Prostate Cancer Screening – Update

As a charity campaigning for better awareness and access to PSA screening for Prostate Cancer (PCa), we flag up significant advances in our fight against our commonest male cancer killing nearly 12,000 UK men every year, a figure now exceeding deaths from breast cancer.  We therefore track reports from scientific journals and international conferences.  The “take home” messages so far this year have come mainly from Europe:

  • There are no new markers available to replace PSA as the initial screening tool for PCa.
  • “Risk Calculators” should be used to determine the optimum frequency of PSA testing for men over 40.
  • Do not stop screening at age 70.
  • Men in PSA screening programmes run for up to 20 years are now consistently benefiting from 50% reductions in the PCa death rate compared with men who are not being screened.  Consequently the European Urological Association has now recommended to the European Parliament that national PSA-based screening programmes be introduced.
  • A raised PSA must be followed by second line tests before undergoing a prostate biopsy.  In the UK mp-MRI is the recommended test but numerous blood and urine tests are competing for recognition.
  • No tests are 100% reliable yet in detecting PCa or differentiating between aggressive cancers that need treatment and non-aggressive, insignificant cancers that do not need treatment, but we are getting close to this objective.
  • mp-MRI scanning is greatly reducing the so-called “over-diagnosis” of non-aggressive, insignificant PCa in the UK.
  • The so-called “over-treatment” rate for non-aggressive, insignificant PCa in the UK has fallen to only 4%.
  • “Active Surveillance” is a safe treatment option for apparent non-aggressive PCa.
  • Minimally invasive treatments for early, localised PCa continue to demonstrate reduced side effects and good cancer control/cure.

In conclusion, the evidence now clearly shows that if a man wishes to reduce his chance of dying from PCa, he should start PSA screening no later than age 50.  All men over 50 in the UK are entitled to have a PSA test as decreed in current NHS regulations.

Chris Booth, Member of Tackle’s Clinical Advisory Board


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