Fewer men should get prostate cancer screening, committee recommends

Most men in the UK will not be offered prostate cancer screening if the government accepts the final recommendation of an expert committee.

The UK National Screening Committee (UKNSC) said attempting to detect the disease using the prostate-specific antigen (PSA) test was “likely to cause more harm than good”.

However, it said men with the BRCA2 gene variant, which put them at higher risk of prostate cancer, should be screened every two years between the ages of 45 and 61 if they had a family history of certain cancers.

It recommended against screening for other at-risk groups, including black men, saying there was “ongoing uncertainty on whether screening would cause more good than harm”. The main harms of population screening included incontinence and erectile dysfunction in men who did not need treatment for the disease.

Prof Sir Mike Richards, the chair of the UKNSC, said: “We absolutely recognise the strong support for prostate cancer screening among a large number of people, but also the very real harm that can be caused by the disease, which patients, and indeed their families, experience.

“We do know that screening can reduce deaths from prostate cancer to a small extent, and it does not improve overall survival.”

He said many men “will live full lives” without the disease causing harm, and screening could “only help if it can separate out that harmful disease from the harmless disease”.

“Once a prostate cancer is found, we still can’t reliably tell which cancers need treatment and which do not,” Richards said. “There’s a spectrum there, and the treatments available for prostate cancer can cause long-lasting harm.”

He said levels of overdiagnosis in prostate cancer remained high despite advances such as MRI scans before a biopsy after a positive PSA test.

The committee recommended screening men with a BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancers because prostate cancer was more common, developed earlier and could be more aggressive in this group. Of 100 men with a BRCA2 variant, between 21 and 35 of them will develop prostate cancer before the age of 80.

Richards said: “That was the only strategy where the UK National Screening Committee had confidence that screening would do more good than harm, and the reason for that is that prostate cancer is much more common in people with the BRCA2 variant, and it tends to be more aggressive.”

He said more work was needed on how to identify these patients and invite them for screening. This would be evaluated over time with the NHS.

The UKNSC’s draft recommendation in November had included men with a BRCA1 gene variant, but they were not included in the final recommendation. This was owing to recent data that emerged between the draft and final guidance being published, experts said.

Anneke Lucassen, a professor of genomic medicine and the director of the Centre for Personalised Medicine at the Nuffield Department of Medicine, University of Oxford, said previous studies “hadn’t been able to clearly separate out” the risks posed by the BRCA1 and BRCA2 variants. She said two large studies published recently suggested the risk among those with BRCA1 was “significantly lower”.

The UKNSC estimated that its final recommendation would lead to “a few thousand” men being screened for prostate cancer each year.

Of the recommendation not to screen at-risk groups such as black men, Richards said: “For black men, it’s more a question of do they differ from the population in the aggressiveness of the cancer.”

He added that more research was needed to address evidence gaps. The UKNSC will work with the Transform trial, which was launched last year by Prostate Cancer UK to gather more data. Richards said it was “particularly important” that a “sufficient number” of black men were invited to take part in the trial.

The government will now consider the recommendation. Richards said he would meet James Murray, the new health secretary, on Monday.

The Department of Health and Social Care said Murray “will give full and careful consideration to the recommendation” and would update on the government’s response shortly.

Prostate cancer is the most common cancer in the UK, with more than 64,000 men diagnosed every year. Freddie Hamdy, the Nuffield professor of surgery and professor of urology at the University of Oxford, said: “Any man who is worried about prostate cancer should go to his GP and discuss that,” adding: “It’s a shared decision between the information that the GP is giving him and the level of concern that the patient has.”

Dr Ian Walker, the executive director of policy at Cancer Research UK, said: “Prostate cancer remains the second biggest cancer killer of men, so it’s critical that we find more ways to save lives from the disease.

“Screening decisions must be guided by the current evidence, with programmes only introduced when the benefits are shown to outweigh the harms, including unnecessary and invasive overtreatment. We urge the UK government to accept the UKNSC’s recommendation.”

Chiara De Biase, the fundraising and health strategy director at Prostate Cancer UK, said the charity was “deeply disappointed” with the UKNSC recommendation. “Without a screening programme for the UK’s most common cancer, we lose more than 12,000 dads, brothers and partners every single year,” she said.