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Let’s be cautious of knee-jerk reactionary medicine

Let’s be cautious of knee-jerk reactionary medicine

NHS England’s new prostate cancer case finding scheme aims to close the ‘treatment gap’ created during the pandemic, but Dr David Turner is sceptical about this approach

I am a self-confessed grump.

I have completed the 12-step course in grumpiness and have full insight into the condition, so I don’t expect the non-grumps out there to agree with me. But I think the latest new shiny thing about to be foisted on the population needs a serious review – NHS England’s prostate cancer case finding pilot.

The prostate cancer screening debate has gone on for as long as I have been a GP, and, from my understanding, the arguments have not really changed much. Prostate cancer does not behave like other cancers. Older men are more likely to die with it than from it. And a raised PSA is more likely to have a non-malignant cause while a raised PSA could mean an invasive biopsy, which is not an insignificant procedure.

A recent BMJ article said this latest initiative is circumventing the usual approval needed for a screening programme by calling it a case finding programme, which targets men who are at high risk of having prostate cancer due to their age, ethnicity or family history.

The problem with this sort of case finding programme is that those who attend are going to be predominantly anxious men and men with an active interest in looking after themselves.

In the case of the former, a slightly raised PSA would ramp up their anxiety a few notches; and in the case of the latter, they would come to us anyway to have a PSA as part of their health MOT.

There was an underdiagnosis of prostate cancer during the Covid pandemic and there will be many men out there with malignant disease who we need to find.

Instead of spending the money on new screening vans, give general practice the resources. I am loathed to say this, but for once, this is an area GPs are best placed to deal with – we can find those at greatest risk in our practice populations and invite them for a PSA test and a rectal examination.

However, this would not be a new, shiny initiative, and would certainly not give those in power any nice sound bites. That might just be the grump in me talking though.

Dr Turner is a GP in Hertfordshire. Read more of his blogs here