A recent review suggests that screening men for prostate cancer with a blood test could reduce deaths from the disease. The analysis, which involved nearly 800,000 patients, indicates that the prostate-specific antigen (PSA) test may be a valuable tool for screening discussions. However, concerns persist about the risks of overdiagnosis and overtreatment, as highlighted by Cancer Research UK.
Prostate cancer is a leading cancer in the UK, with more than 64,000 annual diagnoses, yet opinions on screening remain divided. Some experts argue that the PSA test, which measures prostate-produced protein levels, can lead to inaccurate results and unnecessary treatments. The test may detect non-threatening tumors, potentially causing harm through unnecessary interventions like surgery or radiation.
A recent Cochrane review examined six trials involving over 789,000 patients, with results indicating a decrease in prostate cancer deaths with screening. Without screening, 16 out of 1,000 men would die from the disease, a number reduced to 14 with screening. This contrasts with a previous Cochrane review from 2013 that suggested screening had minimal impact on mortality rates.
Although the recent trials did not assess quality-of-life impacts, concerns about overdiagnosis persist. Dr. Juan Franco, the lead author, emphasized the imperfections of the PSA test and the varying nature of prostate cancer. He noted the potential for overdiagnosis leading to unnecessary treatments and their associated side effects.
Dr. Franco and Dr. Philipp Dahm, the senior author, support initiating discussions about PSA screening for men with adequate life expectancies. They stress the importance of informed decision-making between patients and doctors, considering both benefits and risks associated with screening. Currently, the UK lacks a national prostate cancer screening program, with PSA tests available upon request for men over 50 through their GPs.
In response to the Cochrane review, Dr. Ian Walker of Cancer Research UK emphasized the complexities of prostate cancer screening. While the PSA test may save lives, it can also lead to unnecessary diagnoses and treatments with potential long-term consequences. The Transform trial, funded by Prostate Cancer UK and the National Institute for Health and Care Research, aims to explore alternative screening methods like genetic tests and MRI scans to optimize prostate cancer screening.
