Charity Advocates for Prostate Cancer Screening in High-Risk Men

A cancer charity asserts that screening men with a heightened risk of prostate cancer from age 45 is economically sound. However, Prostate Cancer Research also concedes that more precise diagnostic tools would be necessary to warrant universal screening for all men. The United Kingdom currently lacks a national prostate cancer screening program, a contrast to existing initiatives for breast, bowel, and cervical cancers. Instead, men aged over 50 are responsible for proactively requesting a blood test from their general practitioner. After receiving a recent terminal cancer diagnosis, Olympic cyclist Sir Chris Hoy advocated for increased testing among younger men, particularly those with a family history of the illness. In response, the government has directed the NHS to re-evaluate the existing evidence. Oliver Kemp, who leads the charity Prostate Cancer Research, stated that the present system is ineffective. He informed the BBC’s Today Programme: “Not everyone is even aware that they have a prostate, never mind that they are at higher risk. Not as many people are turning up to their doctors as they should be.” The BBC’s Inside Health program has investigated this matter. The discussion surrounding prostate screening centers on the limitations of current tests and the balance between identifying aggressive cancers sooner in some men versus the potential detriments of diagnosing and treating indolent tumors that would not have impacted a man’s health or longevity. The arguments for and against screening are subject to continuous review within the UK. The National Screening Committee’s most recent report, issued in 2020, concluded that the associated harms were excessive. Additional updates are anticipated within the current year. Even though prostate cancer claims more male lives than breast cancer does female lives, a dependable test for the disease remains unavailable. The blood test available to men over 50, upon request from their GP, quantifies prostate-specific antigen (PSA). This antigen is produced by the prostate, a small gland situated beneath the bladder that contributes to semen production. However, elevated PSA levels can stem from various factors, such as an enlarged prostate, inflammation, infection, recent strenuous physical activity, or sexual intercourse, and conversely, levels may remain within the normal range even in the presence of cancer. Furthermore, prostate cancer manifests in numerous forms, not all of which are fatal. GP Dr Margaret McCartney states: “There are prostate cancers that are so slow-growing that they will not affect a man’s lifespan.” These are detected in one out of three men over the age of 50. Dr McCartney adds: “And then you have a small number of very aggressive prostate cancers which do move quickly and cause harm.” Subsequent magnetic resonance imaging (MRI) scans and tissue biopsies can assist in identifying which men have cancer and require intervention. Nevertheless, some individuals still undergo treatment for conditions that would never have presented a health issue. Dr McCartney comments: “Far more men have tests done to try to work out what kind of prostate cancer it is, than are going to benefit from it – there’s the problem.” Clinical trials concerning screening have yielded inconsistent findings. A European study indicates that it saves lives, while a UK study demonstrates a more limited advantage. Conversely, a third study conducted in the US concludes that it does not. Prof Hashim Ahmed, who holds the chair of urology at Imperial College London, remarked: “We need to screen 570 men to prevent one death – that’s a lot of men to counsel.” Screening enables the treatment of aggressive cancers prior to symptom manifestation. However, trials indicate potential harms associated with testing a large population of healthy men, and any detected cancer, even a low-risk one, necessitates subsequent monitoring. A significant number of men diagnosed with low-risk cancer are merely observed or commence “watchful waiting.” Nonetheless, a cancer diagnosis and its accompanying invasive procedures carry a psychological toll. Prof Ahmed notes that one in ten of these men chooses radical surgery to avoid the apprehension of their cancer potentially progressing. Yet, this intervention can result in an inability to maintain an erection, and one-third of these individuals require incontinence pads for the remainder of their lives due to urine leakage. Prof Ahmed stated on BBC Radio 4’s Inside Health programme: “At the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms. So I would rather avoid finding low-risk disease.” Extensive research in this domain has concentrated on refining the screening methodology to mitigate its associated drawbacks. Furthermore, Prof Ahmed is leading the Transform trial, scheduled to commence next year, which aims to evaluate the most promising technological advancements. However, the outcomes of this trial may not be available for a decade. Meanwhile, a report from Prostate Cancer Research indicates that screening high-risk individuals aged 45-69 – specifically Black men and those with a family history of the disease or certain genetic mutations – would yield an economic advantage, considering the expenses of treatment and the effects on employment and caregivers. Oliver Kemp, the charity’s chief executive, asserts: “Finding and treating cancers early outweighs the harms of over-treatment by four times.” Additionally, Prostate Cancer UK, another charitable organization, states that the report reinforces its demand for a revision of “dangerously outdated NHS guidance that is leading to too many men receiving a late, incurable diagnoses.” Prof Frank Chinegwundoh, a consultant urological surgeon at Barts Health NHS Trust, commented: “It’s very difficult to weigh up the risks and benefits.” However, he frequently encounters men who might have received an earlier diagnosis, noting that these individuals can be relatively young. Prof Chinegwundoh informed Inside Health: “We can do a lot better than we are currently doing.” He also advises that Black men, who face twice the risk of developing the disease, should contemplate undergoing a PSA test at age 40, particularly if there is a significant family history of the cancer. Nevertheless, earlier this year, apprehensions emerged that Black men might be more susceptible than other men to adverse effects from a cancer diagnosis that did not necessitate treatment, owing to their naturally elevated PSA levels. As the debate continues, the question of what men should do currently remains. Prof Ahmed describes it as “It’s a really tough question,” and suggests that the NHS must provide men with improved information to address it. He further states that the balance between the risks and benefits of undergoing testing is “very nuanced, very personal,” implying that what is acceptable for one individual may not be for another. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content of external websites. Information regarding its approach to external linking is available.