TOP doctors will decide today whether the NHS should offer routine prostate testing to catch cancers early in a landmark screening verdict.
Campaigners want the minimum NHS offer to be regular blood tests for men most likely to get prostate cancer, including black men, men whose fathers or brothers have had it, and those with high-risk gene mutations.
Calls for better testing have been backed by celebrities including darts star Luke Humphries, whose father-in-law was diagnosed, Olympic cycling legend Sir Chris Hoy, and former Prime Minister David Cameron.
The UK National Screening Committee could choose a targeted programme for at-risk men, or it could go further and recommend tests for more men, or repeat its previous verdict in 2020 and decide there should be no screening at all.
Health Secretary Wes Streeting will make the final decision and said it must be “evidence-based” but admitted this week that the NHS “needs to do better on diagnosis and treatment of this terrible condition”.
One of the UK’s top prostate surgeons, Professor Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, explains to Sun readers why a vote to stick with the status quo would be a deadly gamble:
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It’s time to stop the prostate cancer lottery.
The National Screening Committee (NSC) is set to announce its decision on a screening programme for prostate cancer this week – a programme that would regularly invite people to be tested and checked for the disease.
The debate has been fierce as to whether we should or shouldn’t screen for the UK’s most common cancer.
But, as a prostate cancer researcher and a doctor treating men every day, here’s why I believe now is the right time.
Prostate cancer kills 12,000 men a year – and too many are dying because the system is stacked against them.
If caught and treated early, virtually all men survive. But if it is not caught until the most advanced stage, 50 per cent die within five years.
Currently, if you want to get tested, you have to ask your GP for a PSA (prostate-specific antigen) test.
But the recent National Prostate Cancer Audit showed that this system means that middle-class, educated white men are the ones who are more likely to come forward to seek tests.
Men living in more deprived areas, who are less aware of prostate cancer, are far less likely to come forward.
So, men living in poorer areas are missing out on having their cancer caught earlier – risking the disease being picked up at later stages, when it is more difficult to treat.
New evidence crushes old arguments
The argument against introducing a screening programme has generally centred on the fact that PSA tests are not always accurate.
The PSA test falsely indicates prostate cancer in men three out of four times, and can detect cancers which grow so slowly they are unlikely to ever be life-threatening – meaning that men may undergo invasive biopsies and treatments such as surgery or radiotherapy.
While many of these men will be ‘grateful their cancer was caught and treated’, they could suffer significant side-effects – from incontinence to erectile dysfunction – for a cancer that may never have posed any harm.
But a crucial fact missing from these arguments is the new evidence that has emerged since the last NSC review of prostate cancer screening in 2020.
Since then, it’s been shown that PSA screening reduces the risk of death from prostate cancer by 13 per cent.
If a PSA result is high, the use of MRIs prior to a biopsy has been introduced – in our clinic this results in around 50 per cent of men not needing a biopsy and also substantially reduces the rate of diagnosis of trivial disease, while preserving the pick-up of more significant cancers.
Testing and treatment are faster, easier and safer than ever
Extra capacity will be needed throughout the NHS to provide these MRIs, but technologies exist that can help.
For example, AI analysis of scans and the use of a new quicker MRI scan – which halves the scan time to just 15-20 minutes and, crucially, it doesn’t involve injecting dye into the patient, which requires a doctor to be present.
Similarly, biopsies can be expanded if they are delivered by nurses.
And, if treatment is required, modern surgical methods and radiotherapy courses are more targeted, and result in fewer side effects for patients.
Recent radiotherapy trials show that older, longer courses of more than a month can be replaced by five treatments given over one to two weeks, again increasing treatment capacity.
If, even in light of this evidence, it is not deemed cost-effective to screen all men, an interim solution must focus on screening those who are known to be at high-risk of prostate cancer.
This includes men in areas of high deprivation, Black men – who are at least twice as likely to get prostate cancer as the rest of the population – and men with genetic mutations that put them at a greater risk of cancer and a greater risk of aggressive disease.
Recent work by The Institute of Cancer Research has shown that annual PSA testing picks up more dangerous prostate cancers in men with BRCA1 and BRCA2 mutations than non-carriers, suggesting all men from the age of 40 with these mutations should be offered regular tests.
Work from my own team at the ICR showed that we can identify the other high-risk groups of men – those in areas of high deprivation and of African heritage – and that they will participate in health check programmes, if they’re given suitable information.
Right now, we have an ad-hoc system for the wealthy. That’s wrong. Screening for prostate cancer is now as effective as breast and bowel programmes.
We can’t keep waiting for results from perfect trials while men die.
Doing nothing is the real gamble.
One in eight men will get prostate cancer
The risk of developing prostate cancer depends on many factors, here are some of the facts about the disease and how many men it affects.
- One in eight men will get prostate cancer in their lifetime
- It is the fourth most common cancer worldwide, and the most common in men
- There are 55,000 new cases every year in the UK, and 1.4million globally
- Around 12,000 people lose their lives to prostate cancer annually in the UK and almost 400,000 around the world
- Prostate cancer accounts for 28 per cent of all new cancer cases in men in the UK, and 14 per cent of all new cancer cases in men and women combined
- Prostate cancer survival has tripled in the last 50 years in the UK
- More than three-quarters (78 per cent) of patients survive for 10 or more years
- About 490,000 men are living with and after prostate cancer in the UK
- It is most common in men aged 75 to 79
- Since the early 1990s, cases have increased by 53 per cent in the UK
- Mortality rates are up 16 per cent since the early 1970s in the UK
- Incidence rates are projected to rise by 15 per cent in the UK between 2023 to 2025 and 2038 to 2040
- Mortality rates are expected to fall five per cent in the UK over the same years
Source: Prostate Cancer UK, World Cancer Research Fund International and Cancer Research UK
