Population-wide testing for prostate cancer has been turned down due to concerns about potentially diagnosing more men with harmless tumors, leading to unnecessary treatments. The UK National Screening Committee (UKNSC) has disappointed advocates by suggesting the prostate-specific antigen (PSA) test be offered only to men with a confirmed genetic risk related to the BRCA gene. The committee did not support proactively screening high-risk groups like Black men and those with a family history of the disease, citing potential harm outweighing benefits.
Notable figures, including Olympic cycling champion Sir Chris Hoy, who is battling a terminal illness, have argued for PSA testing for men with known risk factors at a certain age, regardless of symptoms. Professor Sir Mike Richards, former NHS England cancer director and UKNSC chairman, emphasized the need to weigh benefits against harms in decision-making.
The UKNSC’s stance is based on concerns that widespread PSA screening might lead to excessive diagnoses and unnecessary treatments, as high PSA levels do not always indicate cancer, while normal levels may mask the presence of the disease. The new recommendation proposes targeted screening every two years for men with confirmed BRCA1 and BRCA2 gene variants aged 45 to 61.
Despite Black men having double the risk of prostate cancer, the UKNSC currently lacks sufficient data to support screening them. Similarly, men with a family history of the disease are not recommended for targeted screening. The committee aims to collaborate with initiatives like the Transform trial by Prostate Cancer UK to bridge knowledge gaps in these populations.
Laura Kerby, Prostate Cancer UK’s chief executive, expressed disappointment over the committee’s decision, emphasizing the potential lifesaving impact of a mass screening program. While the focus is on screening men with BRCA gene variations, the committee’s recommendation marks the first step towards any form of prostate cancer screening.
Men aged 50 and above can request a PSA test from their GP, even without symptoms, though many are unaware of their heightened risk. The UKNSC is set to finalize its recommendation to ministers in March.
Approximately three in every 1,000 men carry BRCA 1 and 2 mutations, with a third of them likely to develop aggressive prostate cancer. Efforts are underway to identify carriers, often recognized through family members’ genetic testing for breast cancer.
The lack of a national screening program for prostate cancer in the UK stems from previous doubts about the accuracy of the PSA test beyond symptomatic cases. Former Prime Minister David Cameron and over 120 MPs, including Rishi Sunak, have advocated for a targeted screening program, urging Health Secretary Wes Streeting to act swiftly.
Streeting has committed to launching a screening program promptly if endorsed. There are speculations that he might challenge the committee’s decision if it opposes expanding prostate screening. Public figures like Sir Tony Robinson and Dermot Murnaghan, both prostate cancer survivors, have expressed disappointment over the lack of universal screening recommendations.
Sir Tony, known for his role in Blackadder, stressed the importance of early prostate cancer detection and called for a comprehensive screening program. Collaborative efforts with organizations like Prostate Cancer UK are essential to raise awareness and dispel misconceptions surrounding testing for this often overlooked disease.