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Gold, incentives and meh

Prostate cancer mortality fall reignites PSA testing debate

The debate over whether men should be routinely screened for prostate cancer on the NHS has been reignited by a study showing a striking decline in mortality from the disease in the US.

Between 1994 and 2004, deaths from prostate cancer in the US fell four times as fast as in the UK – at 4%, compared with 1%, a year.

The dramatic figures, published online by The Lancet Oncology, coincide with greater uptake of PSA testing in the US, where with an estimated 60% of men are screened annually, compared with around 6% in the UK.

The difference in death rates was most striking in patients aged 75 years or older.

But the researchers, working at the University of Bristol, acknowledged that other factors, such as the treatment approaches in the two countries and misattribution of cause of death, could play a part in the findings.

But data for other cancers, such as breast, testicular and colorectal, showed no such disparities, they added.

Study leader Simon Collin, a research associate in epidemiology at the University of Bristol, said his group had had no idea they would find such a divergence in mortality trends: ‘This sort of finding could be a plank in an argument for screening but the great big caveat is that for every prostate cancer death you avert through screening a large number of men will be rendered impotent, incontinent and so on as a side effect of radical treatment.'

He added that mortality in the UK had fallen by 20% without screening. ‘I would concur with the NHS approach which is to wait for the evidence – the randomised controlled trials being done at the moment will hopefully provide us with a definitive answer."

Two large randomised controlled trials, one in the US and one in Europe, are due to report on the effectiveness of screening in the next couple of years.

But the UK's primary care guidelines on the management of prostate cancer are currently being revised after researchers found not enough men were being referred to secondary care after PSA tests.

Dr James Kingsland, a GP in Wallasey, Merseyside, and a member of the National Screening Committee's scientific reference group on prostate cancer said the latest results would be looked at seriously.

‘It's very important information but we have got to wait for proper RCTs before we act on reports such as this where there seems to be an effect. The reason we have RCTs is because you can see if there's a definite cause-effect relationship.'

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