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PSA prostate cancer screening programme to be ruled out

By Lilian Anekwe

A formal prostate cancer screening programme using PSA looks set to be ruled out, Pulse can reveal.

The Department of Health ordered the UK National Screening Committee to review the available evidence for a prostate cancer screening programme after two major trials in Europe and the US found PSA testing could cut deaths by up to 20%.

The National Screening Committee review is expected to make its recommendations in July, but a source close to the review told Pulse it was ‘highly unlikely' that the committee will say yes to prostate screening in the UK.

It is thought that PSA testing throws up too many false positives and is still seen as too unreliable a test on which to base a screening programme.

GPs in the England will instead receive a new guidance document in the autumn reasserting the Government's opposition to the use of PSA testing for prostate cancer screening.

The document will be contained in an update to the 2002 Prostate Cancer Risk Management Programme.

The guidance was originally due to have been published last month, but was delayed to allow consideration of the two New England Journal of Medicine trials in March.

The guidance document will recommend GPs neither promote nor discourage patients for opting to have PSA tests, but have a full and frank discussion of the benefits and potential risks of inappropriate treatment.

Professor Mike Kirby, a former GPSI in urology and visiting professor at the University of Hertfordshire, said PSA testing is still associated with a significant risk of overdiagnosis.

‘At the moment PSA testing is not a good enough tool to detect prostate cancer. There are lots of other possible candidates that are currently being tested and in the future it's likely that there will be a test but we don't have it yet.

‘We're not at a stage yet where we can use PSA testing without causing significant harm to patients. Prostate cancer is a very common cancer and for that reason GP case finding is still very important. When men who ask for it should be given information but should also be told the pros and cons.'

Dr James Kingsland, a member of the DH's expert advisory group on prostate cancer screening, said: ‘PSA testing is not a screen for prostate cancer and it never will be. It is an option in the assessment and monitoring of symptomatic men but its use in asymptomatic men is often inappropriate.'

BOX: What the guidance will recommend

• If a patient over 50 asks for a PSA test they can be offered one, but should be counselled about the pros and cons
• No formal upper age limit, but PSA tests should not be given to men with a life expectancy of less than ten years
• PSA tests are not recommended in obese patients or those with significant comorbidities including heart failure, cardiovascular diseases or respiratory disease
• PSA tests are also not recommended in patients who have a urinary tract infection, have has sex or strenuous exercise in the previous 48 hours, a digital rectal examination in the previous week or a rostate biopsy in the previous six weeks

Professor Mike Kirby: PSA associated with significant risk of overdiagnosis. Professor Mike Kirby: PSA associated with significant risk of overdiagnosis.

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