Prostate Cancer Screening Program

A prostate cancer screening program for all men in the UK is not justified, according to a highly influential group of experts. Instead, they say only men with specific genetic mutations that lead to more aggressive tumors should be eligible.

Background

Prostate cancer is the most common cancer in men, killing 12,000 people across the UK every year. It instinctively feels like screening for the disease should be a simple decision – test for cancer, treat it, and save lives. However, it is a much more complex issue. Screening would be based on a blood test followed by prostate scans and a biopsy. However, this can miss deadly cancers and detect those that do not require treatment.

Recommendations

The UK National Screening Committee recommends:

• No screening program for all men as it “likely does more harm than good”
• No screening for black men due to “uncertainties” about impact due to lack of clinical trials in black men
• No screening based on family history
• However, men between the ages of 45 and 61 should be offered screening every two years if they have certain genetic mutations – so-called BRCA variants.

Rationale

These recommendations are based on the balance between lives saved by early detection of cancer and treatment that makes it impossible for patients to control their bladder or maintain an erection whose cancer would not kill them. Many prostate cancers grow so slowly that you would have to live 120 to 150 years before they pose a threat – so they do not require treatment, according to the National Screening Committee.

Reactions

Reactions to the screening recommendations were mixed. Some organizations supported the committee’s conclusion that screening could do more harm than good to other groups of men, while others expressed disappointment and sadness. A large clinical trial called Transform has now begun to address gaps in evidence about how screening could be safely expanded to other groups, including those with a family history and black men.

Lives Saved, But What Are the Costs?

If 1,000 men aged 50 to 60 were tested:

• 28 would be diagnosed with prostate cancer
• 2 lives would be saved
• 20 would be “overdiagnosed,” meaning a slow-growing tumor that does not require treatment would be found
• 12 men are then likely to undergo treatment such as surgery or radiotherapy which, while not beneficial to them, may be associated with harm, including the inability to control the bladder or maintain an erection.