One spring day last year, my father was admitted to hospital with a high fever and a bad general condition. We thought it was long covid. He had been complaining of back pain and poor appetite for several months. After various investigations, we got the answer. He had prostate cancer with spread to large parts of the skeleton and lymphatic system. When the cancer has progressed as far as my father’s, it cannot be cured. The only thing we could hope for was life-prolonging treatment. For my father, that meant immediate chemotherapy and lifelong hormone therapy. How long you live after this horse cure varies. In some the disease is kept stable for a few years, in others the cancer cells come back to life after just a few months. With my father, it worked well for just over six months. Now the cancer is on the rise again. Our oncologist is open about the fact that her toolbox will soon be empty. Prostate cancer affects over 5,000 Norwegian men every year, and one in ten discovers the cancer at a stage where it cannot be cured. In 2022, prostate cancer was the most common form of cancer in Norway. The symptoms are very diffuse and rarely occur before the cancer has spread. About 1,000 men die from prostate cancer each year. Along with lung cancer, prostate cancer is the cancer that kills the most men in Norway. But unlike lung cancer, it can be detected by a simple blood test and cured before it becomes life-threatening. Nevertheless, there is no plan by the authorities to step up work on early and systematic detection of this form of cancer. I have children aged two and four. Although my father is over seventy, both he and I would of course want us and the grandchildren to have more good years together. He has been healthy and strong all his life, and had many good years left. That life is ended by a form of cancer that could probably have been easily detected and cured seems unnecessary. No one can expect to live to be 90 years old. But the average age for those diagnosed with prostate cancer is around seventy. Many are significantly younger. After my father became ill, we have met men aged 45, 50 and 60, who are in the same situation as him. They are terminally ill, and there is no cure. That is despairing in itself. But it is just as depressing that many of these men did not have to become so ill. With a simple blood test for a penny, the cancer could have been detected and stopped, before it was too late. By measuring the so-called PSA value in the blood, the risk of prostate cancer can be assessed with great precision, and treated before it has spread. My father knew little or nothing about PSA testing. He also did not know that prostate cancer has a large hereditary component. Despite his father dying of prostate cancer, he took no precautions to test his PSA level regularly. The normal PSA value for men his age is around 2. When he had the test, it was 350. Values above 10 indicate that the cancer has spread. By monitoring the PSA value, in other words, the cancer can be caught before it has spread. It can then be operated on or irradiated, and the vast majority of people recover completely. A PSA test costs society a fiver. The medicines my father has received over the past year cost society at least half a million, in addition to the fact that the quality of life has deteriorated significantly. Today, there is no public program to inform men about the risks associated with prostate cancer. Neither the Norwegian Cancer Society nor the health authorities do anything to make men aware of familial risk or encourage them to take a PSA test. A good example of the opposite is the information campaigns aimed at women about the necessity of screening for both breast cancer and cervical cancer. The men are left to themselves. In fact, Norwegian GPs are required by the Directorate of Health to warn men against taking a PSA test, if they ask. This practice is a mockery of the many thousands of men living with prostate cancer, and testifies to a malignant form of conservatism in parts of the Norwegian healthcare system. The restrictive practice linked to organized PSA testing is based on outdated studies and methods. Norwegian health authorities justify their inaction on the risk of overtreatment. But today we have more than enough data from clinical studies to conclude that organized measures for early detection prevent death, while unnecessary overtreatment can be avoided. By taking into account risks, such as heredity, and using MRI examinations, it is possible to reveal who needs aggressive treatment, and who can safely wait. In the EU, they have internalized new knowledge about the benefits of organized screening. Before Christmas, the European Commission asked all member states to start investigation programs and pilots to prepare national screening programs. In Norway, a form of “wild screening” still takes place. Some men test themselves frequently, others never test themselves. The testing takes place independently of familial risk and without any systematic follow-up. Although unorganized screening may help an individual, it does not reduce prostate cancer mortality in the population. It is also both more expensive and less effective than if the testing had taken place more systematically. For my father, this is too late. But for thousands of men, a PSA test can be lifesaving. The health authorities must therefore ensure that all men have access to information about prostate cancer and risk factors, so that they are enabled to make good and informed choices about their own health. The GPs’ guide must be updated and the authorities must organize PSA testing in a more efficient and targeted way. The EU is underway. Now Norway must also show that we take the health of our men, fathers and grandfathers seriously.
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Unnecessarily many men die – Statement
