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GP's patient battle for one-stop centre

A national screening programme for prostate cancer would trigger an extra half a million biopsies each year, warns a new report commissioned by the National Screening Committee.

The report warned that there was no evidence screening using the PSA test could save lives and rejected suggestions that national screening should be introduced.

The report reviewed new and unpublished data from the Protect study, which is mimicking the effects of a national programme among men aged 50 to 60. It found that nationally, 500,000 men in the age group would have PSA levels above the threshold for biopsy of 3.0ng/ml, but only 12,500 of them would have cancer.

Dr Jane Melia, author of the report and project co-ordinator at the Institute of Cancer Research's cancer screening evaluation unit in Sutton, Surrey, said: 'The use of the PSA assay continues to increase, despite there being no conclusive evidence of the efficacy and effectiveness of screening to reduce mortality from prostate cancer.

'At present in England there are more than five million men aged 50 to 60 and there are 1,586 prostate cancers diagnosed annually in the age group. Even with an uptake rate of, for example, 50 per cent, a national screening programme has the potential to cause a huge increase in the number of men referred for biopsies and the number of cancers detected,' she said.

But she said the quality of life associated with screening and follow-up treatment was 'potentially poor' and there was no 'agreed effective mode of treatment'.

The report, published in BJU international, concluded there was 'insufficient evidence' to introduce a programme.

Currently it is estimated that two in 100 asymptomatic men aged 45 to 84 undergo PSA testing and 2.8 per 100 men who present with symptoms.

Dr Graham Hornett, a GP in Guildford, Surrey, welcomed the new report but said PSA testing in asymptomatic men was an issue 'most GPs were very experienced with'.

He said: 'The message to patients is they should only be tested if they have symptoms. GPs wouldn't refuse it if a patient really wanted it. We have to be aware of patient autonomy but one does one's best to explain it's not helpful.'

By Emma Wilkinson

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