Charity calls for prostate-cancer testing of high-risk men

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Charity calls for prostate-******* testing of high-risk men

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Screening men born with a high risk of developing prostate *******, once they reach the age of 45, makes financial sense, a ******* charity says.

But Prostate ******* Research also acknowledges more accurate tests would be needed to justify screening all men.

There is no prostate-******* screening programme in the ***, unlike those for *******, bowel and cervical *******.

Instead, the onus is on men to request a blood test from their GP once they are over 50.

Men dying

The debate around prostate screening revolves around an imperfect test and the trade-off between finding some men’s aggressive cancers earlier and the harms of diagnosing and treating slow-growing tumours that would never have affected a man’s health or lifespan.

The case for and against is constantly reviewed in the ***, with the most recent report from the National Screening Committee, in 2020, saying the harms were too great.

Further updates are expected this year.

Despite more men dying from prostate ******* than women from ******* *******, there is no reliable test for the ********.

The blood test men over 50 can request from their GP measures prostate-specific antigen (PSA), released by the prostate, a small ****** located below the bladder involved in the production of ******.

But PSA levels can be high for a variety of reasons – including an enlarged prostate, inflammation or infection, recent vigorous exercise or **** – or remain normal despite *******.

And there are many different kinds of prostate ******* – not all deadly.

“There are prostate cancers that are so slow-growing that they will not affect a man’s lifespan,” GP Dr Margaret McCartney says.

These are found in one in three men over 50.

“And then you have a small number of very aggressive prostate cancers which do move quickly and cause harm,” Dr McCartney says.

Follow-up magnetic resonance imaging (MRI) scans and a tissue biopsy can help narrow down which men have ******* and need treatment – but some still end up being treated for something that would never cause a problem.

“Far more men have tests done to try to work out what kind of prostate ******* it is, than are going to benefit from it – there’s the problem,” Dr McCartney says.

Followed up

Clinical trials have produced conflicting results about screening.

One, in Europe, says it saves lives.

Another, in the ***, shows a more marginal benefit.

And a third, in the US, says it does not.

Prof Hashim Ahmed, chair of urology at Imperial College London, says: “We need to screen 570 men to prevent one ****** – that’s a lot of men to counsel.”

Screening means aggressive cancers can be treated before symptoms appear.

But trials show there are harms to testing large numbers of healthy men – and once a ******* is spotted, even a low-risk one, it needs to be followed up.

***** ******

Many men with a low-risk ******* are simply monitored or begin “watchful waiting” – but a ******* diagnosis and the invasive tests it involves have a psychological impact.

One in 10 of these men opts for ******** surgery rather than live with the anxiety of wondering whether their ******* will grow, Prof Ahmed says.

But this can leave them unable to maintain an ********* – and a third spend the rest of their life needing a pad because they ***** ******.

“At the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms,” Prof Ahmed told BBC Radio 4’s Inside Health programme.

“So I would rather avoid finding low-risk ********.”

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Much research in the field has focused on refining the process to minimise the harms of screening.

And Prof Ahmed is running

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, starting next year, to compare the most promising technologies.

But the results could be 10 years away.

In the meantime,

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says, screening 45-69-year-olds at high risk – ****** men and those with a family history of the ******** or particular gene mutations – would deliver an economic benefit, after factoring in the cost of treatment and the impact on working lives and carers.

“Finding and treating cancers early outweighs the harms of over-treatment by four times,” the charity’s chief executive, Oliver Kemp, says.

And another charity, Prostate ******* ***, says the report supports its call to overhaul “dangerously outdated NHS guidance that is leading to too many men receiving a late, incurable diagnoses”.

‘Very difficult’

Prof Frank Chinegwundoh, a consultant urological surgeon at Barts Health NHS Trust, says: “It’s very difficult to weigh up the risks and benefits.”

But he often sees men who could have been diagnosed earlier – and they can be relatively young, he says.

“We can do a lot better than we are currently doing,” Prof Chinegwundoh told Inside Health.

And he says ****** men – who have double the risk of the ******** – should consider having a PSA test at 40, particularly if they have a strong family history of the *******.

But earlier this year, concerns were raised ****** men were at greater risk than other men of being

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.

‘Tough question’

While the arguments rage, what should men do today?

“It’s a really tough question,” Prof Ahmed says.

And the NHS needs to give men better information.

The trade-off between the risks and benefits of being tested is “very nuanced, very personal”, Prof Ahmed says, and what is acceptable to one man will be unacceptable to another.

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