Prostate cancer remains the most common cancer among men in the UK, with approximately 63,000 cases diagnosed annually, leading to around 13,000 deaths. The prospect of a national screening programme—similar to routine mammograms for breast cancer in women—has been mooted as a way to detect prostate cancer earlier, potentially saving countless lives each year. This idea has gained public support, especially following high-profile cases such as Olympic cyclist Sir Chris Hoy, who revealed his terminal prostate cancer diagnosis at just 48 despite having no symptoms.

However, despite the apparent logic behind such a programme, the UK Government reportedly plans to postpone the introduction of routine national screening for prostate cancer. Many doctors and experts support this cautious approach, citing concerns that screening could cause more harm than good by leading to overdiagnosis and overtreatment. At the heart of this debate is the prostate-specific antigen (PSA) test, which measures protein levels linked to prostate health but is not cancer-specific. PSA levels can be elevated due to benign reasons such as prostate enlargement, infections, recent sexual activity, or even cycling.

Currently, men over 50 can ask their GP for a PSA test, but there is hesitancy in implementing a nationwide screening programme. Critics argue that such a programme would yield numerous false positives, resulting in unnecessary MRI scans and, for those with suspicious findings, biopsies—an invasive procedure involving tissue samples that can have side effects, including infection and stress. Professor Roger Kirby, a retired prostate surgeon, notes that because PSA testing lacks precision, many men with elevated PSA undergo costly MRI scans that turn out normal, which strains healthcare resources without proportional benefit.

Nevertheless, some emerging evidence challenges the long-standing reservations about prostate cancer screening. According to Professor Nicholas James of the Institute of Cancer Research, new data from recent large trials indicate that regular PSA screening can significantly reduce deaths from prostate cancer. One major European trial highlighted that men screened regularly had lower mortality rates, and follow-ups over 15 years have suggested these benefits increase over time, with fewer deaths among those screened versus those who were not.

Yet, the risk of overtreatment remains a significant concern. Many prostate cancers detected early via PSA testing are slow-growing and may never pose a threat during a man’s lifetime. Treatment, however, including surgery, can profoundly affect quality of life, often impairing sexual function and causing long-term complications. Thus, early detection does not always translate into improved outcomes, and treatment decisions are complex.

This nuanced landscape means men must make informed choices about testing. Experts maintain that having a PSA test, particularly for those at higher risk, is advisable, even if the NHS does not yet offer a full national screening programme. High-risk groups include men with a family history of prostate cancer, carriers of certain genetic mutations such as BRCA1 and BRCA2, and black men, who face a significantly higher lifetime risk of diagnosis. PSA tests are accessible on request for men over 50, or from 45 for black men, regardless of symptoms, and GPs should not refuse after a proper risk-benefit discussion. Despite this, surveys reveal that over 60% of men over 50 have never requested a PSA test.

For men at average risk and good health, PSA screening every five years may be sufficient. This approach mirrors how blood pressure or cholesterol levels are monitored, establishing a baseline and acting on changes accordingly. Conversely, men with multiple serious health conditions may not benefit from screening, as their risk of dying from other illnesses outweighs the potential prostate cancer threat.

If a national screening programme is to be considered, a targeted approach prioritising those at highest risk appears to be the most cost-effective and clinically beneficial. A recent report by the charity Prostate Cancer Research advocates annual testing for men aged 45 to 69 with a family history or of black ethnicity, estimating this could deliver significant life years gained for a relatively modest NHS investment, including a handful of additional MRI scanners.

Technological advances may further refine screening strategies. MRI scans have become a crucial adjunct to PSA testing, with improved ability to detect significant cancers and reduce unnecessary biopsies. Recent studies presented at professional congresses and published clinical trials suggest MRI screening, especially when used to target biopsy procedures, lowers the detection of insignificant cancers that might never cause harm, while reliably identifying clinically significant tumours. This reduces overtreatment risks and could improve patient outcomes. Yet, an MRI-only screening may not significantly increase detection over PSA testing alone, although it helps mitigate some harms of unnecessary interventions.

Looking ahead, personalised screening based on genetic profiling offers promise. This individualised risk assessment could tailor PSA and MRI testing to those most likely to benefit, optimising resource use and minimising harms. However, such genomic tools are still under development and unlikely to be standard practice in the near term.

The experiences of men like Junior Hemans underline the importance of early detection. Hemans, a black man, proactively sought PSA testing at 52—years after becoming eligible—and was able to detect his cancer early, which was successfully treated with radiotherapy. He urges other men to advocate for testing, emphasising that catching cancer early typically results in less invasive treatment and better outcomes.

In conclusion, while a universal prostate cancer screening programme remains stalled amid concerns of cost-effectiveness and clinical harm, experts broadly agree on the value of informed PSA testing, particularly for high-risk individuals. Advances in imaging and personalised medicine offer pathways toward better balancing early detection benefits and the risks of overdiagnosis and overtreatment. Men are encouraged to engage in discussions with their healthcare providers and consider their personal risk factors to make educated decisions about prostate cancer screening.

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Source: Noah Wire Services