The proposal for widespread population screening for prostate cancer has been turned down due to concerns about potentially diagnosing more men with harmless tumors, leading to unnecessary treatments. The UK National Screening Committee (UKNSC) has opted to recommend offering the PSA test specifically to men with a known genetic risk associated with the BRCA gene, rather than proactively inviting other high-risk groups, such as Black men and those with a family history of the disease, citing potential harm outweighing benefits.
Advocates, including Olympic cycling icon Sir Chris Hoy, who is battling a terminal illness, argue that men with identified risk factors should be encouraged to undergo a PSA test upon reaching a certain age, regardless of symptoms. Professor Sir Mike Richards, former NHS England cancer director and UKNSC chairman, highlighted concerns about the limitations of the PSA test, suggesting that population-wide screening could lead to excessive overdiagnosis with minimal impact on reducing prostate cancer deaths.
Men with elevated PSA levels may not necessarily have cancer, while some with cancer may register normal PSA levels, potentially subjecting them to unnecessary treatments for benign or slow-growing tumors, risking side effects like incontinence and erectile dysfunction. The UKNSC’s new recommendation proposes a targeted screening program every two years for men aged 45 to 61 with confirmed BRCA1 and BRCA2 genetic variants.
The UKNSC’s decision not to advocate for prostate cancer screening in black men, who face double the risk of the disease, is based on a lack of sufficient data and evidence. Similarly, targeted screening for men with a family history of the disease, despite their elevated risk, is also not recommended at this time. Collaborating with the Transform trial initiated by Prostate Cancer UK, the UKNSC aims to gather more data on these populations to address existing knowledge gaps.
Laura Kerby, CEO of Prostate Cancer UK, expressed disappointment over the committee’s ruling, emphasizing the potential benefits of a mass screening program in saving lives. While acknowledging the limited impact of screening men with BRCA gene variations, she noted this as the first instance where any screening recommendation for prostate cancer had been made by the committee.
Men aged 50 and above are encouraged to request a PSA test from their GP, regardless of symptoms. However, campaigners stress that many men are unaware of their heightened prostate cancer risk and should be actively encouraged to consider undergoing a PSA check. The UKNSC is expected to present a final recommendation to ministers in March.
Approximately three in every 1,000 men carry BRCA1 and BRCA2 mutations, with a third of them likely to develop aggressive prostate cancer. Efforts are underway to identify carriers, with current identification often occurring through a female family member testing positive for BRCA. Prof Richards highlighted the importance of existing guidelines for BRCA testing, though further data is needed to support a screening program targeting a broader male population for checks.
Prostate cancer ranks as the most prevalent cancer in the UK, with 63,000 cases and 12,000 deaths annually. Unlike breast, bowel, and lung cancer, there is no national screening program for prostate cancer due to previous reservations about the accuracy of the PSA test. Recent endorsements for targeted screening from influential figures like former Prime Minister David Cameron and over 120 MPs, including ex-PM Rishi Sunak, have increased pressure on Health Secretary Wes Streeting to consider implementing a screening program swiftly.
Sir Tony Robinson and journalist Dermot Murnaghan expressed disappointment over the decision not to recommend universal prostate cancer screening. Personal experiences with prostate cancer diagnosis from figures like Sir Tony, Dermot Murnaghan, former footballer Les Ferdinand, and actor Colin McFarlane underscore the urgency for improved screening and early detection strategies to save lives and reduce late-stage diagnoses.