Study shows prostate cancer screening can ‘reduce deaths’ as UK scheme assessed

Prostate cancer screening can reduce deaths by 13%, a study suggests.

Cancer screening experts are currently assessing whether the UK should introduce a screening programme for prostate cancer with a decision expected before the end of the year.

The new study, published in the New England Journal of Medicine, suggests that a “targeted” approach to screening could be adopted to reduce deaths from the disease and also prevent problems arising from “overdiagnosis”.

Researchers examined the risks and benefits of screening across eight European countries over a 23-year period, including data on 162,000 men – with 72,000 of these invited for screening.

They found that one death from prostate cancer was prevented for every 456 men who were invited for screening.

And one death from prostate cancer was averted for every 12 men in whom prostate cancer was diagnosed.

Commentators said the findings are “comparable to that seen with breast or bowel cancer screening”.

As well as a reduction in deaths from prostate cancer, the authors of the study said screening has a “more favourable harm-to-benefit profile than previously estimated”.

But they said that harms linked to screening “remain a critical concern”.

These include unnecessary testing, biopsies, overdiagnosis and subsequent overtreatment.

“These findings highlight the need for a more targeted strategy for prostate cancer screening that focuses on identifying population subgroups that are most likely to benefit from early detection while reducing unnecessary interventions for those with the highest risk of overdiagnosis,” they wrote.

The prostate-specific antigen (PSA) test is a blood test which is currently used to check for prostate conditions including prostate cancer or an enlarged prostate.

Routine PSA testing is not currently offered on the NHS but men may be offered a PSA test if a GP suspects they have prostate cancer.

Men over the age of 50 can ask their GP for a PSA test, even if they do not have symptoms.

Officials have faced increased calls for a screening programme to be introduced.

They will be weighing up the concerns outlined in the review.

A recent study published in The BMJ also found that prostate cancer blood tests can lead to men being over-tested, while those who need help may be missed.

Commenting on the new study, Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, London, said: “The latest analysis from the ERSPC (European Randomised study of Screening for Prostate Cancer) further strengthens the evidence base in favour of PSA-based prostate cancer screening.

“The overall reduction, with longer follow-up, in risk of death is comparable to that seen with breast or bowel cancer screening.”

He added: “The well-known harms of screening, of overdiagnosis and overtreatment, can be substantially mitigated with technologies such as MRI pre-biopsy and for monitoring.

“The side effects of treatment, such as incontinence, are substantially less with modern surgery and radiotherapy than the rates documented in the trial, further strengthening the case for screening.”

Rhian Gabe, professor of biostatistics at Queen Mary University London, added: “These results confirm prevention of prostate cancer death with repeat PSA testing, however, concerns remain about the unnecessary biopsies and harms of overdiagnosis and overtreatment.

“Newer technologies provide great hope that these negative aspects can be addressed. Evidence from randomised controlled trials of prostate cancer screening strategies incorporating these new technologies is needed to inform UK screening policies.”

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: “The ERSPC trial was one of the largest prostate cancer screening studies ever conducted, and 23 years on it’s now shown that the balance between the benefits and harms of screening with PSA testing is better than previously thought.

“Although a large number of men were overtreated – a major reason we don’t currently have screening – that number has also reduced in this latest analysis.

“This is exactly the kind of high-quality evidence that the National Screening Committee needs to consider when making its decision on whether to screen men later this year, especially for men at higher risk like black men and men with a family history.”

Dr Ian Walker, executive director of policy at Cancer Research UK, said: “While this long-running study suggests that screening using the PSA test could help reduce deaths from prostate cancer, it also concludes that screening still caused harm.

“Men in the screening group were more than twice as likely to be diagnosed with low-risk disease compared to those not screened, often leading to unnecessary and sometimes invasive treatment.

“The authors highlight that screening all men carries a significant risk of unnecessary testing, overdiagnosis and overtreatment, due to issues with the PSA test.

“The UK National Screening Committee will be taking a look at this trial as part of its independent expert review into prostate cancer screening, and it’s vital that we await its recommendations and alongside this, continue research into better ways to detect and diagnose the disease, in order to save more lives.”

The news comes as the National Institute for Health and Care Excellence (Nice) approved a new treatment option for men with prostate cancer which has spread to other parts of the body.

Nice initially rejected abiraterone, saying that it did not represent value for money for the NHS.

But now it said that abiraterone and its generic variants can be used in combination with other treatments for newly diagnosed men with “high-risk hormone sensitive” metastatic prostate cancer.

Nice said that it was able to reverse its 2021 decision because of lower cost generic versions of the drug.

It said that around 4,000 men will now be able to benefit from the additional treatment option.