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PSA screening in men without symptoms does not save lives, GPs told

GPs should not routinely offer PSA testing to men without symptoms, as it does not save lives, a new study of over 400,000 men has found.

The research, published in the Journal of the American Medical Association, found that while testing men without symptoms did detect disease unlikely to cause harm, it also missed aggressive and lethal prostate cancers.

The randomized trial, funded by Cancer Research UK, compared the outcome of men who received a one-off PSA test with those who had not been screened. It was carried out across 573 primary care practices in the UK, between 2001 and 2016, and looked at men aged 50 to 69.

At the 10-year follow up mark, the team saw that 4.3% of the screened group and 3.6% of the control group had prostate cancer, although both had the same percentage of men dying from the disease.

Researchers found that among the 549 men in the intervention group who died of prostate cancer, 34% had attended the PSA screening clinic, but in the majority of cases the ‘lethal cancer’ had not been picked up by the test.

Cancer Research UK’s GP expert Dr Richard Roope said: ‘The PSA test is a blunt tool missing the subtleties of the disease and causing men harm. This trial illustrates that we need to develop more accurate tools if we want to save men’s lives.

‘Although PSA is a straight forward blood test, the subsequent diagnostic and treatment process can have a significant impact on a man’s life.

‘Unfavourable impacts include adverse effects on quality of life, including risk of infection or sepsis from biopsy, and sometimes incontinence and impaired sexual and bowel function from treatment.’

RCGP commented that it ‘does not recommend that the PSA test is offered routinely to men who do not present with prostate cancer symptoms’.

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs have long held reservations about the effectiveness of PSA testing based on previous research findings, in particular with regard to potential overdiagnosis and its associated risks.

‘This large, high-quality study is really useful in backing up our calls for GPs to have better access to a more specific and sensitive test than the PSA test. It is now important that this research is taken into account as new research is commissioned and new clinical guidelines are developed.’

Earlier this year, researchers developed a personalised genetic score for predicting a man’s risk of developing aggressive prostate cancer. The team hoped that this could help doctors decide who to screen with PSA testing and at what age.


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