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Prostate cancer: Four in 10 cases diagnosed late, charity says

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Four in 10 prostate cancer cases in the UK are diagnosed late, a study suggests.

The report by charity Orchid found a "worrying trend" of late diagnosis with 37% of prostate cancer cases diagnosed at stages three and four.

The report found one in four cases of prostate cancer was diagnosed in A&E.

In February figures showed the number of men dying from prostate cancer had overtaken female deaths from breast cancer for the first time in the UK.

With an aging population, the charity has called for urgent action to prevent a "ticking time bomb in terms of prostate cancer provision".

Orchid chief executive Rebecca Porta said: "With prostate cancer due to be the most prevalent cancer in the UK within the next 12 years, we are facing a potential crisis in terms of diagnostics, treatment and patient care. Urgent action needs to be taken now."

The report canvassed the opinion of the UK's leading prostate cancer experts and looked at previously published data to get a picture of the prostate cancer care across the UK.

The data came from organisations such as NHS England, charities and the National Prostate Cancer Audit.

The report says that 42% of prostate cancer patients saw their GP with symptoms twice or more before they were referred, with 6% seen five or more times prior to referral.

Greater awareness

Prof Frank Chinegwundoh, a urological surgeon at Bart's Health NHS Trust said: "25% of prostate cancer cases in the UK are diagnosed at an advanced stage.

"This compares to just 8% in the US where there is greater public awareness of prostate cancer and greater screening," he added.

He said while there was controversy over the effectiveness of the standard PSA test used to detect the cancer, "it is still vital that patients are diagnosed early to assess if they need treatment or not as advanced prostate cancer is incurable".

The report also said there needed to be renewed efforts to develop better testing methods.

Prostate cancer symptoms

  • prostate cancer is diagnosed by using the prostate specific antigen (PSA) test, biopsies and physical examinations
  • there can be few symptoms of prostate cancer in the early stages, and because of its location most symptoms are linked to urination
  • needing to urinate more often, especially at night
  • needing to run to the toilet
  • difficulty in starting to urinate
  • weak urine flow or taking a long time while urinating
  • feeling your bladder has not emptied fully
  • men with prostate cancer can also live for decades without symptoms or needing treatment because the disease often progresses very slowly

The PSA test is available free to any man aged 50 or over who requests it, but the report said this can "create inequity" with tests being taken up by "more highly educated men in more affluent areas".

Prof Anne Mackie, director of programmes for the UK National Screening Committee, said the test was not offered universally because it was not very good at predicting which men have cancer.

"It will miss some cancers and often those cancers that are picked up when using the PSA test are not harmful," she explained.

"Treatment for prostate cancer can cause nasty side effects so we need to be sure we are treating the right men and the right cancers.

"There is a lot of research into screening and treatment for prostate cancer and the committee, along with NICE and the NHS, is keeping a close eye on the evidence as it develops," she added.

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Carlos Ghosn : Renault names interim replacement

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Image caption Carlos Ghosn was arrested in Japan on Monday

Renault has appointed a temporary deputy chief executive to take over the running of the French car firm following the arrest of Carlos Ghosn.

Renault said its chief operating officer, Thierry Bolloré, would step up to the role because Mr Ghosn was "temporarily incapacitated".

Following an emergency board meeting, Renault said Mr Ghosn would remain as its chairman and chief executive.

But it said Mr Bolloré would lead the firm with the same powers as Mr Ghosn.

Mr Ghosn was arrested in Japan on Monday after allegations of financial misconduct.

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As well as Renault, he is also chairman of both Nissan and Mitsubishi Motors and leads an alliance of the three carmakers.

Japanese prosecutors say Mr Ghosn under-reported his income from running Nissan by 5bn yen (£34.5m) over five years.

On Tuesday evening, Renault said: "At this stage, the board is unable to comment on the evidence seemingly gathered against Mr Ghosn by Nissan and the Japanese judicial authorities."

Meanwhile, the Financial Times reports that Mr Ghosn was planning a merger between Renault and Nissan but that the Japanese company was opposed to a deal.

Image copyright Getty Images
Image caption Thierry Bolloré has been appointed as Renault's deputy chief executive

Mr Bolloré is already in charge of many day-to-day activities at Renault.

The company said its decision to name him as deputy chief executive was a "transitional governance" measure "to preserve the interests of the group and the continuity of its operations".

Earlier, French Finance Minister Bruno Le Maire said Mr Ghosn was "no longer in a position" to lead the carmaker in which the French state has a 15% stake.

He also said Renault's partnership with Nissan remained in the interests of both France and Japan and of both companies.

Nissan and Mitsubishi are both preparing to remove him from his posts.

But Mitsubishi Motors chief executive Osamu Masuko said the alliance would be difficult to manage without Mr Ghosn.

Nissan has a 34% controlling stake in the smaller Japanese carmaker.

What has happened so far?

In a press conference on Monday, Nissan said an internal investigation prompted by a whistleblower had revealed "significant acts of misconduct" including "personal use of company assets".

Image copyright Getty Images

The announcement sent shockwaves through the automotive industry where Mr Ghosn, 64, is seen as a titan, responsible for a dramatic turnaround at Nissan in the early 2000s.

Nissan chief executive Hiroto Saikawa said "too much authority was given to one person in terms of governance".

"I have to say that this is a dark side of the Ghosn era which lasted for a long time," he said, adding he was still debating whether Mr Ghosn was "a charismatic figure or a tyrant".

What are the accusations?

Prosecutors later said in a statement that Mr Ghosn and senior executive Greg Kelly had conspired to understate Mr Ghosn's compensation, starting in 2010.

Mr Ghosn is accused of filing annual securities reports containing fake statements, which could mean up to 10 years in prison, or a fine of 10m yen, or both.

From 2010, Japanese firms have been required to disclose the salaries of executives who earn more than 100m yen.

Japanese prosecutors also said they had already raided Nissan's Yokohama headquarters, near Tokyo, as part of their investigation.

There has been no comment from Mr Ghosn or Mr Kelly.

How will this affect the Alliance?

As misconduct revelations emerged, the future of the car alliance led by Mr Ghosn remained unclear.

He has been credited with turning around both Nissan and Renault before becoming the linchpin of the alliance the companies later formed.

The Renault-Nissan-Mitsubishi Alliance sold 10.61 million passenger cars and light commercial vehicles in 2017, making it the number-one automotive group worldwide.

Nissan chief executive Mr Saikawa insisted the partnership would "not be affected by this event".

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E. coli outbreak: Romaine lettuce probed in US and Canada

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Image caption People in both the US and Canada have been infected

Romaine lettuce has been linked to an outbreak of E. coli in the US and Canada, health officials say.

At least 32 people have been sickened in the US, with 13 taken to hospital, while another 18 people have been stricken in Canada.

US officials said consumers, restaurants and retailers should throw away all kinds of romaine lettuce.

The latest outbreak follows the deaths of at least five people in the summer linked to romaine lettuce.

However, the latest statement from the US Centers for Disease Control and Prevention (CDC) says this outbreak is not directly related to the cases earlier in 2018, with a slightly different DNA fingerprint for this strain of the illness.

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People began to fall ill in early October. An investigation into the outbreak is ongoing.

In Canada, the 18 cases were reported in the provinces of Ontario and Quebec. The infections in the US are spread over 11 states.

In June, five people died and hundreds of people were infected across 35 US states after a romaine lettuce-linked E. coli outbreak.

The illness can cause diarrhoea, vomiting and even kidney failure in severe cases.

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Avoiding E. coli infection

  • Wash hands thoroughly after using the toilet, before and after handling food, and after handling animals
  • Remove any loose soil before storing vegetables and salads
  • Wash all vegetables and fruits that will be eaten raw
  • Store and prepare raw meat and unwashed vegetables away from ready-to-eat foods
  • Do not prepare raw vegetables with utensils that have also been used for raw meat
  • Cook all minced meat products, such as burgers and meatballs, thoroughly
  • People who have been ill should not prepare food for others for at least 48 hours after they have recovered

Source: Public Health England

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