A significant new study indicates that prostate cancer screening could reduce mortality by 13%, as UK health authorities weigh the introduction of a national screening programme. A decision is expected before the end of the year.
Targeted Screening Approach Recommended
Published in the New England Journal of Medicine, the research advocates for a 'targeted' screening strategy. This method aims to not only lower death rates but also address the persistent issue of 'overdiagnosis,' a major concern in prostate cancer detection.
Researchers analysed data from eight European countries over 23 years, involving 162,000 men. Of these, 72,000 were invited for screening. The findings showed that one death from prostate cancer was prevented for every 456 men invited, and one death averted for every 12 men diagnosed. Commentators noted these results are 'comparable to that seen with breast or bowel cancer screening.'
Balancing Benefits and Harms
The study's authors stated that screening now has a 'more favourable harm-to-benefit profile than previously estimated.' However, they warned that 'harms linked to screening remain a critical concern,' including unnecessary testing, invasive biopsies, overdiagnosis, and overtreatment, which can cause significant distress and side effects.
'These findings highlight the need for a more targeted strategy for prostate cancer screening that focuses on identifying population subgroups most likely to benefit from early detection while reducing unnecessary interventions for those with the highest risk of overdiagnosis,' the researchers wrote.
Current UK Screening Policy
Currently, the prostate-specific antigen (PSA) test is not routinely offered on the NHS. Men may receive a PSA test if a GP suspects prostate cancer, and those over 50 can request one even without symptoms. Officials face increasing calls for a national screening programme but are carefully weighing the concerns raised by this and other reviews. A recent study in The BMJ also found that PSA tests can lead to over-testing while potentially missing those who need help.
Expert Reactions
Professor Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, London, commented: 'The latest analysis from the ERSPC further strengthens the evidence base in favour of PSA-based prostate cancer screening. The overall reduction in risk of death is comparable to that seen with breast or bowel cancer screening.' He added that harms like overdiagnosis can be mitigated with technologies such as MRI pre-biopsy and modern treatments with fewer side effects.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, echoed this: 'The ERSPC trial has now shown that the balance between benefits and harms of screening with PSA testing is better than previously thought. Although a large number of men were overtreated, that number has also reduced in this latest analysis. This is exactly the kind of evidence the National Screening Committee needs when making its decision, especially for men at higher risk like black men and those with a family history.'
Ongoing Concerns
Rhian Gabe, professor of biostatistics at Queen Mary University London, noted: 'These results confirm prevention of prostate cancer death with repeat PSA testing, however, concerns remain about unnecessary biopsies and harms of overdiagnosis and overtreatment. Newer technologies provide hope that these negative aspects can be addressed, but evidence from randomised controlled trials incorporating these technologies is needed.'
Dr Ian Walker, executive director of policy at Cancer Research UK, cautioned: 'While this long-running study suggests that screening using the PSA test could help reduce deaths from prostate cancer, it also concludes that screening still caused harm. Men in the screening group were more than twice as likely to be diagnosed with low-risk disease, often leading to unnecessary and sometimes invasive treatment. The UK National Screening Committee will consider this trial as part of its independent expert review, and it’s vital that we await its recommendations and continue research into better detection methods.'
New Treatment Approved
Separately, the National Institute for Health and Care Excellence (Nice) recently approved abiraterone for men with newly diagnosed high-risk hormone-sensitive metastatic prostate cancer. Initially rejected in 2021 due to cost concerns, the drug was approved after lower-cost generic versions became available, benefiting around 4,000 men.
