An NHS screening programme for prostate cancer could come one step closer if it’s backed today by a key committee that advises the government.
The National Screening Committee, comprised of doctors and economists, will reveal whether it now believes the benefits of screening outweigh any risks, and whether testing could be done at a reasonable cost to the NHS.
When it last looked at the evidence in 2020, it rejected calls for screening, even though prostate cancer kills 12,000 men a year.
But in recent months, there has been growing pressure for screening from high-profile public figures such as Olympian Sir Chris Hoy and former Sky News presenter Dermot Murnaghan.
Both have been diagnosed with advanced prostate cancer, yet the disease is curable if detected in its early stages.
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Former prime minister David Cameron has also backed the campaign for screening this week after revealing he had been treated for the cancer.
The committee will decide whether new research has tipped the scales in favour of screening older men, or whether to target only those at higher risk, such as black men and those with a family history of the disease.
The case for…
Lithuania is currently the only country to screen all men aged 50-69 with a blood test for PSA, a protein released by prostate cells.
A low level is normal. But levels can rise steeply in men with cancer.
A recent study showed that regular PSA testing of men over 50 could reduce deaths by 13%.
That’s about the same survival benefit of breast screening.
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…and the case against
But the PSA blood test isn’t completely reliable.
One in seven men with prostate cancer actually have a normal PSA level.
And even those with a high level may have a cancer that is so slow growing that it’s just not a threat.
That’s why the National Screening Committee has warned in the past that PSA screening could lead men to have surgery or other treatment that they don’t actually need. Treatment can result in incontinence or impotence.
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But the evidence has moved on.
These days men with a high PSA should have an MRI scan of their prostate, which significantly reduces the risk of unnecessary treatment. And the treatment itself is getting safer.
But the committee may judge that the risks and benefits of screening all men in their 50s and 60s are still too finely balanced to give the go-ahead.
They may wait for results from the Transform trial, which has just been launched and will compare different screening strategies. That could take many years.
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But campaigners are hopeful that the committee will recommend the screening of men at higher risk of prostate cancer in the meantime.
Black men have twice the risk of those from other ethnic groups.
Men whose father or brothers have had prostate cancer are two and a half times the risk.
And there is also an increased risk for men whose mother or sisters have had breast or ovarian cancer.
Roughly 1.3 million men fall into one of the risk groups.
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But identifying and inviting them for screening could prove tricky. GPs don’t always note a patient’s ethnicity in their medical records, and they would usually only know about a patient’s family history if they have been told.
If the committee recommends screening in some form, it is likely to go out to a public consultation before landing on the desk of Health Secretary Wes Streeting for a final decision.
Ultimately, it is his call whether at least some men are screened for what is now the most common cancer in England.
