No prostate cancer screening for UK men
No prostate cancer screening for UK men
This article waslast modified
on 10 July 2017.
The UK National Screening Committee repeated its recommendation against routine screening for prostate cancer with the prostate specific antigen (PSA) blood test at a meeting in November 2010. The Committee's findings were based on evidence from three large clinical trials: the European Randomized Study on Screening for Prostate Cancer, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the Prostate Testing for Cancer and Treatment Trial.
The first two trials were appraised for the Committee by the School of Health and Related Research in the University of Sheffield. They illustrated their analysis with a flow chart model that showed, in brief, that if 80,000 men aged 50 took up an offer of screening, the 3,000 with a positive PSA test would be likely to go on to have biopsy specimens taken from the prostate. Of these 2,250 would be negative for cancer. Treatment of the 750 patients with positive biopsies would save a total of 280 years of life, but more than a third would have sexual dysfunction, 3% urinary incontinence and 2% rectal problems. They found that a single PSA screen at 50 has little effect on the age-specific incidence of prostate cancer, and there was little benefit from annual or biannual screens.
After reviewing the three clinical trials, the UK National Screening Committee concluded that the potential harms of the PSA test, including the worry and anxiety caused by a high proportion of false positives, outweighed any potential benefits. They noted that benign enlargement of the prostate or a urinary infection can increase serum PSA levels. A more specific and sensitive test is needed, ideally one that can distinguish cancers that will progress from those that are indolent and may be safely watched.
The Committee will review their recommendation in 2013/14, or earlier if significant new evidence emerges. Individuals who are concerned can obtain the Committee’s information leaflet about the risks and benefits of PSA from their GP and request a test if they wish.
The first two trials were appraised for the Committee by the School of Health and Related Research in the University of Sheffield. They illustrated their analysis with a flow chart model that showed, in brief, that if 80,000 men aged 50 took up an offer of screening, the 3,000 with a positive PSA test would be likely to go on to have biopsy specimens taken from the prostate. Of these 2,250 would be negative for cancer. Treatment of the 750 patients with positive biopsies would save a total of 280 years of life, but more than a third would have sexual dysfunction, 3% urinary incontinence and 2% rectal problems. They found that a single PSA screen at 50 has little effect on the age-specific incidence of prostate cancer, and there was little benefit from annual or biannual screens.
After reviewing the three clinical trials, the UK National Screening Committee concluded that the potential harms of the PSA test, including the worry and anxiety caused by a high proportion of false positives, outweighed any potential benefits. They noted that benign enlargement of the prostate or a urinary infection can increase serum PSA levels. A more specific and sensitive test is needed, ideally one that can distinguish cancers that will progress from those that are indolent and may be safely watched.
The Committee will review their recommendation in 2013/14, or earlier if significant new evidence emerges. Individuals who are concerned can obtain the Committee’s information leaflet about the risks and benefits of PSA from their GP and request a test if they wish.