Quarter of GPs would strongly support NHS prostate cancer screening

Exclusive A quarter of GPs are ‘strongly supportive’ of the NHS introducing prostate cancer screening, but many highlight issues with current PSA testing, a Pulse survey has found.

The survey of over 730 GPs across the UK suggested that overall, 60% of GPs are either fairly or strongly supportive of a central screening programme, while only 14% are against it. 

But GPs told Pulse that PSA testing alone is inadequate, and many want to see evidence for a screening model with a better balance of benefits and harms. 

Currently, any man aged over 50 can request a PSA test from their GP, but the National Screening Committee does not recommend a screening programme as the test is ‘not accurate enough to detect prostate cancer that needs treatment’. 

At the recent UK conference of LMCs, local GP leaders voted in favour of a motion which raised concerns about the ‘unresourced and un-evidenced expansion of PSA testing and monitoring, driven by secondary care and local advocacy groups’.

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West Berkshire GP partner Dr Angus Tallini said he is strongly supportive of a screening programme, but that it ‘cannot use the PSA test as currently available’, and that a rectal examination would not be ‘sensitive enough’ either. 

‘There needs to be a more sensitive and more specific test available to ensure that screening causes more good than harm.’

He also pointed out that there are not ‘enough MRI scanners in the country’ to screen for prostate cancer using MRI investigations.

But Dr Tallini said a ‘system-wide screening’ process for prostate cancer, similar to breast cancer screening, ‘would be more effective than the current haphazard approach where interest in PSA testing peaks depending on media coverage or charities offering mass testing events’.

‘People can then be properly informed in a balanced way without the inevitable emotional overlay of a beloved celebrity going through cancer,’ he told Pulse. 

Similarly, a GP in the North East, who preferred to remain anonymous, said the ‘informal’ screening offered to men now via PSA testing ‘is not equitable, nor funded, nor evidence-based’. 

The GP, who is strongly supportive of screening, said: ‘I think a national screening programme needs to be evaluated and delivered centrally like all other screening programmes. Providing that it meets the criteria for a screening program as laid out in government policy.’

London GP Dr Nick Mann said he was fairly supportive of the NHS introducing prostate cancer screening, but is waiting for the outcome of trials such as the TRANSFORM study, which will examine four screening methods including the genetic saliva test.

He told Pulse: ‘It’s likely that TRANSFORM will come out with a positive finding for prostate cancer screening, which obviously ends up being a good thing and important to lots of men. 

‘But there’s a big caveat that I’m not just blanket in favour of it, and certainly, as the evidence is at the moment, I couldn’t say yes we should be doing it now. But the chances are it will turn out to be positive once the results from the TRANSFORM trial are known.’

The TRANSFORM trial, which is expected to begin this year, is backed by £42m of funding and will screen ‘hundreds of thousands of men’ with recruitment by GP practices.

It was developed in partnership with Prostate Cancer UK, and the National Screening Committee has committed to assessing its evidence as it is published to inform its decisions.

However, the first significant evidence is not likely to arrive until around three years after the trial begins. 

Ahead of these results, Dr Mann said he is worried about patient advocacy groups ‘ending up making policy’, as the implications of PSA testing results are ‘much more complicated’ than these groups suggest.

‘We should be firmly pulling back to what is clinically relevant and actually balances the risks and harms of patient care and patient interventions,’ he told Pulse.

Another GP, who was a partner for 20 years and now works in the medico-legal field, said he is strongly against the NHS introducing prostate cancer screening, and that the PSA test is ‘no good at all’.

He told Pulse that a ‘really high’ or ‘really low’ result is useful, but that the ‘vast majority’ of people are ‘borderline upper end of normal’.

‘It’s very difficult – all you do is get into situations where you just keep repeating it until you eventually refer them.’ 

The GP, who preferred to remain anonymous, said the ‘only way to have a proper screening programme’ would be to do an MRI scan, saying it is ‘very, very difficult to catch prostate cancer at a treatable stage unless you’re doing very regular MRI scans on the whole male population’. 

He also highlighted the cost of doing this: ‘If [the NHS] really wants to do it, they can divert 10% of the entire NHS budget to doing MRIs on chaps every two or three years – everyone will know if they have or haven’t got possible prostate cancer, but then you won’t have any money to actually do anything else.’

Speaking in favour of the motion on PSA testing at the LMC conference last week, Surrey GP Dr Larisa Han said general practice is ‘now running an unfunded, unofficial screening and surveillance programme on behalf of charities, urologists and public perception’.

The motion she proposed, which passed in all its parts, called for a ‘national review of PSA screening and monitoring pathways’ while ‘ensuring that primary care is not burdened with additional work without adequate resources’.

In 2023, the UK National Screening Committee (NSC) said it will consider six different proposals for prostate cancer screening, including a targeted service for men at higher risk.

And in February this year, the expert group said it had come under increased pressure in recent months to reconsider PSA testing policy, following Sir Chris Hoy’s announcement that he had been diagnosed with terminal cancer.

But latest decision of the NSC, from 2020, said: ‘A PSA-based screening programme could harm men as some of them would be diagnosed with a cancer that would not have caused them problems during their life. This would lead to additional tests and treatments which can also have harmful side effects.’

Health secretary Wes Streeting recently told MPs that he would like to see a national screening programme in place for men at high risk of the disease – but he stressed that any decisions need to be ‘evidence-based and evidence-led’.

He revealed that he has asked the NSC to look into a national prostate cancer screening programme.

Prostate Cancer UK has also recently called for GPs to discuss PSA testing with Black men from the age of 45 years after figures showed disproportionately high rates of late-stage prostate cancer diagnosis among this demographic.