Prostate cancer screening for ALL middle-aged men in pipeline after scientists uncover new techniques that slash chances of over-diagnosis
- Prostate cancer is the second most common cancer in UK behind breast cancer
- Experts say only a national screening programme will reduce deaths
Prostate cancer screening could soon be offered to all middle-aged men after trials showed new techniques slashed the chances of overdiagnosis.
Experts have long argued that only a national screening programme will significantly reduce deaths from the leading cancer in men.
Until now, tests have been too unreliable to pass the threshold, with the potential for unnecessary harms deemed to outweigh the benefits.
But new analysis of advances in screening and biopsy techniques in trials involving more than 600,000 men has been shown to cut potential harms by two-thirds (67 per cent).
Trials have found MRI scans can effectively pick up tumours while a new biopsy technique, known as transperineal guided biopsies, slashes the risk of infection
It comes as the UK’s National Screening Committee announced it will review all evidence for prostate screening, with a decision expected by the end of the year.
Charities welcomed the review, with estimates an NHS programme – similar the breast screening offered to women – could save thousands of lives every year.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: ‘We’ve known for some time now that testing more men reduces prostate cancer deaths.
‘But there have always been concerns about how many men would be harmed to achieve this.
‘However, our evidence shows that screening may now be a lot safer than previously thought.
‘That’s why we are so pleased that the committee is going to review the evidence once more.
‘It’s important that they consider this study and actual outcomes from the real-world NHS data and we hope they will find that we’ve reduced harm enough to be ready to launch a screening programme for prostate cancer.’
As it stands, men usually only find out they have prostate cancer when they start displaying symptoms such as frequent or difficulties urinating.
They can request a ‘PSA’ blood test from their GP, which they are eligible for over the age of 50 but this is far from accurate – missing many aggressive cancers and picking up too many cancers that would not cause problems if they had not been detected.
As a result, it has never been deemed accurate enough for a screening programme.
But trials have since found MRI scans can effectively pick up tumours while a new biopsy technique, known as transperineal guided biopsies, slashes the risk of infection.
Prostate Cancer UK analysed several clinical trials and current practice alongside real-world data from 16 NHS trusts in London and the South-West.
When compared to screening trial data using old methods, they found the percentage of men who suffered harm during the diagnostic process dropped from 13.39 per cent to 4.37 per cent.
The number of unnecessary biopsies fell from 9.46 per cent to 3.44 per and the number of men who developed sepsis fell by half from 0.1 to 0.5 per cent, according to findings presented at the ASCO Genitourinary Cancers Symposium in San Francisco.
Meanwhile the number of men being diagnosed with clinically insignificant cancer – meaning is unlikely to ever spread or cause real harm – fell by 77 per cent.
Ros Eeles, Professor of Oncogenetics at The Institute of Cancer Research, said the data ‘supports the shift towards the investigation of how to implement prostate screening’.
She said: ‘It shows us a rationale for the way forward to implementing a prostate screening programme in the UK.
‘The challenge will be to find better markers which indicate the presence of aggressive disease and to refine our use of genetic risk stratification to be able to target new methods of screening to those at highest risk.’
Prostate cancer is the second most common cancer in the UK behind breast cancer, responsible for around 12,000 deaths a year.
It is estimated screening could cut deaths by a fifth but the current test is unreliable, resulting in men suffering harms such as unnecessary or repeated biopsies, which can lead to serious infections.
WHAT IS PROSTATE CANCER?
How many people does it kill?
More than 11,800 men a year – or one every 45 minutes – are killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.
It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain.
In the US, the disease kills 26,000 men each year.
Despite this, it receives less than half the research funding of breast cancer and treatments for the disease are trailing at least a decade behind.
How many men are diagnosed annually?
Every year, upwards of 52,300 men are diagnosed with prostate cancer in the UK – more than 140 every day.
How quickly does it develop?
Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS.
If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it is diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.
Tests and treatment
Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge.
There is no national prostate screening programme as for years the tests have been too inaccurate.
Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.
Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.
But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not fool-proof.
Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks.
Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org
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