The Department of Health and Social Care recently advised men over 50, and black men over 45, to consult their GP about their risk of prostate cancer. This is because one in eight men will develop the disease in their lifetime, resulting in 12,000 deaths each year. Prostate cancer is the second most common cause of cancer-related deaths in men, after lung cancer. However, this advice has been met with apprehension from senior GPs and government advisers, who fear that GPs would be overwhelmed by the number of men seeking prostate checks. They also highlight concerns about the reliability of PSA tests, which can lead to false positives.
Despite these concerns, experts in prostate cancer, including the charity Prostate Cancer UK, argue that new diagnostic methods have made the diagnosis safer and more accurate. The European Commission recommended screening programs in EU member states last year, and experts believe the UK may soon follow suit. Dr. Matthew Hobbs, director of research at Prostate Cancer UK, suggests that GPs should be allowed to be more proactive and offer PSA tests to high-risk individuals. Previously, men with a raised PSA were referred for invasive biopsies, but now they are given a new type of MRI scan called mpMRI, which reduces the need for biopsies.
However, some questions still need to be answered before widespread screening is implemented. Over-diagnosis remains a concern, as slow-growing cancers that would not have caused harm are treated aggressively. The potential complications of treatment, including sexual dysfunction, bladder, and bowel problems, are troubling. Historically, for every man with life-threatening prostate cancer detected through a PSA test, 12 more were diagnosed with cancer that wouldn’t have caused harm. It is unknown if new diagnostics will reduce over-diagnosis or deaths.
Despite the uncertainty, Professor Nick James, a urological cancer expert, believes that a larger proportion of those receiving treatment now have significant cancers that will benefit from intervention. Monitoring with MRI scans and repeat PSA tests may be sufficient for those with less significant cancers. Critics of screening argue that it will detect cancers that wouldn’t have been fatal, leading to unnecessary treatment. However, Professor James suggests that these criticisms are based on outdated studies from 20 years ago. In his clinic, only half of the men with a raised PSA require treatment.
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