PSA trial prompts Government prostate cancer screening review
By Lilian Anekwe
The Department of Health is to review its policy on screening for prostate cancer after a major European trial found a programme based on PSA testing could cut deaths by 20%.
The study of 162,000 men aged 50 to 74 across seven European countries found PSA screening identified nearly twice as many cancers as among controls.
Ministers responded by asking the National Screening Committee to look afresh at the evidence on screening, with charity Cancer Research UK claiming a structured programme could save as many as 2,000 lives a year.
Yet the decision appears to conflict with chief medical officer Sir Liam Donaldson's recommendation last week that GPs warn men considering a PSA test there is a ‘high chance they will be diagnosed with a cancer that will never affect their health'.
Over the course of the new study, published last week in the New England Journal of Medicine, prostate cancers were identified in 8.2% of men offered a PSA test an average of once every four years, compared with 4.8% in the unscreened population.
The absolute difference between the screening and control groups was 0.71 deaths per 1,000 men, which the researchers said was equivalent to a 20% reduction in prostate cancer mortality.
A quarter of all biopsies in the screen-detected group were diagnosed as cancer and the number needed to screen to prevent a death was 1,410 - comparable with that for faecal-occult blood testing for colorectal cancer and mammography for breast cancer.
The study found half of the men diagnosed did not show any clinical symptoms.
Professor David Weller, a GP in Edinburgh and cancer screening expert, said: ‘I think a key issue for GPs is the number of people needed to screen was high to prevent one death from prostate cancer. There's also a big problem with over-diagnosis, and a 20% mortality reduction does not overcome that.'
A second study of 76,000 men screened in the US, also published in the New England Journal of Medicine, found no significant difference in death rate.
But despite this, health minister Ann Keen said last week: ‘We will formally ask the UK National Screening Committee to review the evidence and make recommendations.
‘We look forward to examining this new evidence and are committed to having a prostate cancer screening programme if and when screening and treatment techniques are sufficiently well developed.'