If you’re a man in your late 40s, you should be offered a screening test for prostate cancer. This is according to a group of Swedish researchers, who say that checking every man aged 45-49 would predict nearly half of all prostate cancer deaths. However, this advice, based on their study published in the British Medical Journal (BMJ), is controversial, as prostate specific antigen (PSA) testing can be unreliable.
There is no routine screening programme for prostate cancer in the UK, but men over 50 can request a free PSA test on the NHS if they wish. The problem with PSA testing is that it can often give false positive results, which can take its toll on your wellbeing, causing undue worry and even treatment over something benign. The prostate cancer screening trial in Europe, ERSPC, showed that screening reduced mortality by 20%, but this was associated with a high level of “over treatment”; 48 additional cases of prostate cancer needed to be treated in order to save one life.
When the UK National Screening Committee in England last reviewed the issue in 2010, it again decided screening should not be introduced. However, the new study, which involved more than 21,000 men, found that there could be a strong case for routine PSA testing, for which men in their late-40s are prime candidates. Carried out by Professor Hans Lilia and colleagues from Lund University in Sweden and the Memorial Sloan-Kettering Cancer Centre in the US, the researchers evaluated a 10-year study which finished in 1984, using stored donated samples to run PSA tests.
The researchers found that men with a high PSA were more likely to develop prostate cancer, but this was best detected between the ages of 45 and 49 – any earlier detected too few deadly cancers, and delaying screening until after a man’s 50th birthday missed too many. The researchers commented, ‘At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime. This is likely to reduce the risk of over-diagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis.’
Dr Anne Mackie, Director of NHS Screening Programmes at Public Health England, said that every three years, the organisation reviews evidence for screening to ensure that the programmes offered by the NHS are based on the best and most up-to-date information available. She said, ‘We are currently in the process of a scheduled review for a screening programme for prostate cancer and will make a recommendation towards the end of 2013.’