Prostate tests ‘should just be for men with symptoms’
Unnecessary checks for cancer have little benefit as treatment can cause its own problems, say experts
TESTS for prostate cancer should not be offered on request unless the patient has symptoms, experts say.
There is no UK screening programme for prostate cancer. However, asymptomatic men aged over 50 can get a test after consulting with their doctor.
A group of international experts say this policy has resulted in unnecessarily high rates of prostate-specific antigen (PSA) testing, which can lead to overdiagnosis and harm patients.
About 47,000 men are diagnosed with prostate cancer in the UK every year, but estimates suggest that 10,000 of those would never have experienced any symptoms.
Most men with an abnormal PSA result go on to have a prostate biopsy, because it is not possible to diagnose the cancer through the test alone. However, only a minority will have aggressive prostate cancer that requires treatment. Even if low-risk tumours are detected, most men go on to have either surgery or radiotherapy which can increase the risk of urinary, erectile and bowel dysfunction.
Researchers from the University of Sheffield, Cork University Hospital, Ireland, and the Memorial Sloan Kettering Cancer Centre, New York, said PSA testing should be restricted to men with urological symptoms, or targeted with a risk-based early detection programme.
The analysis, published in the British Medical Journal (BMJ), said relying on shared decision making to inform PSA testing, the standard practice in most high-income countries, has led to high testing rates among older men who are most likely to be harmed by screening and the least likely to benefit.
“Although we believe that early detection of prostate cancer should involve shared decision making, the current approach of determining testing by shared decision making has resulted in the worst possible practical outcome of high levels of PSA testing and medical harm, with minimal benefit and inequity,” the authors say.
“To make better use of PSA testing, policymakers should choose between a comprehensive, risk-adapted approach that is designed to reduce overdiagnosis and overtreatment, or restricting PSA testing to people referred to urologists with symptoms,” they add.
Dr Andrew Vickers, the lead author from Memorial Sloan Kettering Cancer Centre, New York, said that they hope policymakers will read the BMJ paper and would respond to any inquiries they may have.
Last year, NHS England launched new “case-finding” schemes to speed up the detection of missed prostate cancer cases during the pandemic.
The pilots, including in Surrey and Sussex, target men over 50, those with a close relative who has had prostate cancer and black men aged over 45.
It comes after Dame Cally Palmer, NHS England’s National Cancer director, told MPS in March that a push to diagnose prostate cancer cases, as well as two other cancers, through awareness drives has led to a rise of 7 to 15 per cent in people seeking assessment.
Screening for prostate cancer is not recommended in the UK, but NHS England has an “informed choice programme” where men aged 50 or older can decide to have their PSA tested after discussing with their GP. Prostate cancer incidence has increased by about 50 per cent in the UK since PSA testing became available in the 1990s.
“Around 25 to 50 per cent of men who have prostate cancer detected after PSA testing would have lived out their natural lives without a prostate cancer diagnosis, suggesting that overdiagnosis occurs in about 10,000 men in the UK every year,” the authors say.