Updated draft recommendations for British prostate cancer screenings have advised the government against a population-wide screening programme, with the UK National Screening Committee (UKNSC) saying that attempting to detect the disease using the prostate specific antigen (PSA) blood test is “likely to cause more harm than good”, and that only “a few thousand high-risk men should be tested”.
However, reports The Independent, it does recommended that men with BRCA2 genetic mutations – which puts them at far higher risk of prostate cancer – should be screened every two years, between the ages of 45 and 61, if they have a family history of certain cancers.
The final decision differs from the draft recommendation published in November, which said men with both BRCA1 and BRCA2 gene mutations should be screened.
The UKNSC also recommends against screening for other at-risk groups, including black men, saying there is “ongoing uncertainty on whether screening would cause more good than harm”.
The main harms of population screening “include incontinence and erectile dysfunction in men who do not need treatment” for the disease, it noted.
Professor Sir Mike Richards, chairman of the UKNSC, said: “We absolutely recognise the strong support for prostate cancer screening among a large number of people, but also the very real harm that can be caused by the disease, which patients and their families, experience.
“We do know that screening can reduce deaths from prostate cancer to a small extent, and it does not improve overall survival.”
He said that many men “will live full lives” without the disease causing harm and screening can “only help if it can separate out that harmful disease from the harmless disease”.
“Once a prostate cancer is found, we still can’t reliably tell which cancers need treatment and which do not. There’s a spectrum there and the treatments available for prostate cancer can cause long-lasting harm.”
The levels of over-diagnosis in prostate cancer remain high, he added, despite advances like MRI scans before a biopsy and after a positive PSA test.
The committee recommends screening men with a BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancers, as prostate cancer is more common, develops earlier and can be more aggressive in this group.
Of 100 men with a BRCA2 variant, between 21 and 35 of them will develop prostate cancer before the age of 80.
Richards said more work needs to be done to determine the best way of identifying and inviting these patients, which he said will be evaluated over time by working with NHS organisations in the UK.
The UKNSC also said that screening is likely to cause more harm than good in men who have a family history of breast, ovarian and prostate cancer, but do not have the BRCA2 mutation.
The change in recommendations was down to recent data which emerged between the draft guidance and final guidance being published, experts said.
Anneke Lucassen, Professor of Genomic Medicine and Director of the Centre for Personalised Medicine at the Nuffield Department of Medicine, University of Oxford, said previous studies “hadn’t been able to clearly separate out” the risks posed by both the BRCA1 and BRCA2 variants.
She said that two large studies published recently suggest the prostate cancer risk is mainly from BRCA2 and not BRCA1, and that the risk among those with BRCA1 is “significantly lower”.
Richards said: “There really is insufficient evidence at present as to whether screening would do more good than harm.”
He added: “For black men, it’s more a question of do they differ from the population in the aggressiveness of the cancer.”
More research was needed to address evidence gaps, he said.
The UKNSC will work closely with the Transform trial, which was launched last year by Prostate Cancer UK to gather more data.
Richards said it is “particularly important” that a “sufficient number” of black men are invited to take part in the trial, and that the committee received a “very large” number of responses during the 12-week consultation period after publication of its draft recommendation last year.
“I personally, and the National Screening Committee as a whole, hope that new evidence and new tests and a better understanding of prostate cancer will support wider prostate cancer screening in future. We are in favour of doing that, but we do need the evidence first.”
Chiara De Biase, fundraising and health strategy director at Prostate Cancer UK, said the charity is “deeply disappointed” with the UKNSC recommendation.
“Without a screening programme for the UK’s most common cancer, we lose more than 12 000 dads, brothers, and partners every single year,” she said.
“We know that a mass screening programme could save thousands of men’s lives, and while we recognise the current evidence does not yet show that screening all men at risk would do more good than harm, the decision is a step backwards, narrowing the recommendation to a smaller pool of eligible men.”
Former prime minister Lord David Cameron, who has been treated for prostate cancer, also expressed disappointment. The recommendation is a “real step back”, he said, and urged the Health Secretary to reject it.
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