A panel of expert government health advisers has said prostate cancer screening should not be made available to most men across the UK, leaving many charities and campaigners “deeply disappointed”.
Instead the UK National Screening Committee (UKNSC) has recommended that there should be a targeted screening program for men with a confirmed BRCA1 or BRCA2 defective gene variant, meaning they have a higher risk of fast-growing and aggressive cancer at a younger age. Men in that category can be screened every two years between the ages of 45 and 61, he said.
The committee found that if prostate cancer screening were recommended for all men and men with a relevant family history of cancer, “the harms would outweigh the benefits”, as it might lead to a small reduction in prostate cancer deaths, but “much more diagnoses”.
When it came to screening black men, who have a higher risk of prostate cancer, the committee found that the current evidence is “incomplete and inconclusive”.
In response to the committee’s draft recommendation, the Health Secretary, Wes Streeting, said he would “thoroughly examine the evidence and arguments in this draft recommendation”.
The draft recommendation will now be open for 12 weeks of consultation before a final recommendation is made to the government in March.
Prostate cancer is the most common male cancer, affecting one in eight men, with approximately 55,300 new diagnoses and 12,200 deaths each year. Despite being the second most common cancer in the UK after breast cancer, there is currently no screening program due to the unreliability of the prostate specific antigen (PSA) test.
One in four black men will be diagnosed with prostate cancer in their lifetime and this group has a higher risk of late diagnosis of the disease than their white counterparts, but the committee did not recommend that they be screened due to uncertainties in the data.
Screening of black men could lead to “high rates of over-diagnosis and over-treatment”, he said, adding that their modeling showed that an annual screening program for black men aged 55 to 60 could lead to “over-diagnosis” of 44% of prostate cancer. This is because some prostate cancers that grow slowly and are not aggressive do not require definitive treatment.
The committee estimated that approximately 40–50% of prostate cancer cases detected by PSA screening would be slow-growing, and that further treatment and testing for these slow-growing cancers would lead to “high levels of over-diagnosis and over-treatment, leading to unnecessary worry and lifelong side effects such as incontinence, erectile dysfunction and bladder problems” for cancers that would never cause harm.
The committee concluded that screening all men in the UK for prostate cancer, regardless of their risk, would slightly reduce the number of deaths from the disease, but would lead to “overdiagnosis of a very large number of men”. Men with a family history of prostate, breast or ovarian cancer were also not recommended for screening by the committee for similar reasons.
BRCA1 and BRCA2 gene variants are faulty genes that can increase a person’s risk of developing breast, pancreatic, ovarian and prostate cancer.
According to Cancer Research UK, around one in 300 to one in 400 people will have a faulty BRCA1 or BRCA2 gene, with many people unaware of their condition.
People with Jewish ancestry have a higher risk of having the faulty gene, with one in 40 Ashkenazi Jews and one in 140 Sephardi Jews at risk.
Men are encouraged to talk to their GP about having a blood or saliva test for the faulty gene if there is a history of cancer in their family.
Although the screening committee could not give an exact figure for the number of men who would be eligible for prostate cancer screening under their proposal, it is expected to be only a few thousand men, given the rarity of the gene mutation.
Although some charities welcomed the screening committee’s decision, others and some public figures expressed “deep disappointment” that men most at risk of the disease would not be offered screening.
Cancer Research UK said it “supports the committee’s conclusion that for other groups of men, there is currently not enough high-quality evidence that screening will do more good than harm”.
Dr Ian Walker, executive director of policy at Cancer Research UK, said: “It may miss dangerous cancers and detect cancers that do not need treatment.
“Work still needs to be done to understand how the proposed screening program can be delivered, and we look forward to the UKNSC presenting further details in due course.”
However, public figures including the charities Prostate Cancer UK and Prostate Cancer Research, Stephen Fry and Rishi Sunak expressed “deep disappointment” at the screening committee’s decision and warned that many more men would be at risk of late diagnosis or even death from the disease.
Laura Kerby, chief executive of Prostate Cancer UK, said the decision was “a blow to the thousands of men, loved ones and families who have fought to get into the screening programme.”
Kerby said: “Although only a fraction of this would be saved by screening men with BRCA gene variations, the committee’s decision is the first time they have recommended any type of screening for prostate cancer. It shows that research and evidence can turn the dial and save men’s lives.”
Prostate Cancer Research said that excluding black men and men with a family history of the disease is a “serious error that ignores modern evidence and risks exacerbating health inequalities for another generation”.
Both Fry and Sunak, ambassador for prostate cancer research, expressed disappointment at the decision. Sunak said it was “a missed opportunity to drive generational change in male health”, while Fry said that “men in the UK deserved much better”.
Streeting said: “I have always said I would like to see screening for the most common cancers in men, provided it is supported by evidence.
“I want to change the NHS so that it diagnoses earlier and treats faster. This aim will be balanced against the harms that widespread screening may cause men.”
He added: “Ahead of the final recommendation in March, I will thoroughly examine the evidence and arguments in this draft recommendation and bring together people with different views.
“Meanwhile, we will continue to make progress on cutting cancer waiting times and investing in prostate cancer detection research – in the last 12 months, more than 193,000 patients received a suspected cancer diagnosis in time.”
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