlier. Black men have a higher risk of also finding cancer. And so those are a higher risk group as well. And there are some other smaller groups of family members who actually carry mutations, which would be considered high risk.