Article from Chris Booth, a retired and very experienced urulogist and Clinical Director at CHAPS.

NEWSFLASH: PROSTATE CANCER SCREENING

This controversy has hit the headlines again with the news that the UK’s annual death toll from Prostate Cancer (PCa) has risen to over 11,800 and now exceeds that for breast cancer. Comparisons between the two cancers are striking!No national screening programme exists for PCa, UK testing and referral guidelines are confusing and PCa attracts less than half the research funds for breast cancer. It is estimated that UK treatment of PCa lags at least 10 years behind breast cancer and we are down at 27^th in the world rankings for survival from PCa!Most national and international guidelines recommend screening for appropriately informed men over the age of 40, especially those with a family history of PCaand for all black men of African or Caribbean heritage who have a genetic and racially determined increased risk. So, why is there no UK screening programme for a cancer now killing one man every 44 minutes?In a nutshell, it is argued that the screening blood test PSA is too imprecise, leads to too many invasive and inaccurate biopsies of the prostate and the biopsy specimens themselves then lead to “over-treatment” of non-aggressive cancers that would never cause any harm anyway. Also, radical treatment of PCa by whatever method always carries the risk of major complications such as incontinence, impotence and bowel damage. These “harms” for too many men then outweigh the benefit of lives saved by early detection through screening. However, last year two major UK trials went a long way to invalidating this claim.Firstly, the PROMIS trial showed  that if an MRI scan of the prostate was normal in a  man with an abnormally raised PSA, a biopsy was unnecessary and surveillance alone was all that was required. This is now  saving many unnecessary biopsies and preventing “over-diagnosis” of non-aggressive PCa; this in turn reduces the risk of “over-treatment. Secondly, the ProtecT study showed that for men actually found to have apparent non-aggressive PCa, surveillance alone was a safe treatment strategy.If any doubts still exist on the value of PSA-based screening, they should surely have been answered by the UK’s 2017 National Prostate Cancer Audit of PCadiagnosis and treatment. This showed that UK practice now increasingly mirrors the PROMIS and ProtecT study results with only 8% of men still being “over-treated” for low risk disease. Unfortunately however, far too many UK men (51%) are still being diagnosed with “advanced” and probably incurable PCa which reflects the low use of PSA  for screening in the UK.There is now freely available, expert, comprehensive, UK tailored information on the optimum use of PSA as a screening tool. In our opinion this evidence now shows that the benefit of screening clearly outweighs the so-called harms. If we are to reduce our unacceptable death rate from this thoroughly unpleasant cancer, UK men need to know this information and the NHS needs to provide PSA screening without hindrance to appropriately informed men over age 40. Only then will we catch the cancer early whilst it is still inside the prostate, amenable to new minimally invasive techniques that avoid the complications of radical treatment and , above all, is still curable!#PSATesting  #prostatecancer #Menshealth