Limited prostate cancer screening backed in UK
Prostate cancer screening should not be made available to the vast majority of men across the UK, according to a committee set up to recommend a screening policy for the health service.
Rather, the UK National Screening Committee (NSC) has recommended a targeted approach, only for men with a confirmed BRCA1 or BRCA2 gene variant who are at an elevated risk of developing prostate cancer. According to the proposal, men in that category could be screened every two years between the ages of 45 and 61.
The government has said it will take the draft recommendation on board before a final decision on the programme is made in March, after a 12-week public consultation.
The long-awaited recommendation has disappointed patient organisations Prostate Cancer UK and Prostate Cancer Research, as well as public figures who have pushed for more widespread screening, including former Prime Minister Rishi Sunak, Olympic cyclist Sir Chris Hoy, and actor and broadcaster Sir Stephen Fry.
Prostate Cancer UK said that the disease is the only cancer without a screening programme in the UK, saying it "can't stand still and let thousands of men miss their chance for an early diagnosis."
Screening is carried out using a PSA blood test, which can be indicative of cancer, but also other benign prostate conditions. Currently, men are not automatically offered a PSA test on the NHS, but can request one after they reach the age of 50, even if they do not have symptoms.
A positive PSA result can result in them having an MRI and, in some cases, a biopsy, which is generally complication-free, but can cause infections, urinary problems, and erectile dysfunction.
Medical groups, meanwhile – including Cancer Research UK and the Royal College of GPs – have said that the recommendation is the correct approach, as it strikes a balance between finding cases of prostate cancer and over-diagnosis, as well as avoiding harm that may result from unnecessary interventions, such as treatment for low-risk prostate cancer that would not have gone on to cause harm.
The major point of contention with the recommendation revolves around the decision not to recommend screening of Black men, who have around twice the risk of developing prostate cancer compared to the overall male population in the US, as well as men who have a family history of the disease, but no BRCA mutations.
Sir Chris, who falls into the latter category and confirmed last year that his prostate cancer diagnosis was terminal, said he was "disappointed" by the NSC's decision.
"While introducing regular checks for men carrying the BRCA genes is a very small step forward, it is not enough," he added, noting that more than 12,000 men in the UK die from prostate cancer every year.
"I know, first hand, that by sharing my story following my own diagnosis two years ago, many, many lives have been saved. Early screening and diagnosis saves lives."
In October, the long-running European ERSPC study found that, after 23 years of follow-up, mortality among men screened using PSA testing followed by a biopsy was 13% lower than a matched population of unscreened subjects.
A new large-scale clinical trial, TRANSFORM, has now started and will try to fill gaps in the evidence on how prostate cancer screening could be safely rolled out more broadly, including to Black men and those with a family history of the disease.
TRANSFORM co-lead investigator Rhian Gabe of Queen Mary University of London said that, while the decision to screen men with BRCA1/2 variants is to be applauded, "it now becomes more important than ever to provide evidence to inform policy regarding whole population screening in men and higher risk groups."
One in 300 people in the population has an alteration in one of the BRCA genes, and Ros Eeles, an oncogenetics specialist at The Institute of Cancer Research in London, questioned the cutoff age for screening at 61.
"If you stop screening at 61 years of age, you miss nearly half of all cancers for BRCA carriers between 40-69 years," she said, referring to the results of the IMPACT screening trial, which showed the benefit of screening in the BRCA 1/2 group.
She also said the data suggested screening every year was preferable to every two years, "to avoid the risk that an aggressive cancer could be allowed to grow unchecked for a whole year."
The NSC's final advice will be delivered to health ministers in the four UK nations, which will then have to decide on their own screening policies.
