Experts have advised against routine screening for prostate cancer in most men across the UK. The UK National Screening Committee (UKNSC) has stated that using the prostate-specific antigen (PSA) test for population-wide screening could result in more harm than benefit. The committee’s draft recommendations, which are subject to public consultation, propose screening men at higher genetic risk, particularly those with confirmed BRCA1 and BRCA2 genetic variants, beginning at age 45.
The UKNSC does not recommend screening for black men at this time, citing a lack of sufficient data. Despite evidence that prostate cancer is most prevalent among men over the age of 50, particularly those of black African or Caribbean descent, the committee remains cautious. Additionally, it has not endorsed targeted screening for men with a family history of prostate cancer, who are also at elevated risk.
The UKNSC’s decision stems from concerns over the reliability of the PSA test. Professor Sir Mike Richards, former national cancer director and current chairman of the UKNSC, noted during a recent briefing that while population-wide screening might slightly reduce prostate cancer mortality, the high rates of overdiagnosis present significant risks. Men with elevated PSA levels may not have cancer, while some with cancer could register normal PSA results. Consequently, a positive result could lead to unnecessary treatments for slow-growing or benign tumours, exposing men to potential side effects such as incontinence and erectile dysfunction.
The announcement follows former Prime Minister David Cameron revealing his own treatment for prostate cancer. This has reinvigorated calls from organizations like Prostate Cancer Research for improved screening options for high-risk individuals.
Laura Kerby, chief executive of Prostate Cancer UK, expressed disappointment with the committee’s ruling, stating, “The committee’s decision will come as a blow to the tens of thousands of men, loved ones and families who’ve fought for a screening programme.” She emphasized the potential for a national screening programme to save thousands of lives, despite the committee’s limited recommendation for those with BRCA gene variations.
In a positive note, Dr. Ian Walker, executive director of policy at Cancer Research UK, acknowledged that targeting screening for men with faulty BRCA genes is a step forward. He affirmed that the UKNSC’s analysis suggests this focused approach has the potential to save lives.
The UKNSC’s current position is reinforced by ongoing research efforts. Experts are awaiting results from a large trial initiated by Prostate Cancer UK that aims to determine if combining the PSA test with rapid MRI scans could lead to a recommendation for broader screening. The Transform trial will explore various screening methodologies, including PSA blood tests, genetic assessments, and 10-minute MRI scans, with results anticipated within two years.
As the debate continues, the UKNSC stands firm in its cautious approach, focusing on the need for robust evidence before endorsing comprehensive screening practices. This complex issue highlights the delicate balance between the benefits and risks associated with prostate cancer screening, particularly for vulnerable populations.
