CampaignsHealthcare RationingCancer Screening & TreatmentProstate Cancer screening - "doubts remain" Prostate Cancer screening - "doubts remain"
By Alan Taylor - 09/07/2007
I was interested to read James Nicolson’s views about prostate cancer screening and the PSA test in “Let’s learn from the Bob Monkhouse prostate cancer film” (Mature Times online June 18th 2007).
For the benefit of readers I think it would be useful to repeat some of the issues about prostate cancer which I mentioned in my earlier article on June 7th. Prostate cancer is a very complex disease which is not yet fully understood either in the UK or worldwide. At present there is no substantive evidence that a prostate screening programme would save lives or that a screening programme would bring more benefits than harm. Linked to this is that medical opinion is divided on how best local, or early, prostate cancer should be treated. These conclusions are not restricted to the UK but are shared by the medical professions in the US and elsewhere.
We need to be clear about what is meant by a screening programme. For prostate cancer this means a mass screening programme when men over a certain age - say 45 - and without symptoms, are invited to visit their GP for a PSA test. James referred to the prostate cancer screening programme in the US but actually the US does not have a national prostate cancer screening programme. In the UK we talk about a man without urinary symptoms having a random PSA test, and in the US when a man has a random PSA test it may be said that he is being screened for prostate cancer - but in both countries this is not by invitation under a national screening programme.
The situation is that random PSA testing, however this may be described, is an option in the UK and the US but there is a much greater take up in the US - probably because of the US healthcare insurance arrangements which makes them much more likely than elsewhere to have a random PSA test and subsequent annual tests. The doctors in most of the major US medical organisations carry out PSA tests and, similar to the UK, they discuss the harms and benefits of the PSA test with the man before he decides to have a test.
I have lived with prostate cancer for seven years and actively supported prostate cancer charities for a number of years, so I am aware of the limitations of the PSA test and the arguments for and against a national screening programme. There is no doubt that some men are angry because there is still no reliable test to use in a screening programme and that some men who are diagnosed with prostate cancer get a raw deal. These concerns are not helped by the serious under funding over many years for research to understand and deal with prostate cancer.
Prostate cancer attracts a lot of misconceptions and misinformation, and for many men and their families it is difficult to sort fact from fiction. This is why promoting prostate cancer awareness is so important and the starting point for me is to tell men and their families where they can find reliable information from authoritative sources which has the backing of current medical opinion.
Unfortunately, whenever prostate screening is mentioned very little is said or known about the detail of the Department of Health’s policy for not introducing a screening programme. Because it is important for men and their families to understand why there is not a screening programme, I outlined the Department of Health’s policy in my article and included a link to the website of the Department of Health’s NHS Cancer Screening Programmes unit.
Readers may wish to have a look at the information on that website and also the corresponding information on a national screening programme and the PSA test on the websites of The Prostate Cancer Charity, Cancer Research UK and Cancerbackup and reach their own conclusions (links are at the end of this article). I was not defending the Department of Health’s policy on screening in my article but the reasons for not introducing a screening programme are persuasive and recognised worldwide.
Although there is not a national screening programme in the UK this does not mean that men cannot be tested for prostate cancer. The fall back position for men who do not have any urinary symptoms, particularly those over the age of 50, is to have a PSA test when they have considered the pros and cons of this. The downside of this is that going for a PSA test voluntarily rather than by an invitation, as would happen if there were a national prostate cancer screening programme, takes some effort and this is why it is important to know about prostate cancer. Men who would like to have a PSA test should speak to their GP as explained in my article.
So what is the chance of a national prostate cancer screening programme in the future? Until more is known about prostate cancer, how best to treat local or early prostate cancer and it is shown that a national screening programme would save lives then the chances of a screening programme being introduced look slim. However, these uncertainties may become clearer when the results of a number of studies are published over the next few years.
These are:
- The European Randomised Study of Screening for Prostate Cancer (ERSPC). This study is being carried out in eight European countries and is examining whether the early detection and treatment of prostate cancer will save lives;
- The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). This is a large scale trial in the US, which is examining whether certain screening tests reduce deaths from these cancers
- The Prostate Testing for Cancer and Treatment Study (ProtecT). This study is examining whether the treatments for localised prostate cancer are effective, cost effective and acceptable.
There is a lot going on and further information about these trials is given on the website of the NHS Cancer Screening Programmes unit under Prostate Cancer Risk Management, then Research.
Prostate cancer is an important issue for men and their families and I hope the links in this article give men a starting point to understand the disease - especially as it is the 10th Everyman Male Cancer Awareness Month this July.