Prostate cancer test 'saves lives' but risk of overtreament remains
A major assessment of the effectiveness of the PSA blood test to detect prostate cancer has been delivered
Screening men for prostate cancer using a blood test is likely to reduce deaths from the disease although experts have stressed there are still risks around overdiagnosis and overtreatment.
The findings of the analysis, which included almost 800,000 patients, may “support a conversation” around screening using the prostate specific antigen (PSA) test, which researchers described as “imperfect”.
Cancer Research UK also said the test is “not effective enough”.
Now, in a major new Cochrane review, experts have analysed the results of six trials involving 789,086 patients.
The men involved spanned from 45 to 80, but were primarily aged between 50 and 70.
The analysis found that, without screening, 16 men per 1,000 would die from prostate cancer.
Screening reduced this by two deaths, to 14 per 1,000 men.
The latest findings are a shift from a previous Cochrane review in 2013, which found that screening did not significantly reduce deaths.
The trials included in the latest research did not look at impacts on quality of life, such as complications from biopsies, sexual dysfunction and urinary problems.
However, first author Dr Juan Franco, of Heinrich Heine University Dusseldorf, highlights other studies which estimate the overdiagnosis rate to be between 20% to 50% for prostate cancer.
He described the PSA as “an imperfect test” and stressed there are “many kinds” of prostate cancer.
Dr Franco said: “There are very aggressive kinds that can cause death, but there’s also very benign forms that take the whole life to grow and perhaps never cause any problems for men.
“That is what we call overdiagnosis and that is another side effect related to the screening.”
He added that the test can “detect a lot of benign cancers in men that ultimately would have never had caused any problems and those men who received the diagnosis may receive treatment”.
“That could be radiation, surgery, hormone therapy and they may suffer the side effects of those treatments,” he said.
However, senior author Dr Philipp Dahm, of the University of Minnesota, said the findings “support a conversation about PSA screening”.
“With new data now available, we can now say with moderate certainty that PSA screening reduces prostate cancer deaths in men with a sufficient life expectancy,” he said.”
There is currently no screening programme for prostate cancer in the UK, although men over 50 can request a PSA test from their GP.
The UK National Screening Committee (UKNSC) does not recommend screening using the PSA test because it “is likely to cause more harm than good”.
However, men with BRCA1 and BRCA2 genetic mutations should be screened every two years.
Leading figures from the world of business and sport, including Sir Chris Hoy - who was initially diagnosed with stage four prostate cancer in September 2023 with the disease now terminal - and Sir Tom Hunter urged tens of thousands of Scots men to take part in a free new screening programme for the cancer.
Some 25,000 men aged between 40 and 80 will initially be offered free PSA testing with the Scottish Prostate Cancer Initiative. A range of more advanced diagnostic tests will be deployed across selected groups with the study also aiming to improvethe existing clinical pathway for detecting and treating prostate cancer.
Reacting to the findings of the Cochrane review, Dr Ian Walker, executive director of policy at Cancer Research UK, said: “This is the most comprehensive study of prostate cancer screening to date and highlights why there isn’t currently a widespread screening programme in the UK.
“Unfortunately, the test currently used to detect prostate cancer is not effective enough.
“The study shows the complex challenge of balancing benefits against unintended harms when informing recommendations around screening.”
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