Prostate screening

SIR – Michael Fitzpatrick (The Surgery, April 1) argues against screening for prostate cancer using the prostate specific antigen (PSA) blood test.

The largest and most scientifically rigorous longitudinal screening programme using PSA (the European Randomised Study of Screening for Prostate Cancer) has shown that, compared to men who were not screened, men aged 50-69 whose PSA was checked every three years had a significant reduction in metastasis (distant spread) and prostate cancer-related death, which in the United Kingdom alone claims the lives of 11,000 men a year.

This survival advantage has been shown to increase with longer follow-up: after 11 years the benefit was a creditable 29 per cent, while analysis of the data this year has shown a 57 per cent reduction in metastasis and deaths in screened individuals.

There is no question among experts that screening for prostate cancer using PSA saves lives.

The issue that limits its use at present is concern regarding overdiagnosis of indolent prostate cancers, with the attendant risk of their over-treatment and the generation of side effects that might otherwise be avoided.

This has been partly addressed by closely monitoring, rather than treating, low-grade prostate cancer. However, 50 per cent of these patients ultimately receive treatment, often because of anxiety rather than a demonstrable biological need.

The risk of under-diagnosis and under-treatment of prostate cancer continues to attract insufficient attention, in my (expert) opinion. Professor Christopher Eden

Consultant Urological Surgeon Guildford, Surrey