As UK mulls prostate cancer screening, study shows benefit
With a UK committee poised to deliver a decision on a national prostate cancer screening programme, a long-running European study has shed further light on the benefits and risks of such a policy.
At the moment, 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.
After 23 years of follow-up, the ERSPC trial showed that mortality among men screened using PSA testing followed by a biopsy was 13% lower than a matched population of unscreened subjects.
The latest readout is in line with what has been reported before from the trial, and reinforces data on the trade-off between spotting prostate cancer cases and overdiagnosis, with intervention in men with prostate disease that would not have caused any serious harm.
Biopsies are generally harmless, but in some cases can cause infections, urinary problems, and erectile dysfunction.
The new data, published in the New England Journal of Medicine, shows that screening prevented 22 prostate cancer deaths per 10,000 men screened. That has improved from a rate of 14 deaths per 10,000 at the 16-year follow-up point.
In addition, it also shows that the harms of screening have reduced with longer follow-up, as the number of additional men who needed treatment to prevent one prostate cancer death fell from 18 to 12 between the two readouts.
The update is timely, given the ongoing deliberations by the national screening committee, although it is important to point out that the PSA/biopsy approach used in the ERSPC has been superseded by a less invasive diagnostic pathway with an MRI introduced before men with a positive PSA result have a biopsy.
"This research highlights both the value of large, long-term studies like this one, and the need for continued research to improve screening approaches, reduce harms, and save more lives," said Dr Matthew Hobbs, director of research at Prostate Cancer UK, noting that the level of harm in the trial remains a real concern.
"This is exactly the kind of high-quality evidence that the national screening committee needs to consider in its upcoming review – especially for groups who might get more benefit than the 'average man' screened in the ERSPC trial, such as Black men and men with a family history."
Studies have suggested the risk of prostate cancer in Black men is higher, and they are also less likely to request or attend prostate cancer screening tests.
Prostate Cancer UK started a £42 million ($55 million), large-scale study called TRANSFORM last year to test that MRI-refined pathway and other screening options like genetic testing using a saliva sample and a shorter 'fast MRI' technique – in a similar way to the ERSPC – to see if the 22 deaths prevented per 10,000 screens can be improved upon.
One voice calling for a national screening programme is former UK Prime Minister Rishi Sunak, who started an ambassadorial role with Prostate Cancer UK earlier this year and has said screening will "save the NHS money and make progress towards the Government's early diagnosis targets, but, most crucially, save thousands of lives."
UK company Oxford BioDynamics is developing a combined PSA/DNA test that, in studies, has been shown to detect prostate cancer with 94% accuracy and reduce the need for biopsies by 50%.
