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prostate cancer Screening should not be made available to most men in the UK, A committee advising the government has said.
In a draft recommendation, the UK National Screening Committee (UKNSC) said it does not recommend population-wide screening using prostate-specific antigen (PSA) test, as doing so would be “likely to cause more harm than good”.
Experts are waiting to see data from a larger trial Launched by Prostate Cancer UK last week, which aimed to establish whether combining the PSA test with other tests, such as rapid MRI scans, could be a more effective protocol than what currently exists. The research could potentially lead to recommendations for population-wide screening.
For now, the committee will recommend screening only men with BRCA1 and BRCA2 genetic mutations – Due to which they have a higher risk of prostate cancer. – Every two years, between the ages of 45 and 61.
Health Secretary Wes Streeting said he would consider the findings, although he would like to see earlier diagnosis and quicker treatment, but this would need to be balanced against “the harm to men from widespread screening”.
professor sir mike richardsThe former National Cancer Director and chair of the UKNSC, told a briefing that modeling showed that “screening the whole population could lead to a small reduction in prostate cancer deaths, but very high levels of overdiagnosis” mean the harms are likely to outweigh the benefits.
Many high-profile personalities including Sir Tony Robinson and journalists Dermot Murnaghan, Expressed its “disappointment” at the decision.
Many experts argue that the PSA test is not very reliable.Because men with high PSA levels may not have cancer, and some men with cancer have normal PSA results.
A positive test result could lead to unnecessary treatment for a slow-growing or harmless tumor, putting men at risk for side effects such as incontinence and erectile dysfunction.
The UKNSC said on Friday it would not recommend widespread prostate cancer screening for black men – who have twice the risk of the disease – because there is currently not enough data or evidence related to this group. Nor does the committee recommend targeted screening for men with a family history of the disease, who also have a higher risk of developing prostate cancer.
The UKNSC said it would work closely with the TRANSFORM trial, launched last week by Prostate Cancer UK, to gather more data in these areas.
The trial is looking at the most promising screening technologies available, including the PSA blood test, genetic testing and 10-minute MRI scans, and whether they can be combined to provide population-wide prostate screening.
It is expected that the results will be ready within two years.
Laura Kerby, chief executive of Prostate Cancer UK, said: “The committee’s decision will be a blow to the thousands of men, loved ones and families who have fought for the screening programme. We are deeply disappointed today, but as determined as ever, and it will not slow us down.
“People are sick and tired of seeing their beloved men suffer from this disease, and we will not rest until anyone is diagnosed.
“We know that a mass screening program could save thousands of men’s lives. While only a fraction of this would be saved by screening men with the BRCA gene variation, the committee’s decision is the first time they have recommended any type of screening for prostate cancer.
“This shows that research and evidence can turn the dial and save men’s lives. And the research program that can achieve screening for all men is already underway – our £42m Transform trial, which will bring new evidence to the screening committee in just two years.”
Dr Ian Walker, executive director of policy at Cancer Research UK, said: “It is good news that prostate cancer screening is being considered for men with faulty BRCA genes, which puts men at increased risk of developing the aggressive type of disease. Analysis from the UK National Screening Committee shows that screening this group will save lives.
“We support the committee’s conclusion that for other groups of men, there is currently not enough high-quality evidence that screening will do more good than harm – it may miss dangerous cancers, and detect cancers that do not need treatment.”
Mr Streeting said: “I have always said that I want to see screening for the most common cancers in men, provided it is supported by evidence. I want to change the NHS so that it diagnoses earlier and treats faster. This aim will be balanced against the harms that widespread screening could cause men.
“Before the final recommendation in March, I will thoroughly examine the evidence and arguments in this draft recommendation, and bring together people with different views.”
He said the government was providing funding for the TRANSFORM trial, “which has the potential to revolutionize prostate cancer screening, reduce harmful side effects and make screening more accurate”.
About three out of every 1,000 men have BRCA 1 and 2 mutations. UKNSC said it is working with the NHS on ways to find people who may be carriers.
Currently, men find out they have the faulty gene when a woman in their family with breast cancer tests positive for BRCA.
Professor Richards said: “There are existing guidelines on who should get it [BRCA] Testing, and I think we’ll probably make these more prominent during the counseling process.” He added that men with a strong family history of prostate cancer can still get PSA testing through their GP, but more data is needed to justify widespread testing of men with this history and to introduce widespread screening for black men.
The charity Prostate Cancer Research described this recommendation as a “missed opportunity” and said that “historical harms” associated with screening (such as unnecessary biopsies) have been dramatically reduced by modern “MRI-first technologies”.
Its chief executive, Oliver Kemp, said: “Today’s decision to recommend screening to BRCA variant carriers does not go far enough. It is a missed opportunity for other high-risk groups, including black men and men with a family history.
“We are failing these groups, and deepening inequalities, by not providing them with the best chance of catching their disease early – when they are most likely to survive. There is still time for the Government to reconsider this decision for all high-risk men, as further delays will continue to condemn thousands of lives.”
Data published by the UKNSC shows that around 80 per cent of men whose prostate cancer is identified through PSA screening will not “benefit in terms of preventing prostate cancer deaths and [advanced disease],
Ross Eales, professor of oncogenetics at the Institute of Cancer Research in London, said screening men with BRCA mutations would save lives. But he said his institute recommends annual screening instead of every two years.
He added: “Men with BRCA1 gene defects are more than three times as likely to develop aggressive prostate cancer, which is more likely to grow and spread rapidly, than non-carriers.
“BRCA2 carriers have more than double the risk of prostate cancer, as does the risk of aggressive prostate cancer, and they will develop prostate cancer at a younger age on average.
“If you stop screening at age 61, you avoid about half the cancer of BRCA carriers between the ages of 40 and 69.”