Widespread prostate cancer screening not beneficial, says UK committee

The UK National Screening Committee (UKNSC) has announced that it does not recommend widespread screening for prostate cancer at the current time.

The recommendations are that only men who have a mutation in the BRCA2 gene should be routinely screened. In men who are not carriers – including black men, who are more likely to get prostate cancer (see BioNews 1078) – the risks of screening currently outweigh the benefits.

The chair of the UKNSC, Professor Sir Mike Richards – an oncologist who has had prostate cancer himself – said: 'That was the only strategy where the UK National Screening Committee had confidence that screening would do more good than harm, and the reason for that is that prostate cancer is much more common in people with the BRCA2 variant, and it tends to be more aggressive.'

The main screening tool for prostate cancer is a blood test for prostate-specific antigen (PSA). High levels of PSA can indicate the presence of prostate cancer, but there are very high rates of false positives, and it misses some men who do have cancer. Men aged 50 or over can request a PSA test through their GP.

Furthermore, even when cancer is present, current tests cannot distinguish between the majority of prostate cancers that cause no harm and the minority which can be life-threatening.

The screening committee found that of every 1000 men screened, two could potentially have lifesaving treatment, but this would be unlikely to improve lifespan. Another 20 men would be diagnosed with cancers that would have been harmless, and of these, 12 would probably have unnecessary treatment.

The main treatment for prostate cancer is surgical removal of the prostate gland. This results in infertility in virtually all cases, as well as significant risks of urinary incontinence and erectile dysfunction.

'Today's announcement will be disappointing for many people, but the PSA test currently used to help detect prostate cancer isn't effective enough to support wider screening, as shown in multiple large-scale trials,' said Dr Ian Walker from Cancer Research UK.

Health ministers in England, Scotland, Wales and Northern Ireland will have the final say on whether the recommendation will be followed, or whether to offer screening more widely. James Murray, the Secretary of State for Health and Social Care, is meeting Professor Richards today and told BBC Breakfast that he will consult with Department of Health officials and other charities and organisations before making a decision.

The UKNSC said they will keep monitoring new evidence as it emerges from trials such as TRANSFORM (see BioNews 1316). Professor Richards said he hoped 'new evidence and new tests and a better understanding of prostate cancer will support wider prostate cancer screening in future.'