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 from Europe and the UK are:
• There are NO new markers available to replace PSA as the initial screening tool for PCa.
• “Risk Calculators” can be used to determine risk and optimum frequency of PSA testing for men over 40 ref 1
• The key risk factors are: the initial PSA level* ref 2,3, advancing age, a family history of prostate cancer or breast cancer and black ethnicity, including men of mixed African or Caribbean descent. Most GPs are not familiar with these risk factors ref 4.
• DO NOT stop screening at age 70 ref 5.
• 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 ref 6,7. Consequently the European Urological Association has now recommended to the European Parliament that national PSA-based screening programmes be introduced ref 8.
• A raised PSA must be followed by second line tests BEFORE undergoing a prostate biopsy. In the UK mp-MRI is the recommended test ref 9 but numerous blood and urine tests are competing for recognition.
• mp-MRI scanning is greatly reducing the so-called “over-diagnosis” of non-aggressive, insignificant PCa in the UK ref 10.
• 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 the “over-treatment” rate for non-aggressive, insignificant PCa in the UK has now fallen to only 4% ref 11.
• “Active Surveillance” is a safe treatment option for apparent non-aggressive PCa ref 12.
• Minimally invasive treatments for early, localised PCa continue to demonstrate reduced side effects and good cancer control/cure.
* For men age 40-60, a “normal” initial PSA of 1-2ng/ml carries a 26% risk of later PCa; an initial PSA of 2-3ng/ml carries a 40% risk of later PCa. Such men require 1-2 yearly screening.
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 on the NHS, after appropriate counselling, which can be arranged via your GP. This is a current NHS entitlement ref 13.
1. Prostate Cancer Research Foundation, Reeuwijk. In partnership with the European Randomised Study of Screening for Prostate Cancer; accessed 4/10/19.
2. Scand J Urol. 2018. Sep 21: 1-7.
3. Eur Urol. 2013. 64(3): 347-54
4. 2019. https://orchid-cancer.org.uk: Prostate Cancer: Survey of GPs. Censuswide; accessed 21/10/19.
5. BJU Int. 2014; 113: 186-88.
6. Eur Urol. 2015; 65: 329-36.
7. Urology. 2018; 118: 119-26.
8. Policy Paper on PSA Screening for Prostate Cancer. European Association of Urology.
9. nice.org.uk/guidance/ng 131/chapter/Recommendations # assessment-and-diagnosis. May 2019; Accessed 21/10/19.
10. Lancet 2017; 389: 815-22.
11. National Prostate Cancer Audit; Annual Report 2019, HQIP.
12. N Eng J Med 2016; 375: 1415-24.
13. Public Health England. www.gov.uk/guidance/prostate-cancer-risk-management-programme-overview. Accessed 21/10/19.