Testing for prostate cancer is ‘much less harmful’ than it used to be and the evidence on introducing a PSA screening programme should be reconsidered, a charity has said.
An analysis by Prostate Cancer UK and presented at the American Society of Clinical Oncology meeting in San Francisco has claimed he introduction of MRI before biopsy as well as changes to the way biopsies are done has tipped the seesaw in favour of screening.
However, GPs and other experts have warned that this push by charities for screening is ‘unhelpful’, and full evidence needs to be considered, and that current tests for prostate cancer do not reduce the number of men dying.
The National Screening Committee (NSC) last reviewed the evidence for PSA screening in 2020 and concluded the test was not accurate enough to detect prostate cancer that needs treatment and could lead to unnecessary and often unpleasant tests and treatment.
Decisions are reconsidered on three-to four-year cycles and it is understood that while there is as yet no formal decision to review the evidence the NSC will be exploring a number of proposals around prostate cancer screening including the possibility of targeting to certain groups.
Dr Matthew Hobbs, the charities director of Prostate Cancer UK, told the American Society of Clinical Oncology meeting: ‘At a minimum, these results allow us to be confident in more proactively encouraging men at high risk of prostate cancer to have a PSA blood test.’
Future evidence reviews should consider harm reductions across the whole prostate cancer screening pathway, he added.
In January a leading urologist speaking on the Radio 4 Today Programme advocated all men over the age of 50 going to their GP for a PSA test or over the age of 45 if from a black ethnic minority or had a family history of the disease.
Other research is being done to see if screening can be better targeted at those most at risk and if other markers of disease could be added to PSA to make it more accurate.
Dr Hobbs said: ‘We’ve known for some time now that testing more men reduces prostate cancer deaths, but there have always been concerns about how many men would be harmed to achieve this. However, our evidence shows that screening may now be a lot safer than previously thought.
‘That’s why we are so pleased that the committee is going to review the evidence once more.
‘It’s important that they consider this study and actual outcomes from the real-world NHS data and we hope they will find that we’ve reduced harm enough to be ready to launch a screening programme for prostate cancer.’
Dr Margaret McCartney, a GP in Glasgow and founder of the RCGP overdiagnosis group said: ‘It’s essential that the UK NSC are able to make independent high-quality recommendations based on a full appraisal of all the evidence.
‘That means access to the full data – not just a conference poster or headlines in a newspaper.
‘Screening might now be useful and cost effective – but all the data needs to be appraised first in a full updated review of the evidence available.
‘It is not helpful for charities to make non-evidence-based recommendations and it is essential that men have access to balanced, independent information about the potential for harm and benefit from screening.’
Commenting on the NSC reviewing the screening programme, Cancer Research UK’s head of health and patient information, Dr Julie Sharp, said: ‘There is no national screening programme for prostate cancer because the current test we have, the PSA test, isn’t reliable enough.
‘Overall research has shown that current tests don’t reduce the number of men dying from prostate cancer, so large longer-term studies are vital to fully understand how effectively any new tests would work in practice.’
A Department of Health and Social Care spokesperson said: ‘The UK National Screening Committee has received a set of proposals relating to screening for prostate cancer.
‘It will explore these further and consider how best to take them forward.’
What Prostate Cancer UK has claimed
The latest analysis by Prostate Cancer UK used a model based on trial data and national audit data to predict outcomes for 10,000 men having a PSA test where an MRI is done before biopsy and transperineal biopsy is used in those that need further investigations.
They reported at ASCO that previously 1,610 men would have a raised PSA level, all of which would have a biopsy and 10 would be at risk of sepsis after the procedure.
When they the applied their model to a trial cohort, a group of men treated at three large London hospitals and separate data from 13 hospitals in South West England, the results varied but they found that on average,67% fewer men experienced harmduring the diagnostic process – amounting to 902 fewer men for every 10,000 PSA tests carried out – due to fewer biopsies and fewer cases of sepsis.
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READERS' COMMENTS [4]
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Cancer UK annual funding for research;
Breast Cancer £25million
Prostate Cancer £12 million
No screening programme should be initiated until it meets the screening criteria on balance of benefit to harms.
Unfortunately a top Urological Surgeon has initiated a very faulty screening programme in 2020 which means all men over 45/50 will be having an incomplete annual – or 6-monthly – screen which will nevertheless drown Urologists (any spare anywhere??) with any man who has a PSA greater then 3; or if it has risen at all.
This will wreck NHS urology, push more people to private medicine at great expense, and harm many many men.
It should have been done properly.
Bravo Margaret,
We need to be as suspicious about self interest parties wherever they come from, big pharma or otherwise.
Regards
Paul C
Meanwhile men will present. The time and appointment numbers will increase yet again) for something that is dubious at best leaving us with the medico-legal risks of saying no; even with evidence to suggest that no is more appropriate than yes the time to answer complaints is huge. Therefore, I wouldn’t be surprised if a lot follow the path of least resistance. As we all know: in medicine there is one certainty-> sh!t happens,