Prostate Cancer Screening

Jan 2014

Although prostate cancer is diagnosed in about 40,000 men and is the second commonest male cancer causing nearly 11,000 deaths each year in the UK, there is no national screening programme to detect the cancer when it is still curable. There have been good reasons behind this in the past, but recent research is tipping the balance towards screening.

In 2008 the British Journal of Urology International reported a study comparing Tyrolean men in an organised PSA screening programme with the rest of Austria where screening was only random and voluntary during the same period from the early 1990s to 2007. In the rest of Austria the death rate from prostate cancer fell by 29% but in the Tyrol the fall was 54% - a 25% benefit in favour of screening (BJUI, 2008, 101, 809-816)

In 2009 'The European Randomised Study of Screening for Prostate Cancer' was the first and biggest multinational, controlled study to demonstrate the benefit of screening. Covering seven western European countries and running from the early 1990s, PSA was used randomly to screen half of a group of 182,000 men aged 50-74 for prostate cancer. The results published in the New England Journal of Medicine (vol 360, 1320-1328, March 26, 2009) showed that twice as many men in the screened group had prostate cancer diagnosed and the death rate from prostate cancer in the screened group was 20% lower than the unscreened group.

In 2010 the Goteborg randomised screening trial showed a reduction in prostate cancer death rate of nearly 50% and that the benefit compares favourably with screening programmes for other types of cancer (The Lancet Oncology: 2010: 11, 8, 725-732).

Therefore, three major European controlled population studies have reported a significant saving of lives through screening, whilst in the USA, where most men screen themselves anyway, the death rate from prostate cancer has dropped steadily since 1992 'five years after the introduction of PSA testing and the American Urological Association now recommends that the PSA test should be offered to well-informed men aged 40 years or older who have a life expectancy of at least 10 years.

Recent British research highlights problems for UK men seeking PSA prostate cancer screening. The 'current' NICE guidelines date from 2010 and do not include the above information, of which many GPs are unaware. Consequently the benefits of screening appear outweighed by the downsides.

One clear downside of PSA screening is the large number of men who unnecessarily undergo biopsy for benign conditions. However, this number can be reduced considerably by better risk profiling using new second line markers (eg hK2) and better imaging with MRI before resorting to biopsy.

Further research and clinical experience strongly suggests UK men make sensible decisions when given balanced options from which to choose. We believe that better awareness and up to date information will allow men to make a rational choice on screening and this alone will be the single biggest factor in reducing the death rate from prostate cancer.

Chris Booth