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Prostate cancer: Call to test men in their 40s | Prostate cancer: Call to test men in their 40s |
(about 9 hours later) | |
Men should be offered a screening test for prostate cancer in their late 40s, researchers say. | Men should be offered a screening test for prostate cancer in their late 40s, researchers say. |
The idea is controversial as prostate specific antigen (PSA) testing can be unreliable, throwing up false positive results that can cause undue worry and even treatment over something benign. | The idea is controversial as prostate specific antigen (PSA) testing can be unreliable, throwing up false positive results that can cause undue worry and even treatment over something benign. |
But the Swedish team say checking every man aged 45-49 would predict nearly half of all prostate cancer deaths. | But the Swedish team say checking every man aged 45-49 would predict nearly half of all prostate cancer deaths. |
Their findings, in The BMJ, come from a study of more than 21,000 men. | Their findings, in The BMJ, come from a study of more than 21,000 men. |
No consensus | No consensus |
There is no routine screening programme for prostate cancer in the UK. | There is no routine screening programme for prostate cancer in the UK. |
Men over 50 can request a free PSA test on the NHS if they wish. | Men over 50 can request a free PSA test on the NHS if they wish. |
A recent prostate cancer screening trial in Europe, ERSPC, showed that screening reduced mortality by 20%. However, this was associated with a high level of "over treatment". To save one life, 48 additional cases of prostate cancer needed to be treated. | A recent prostate cancer screening trial in Europe, ERSPC, showed that screening reduced mortality by 20%. However, this was associated with a high level of "over treatment". To save one life, 48 additional cases of prostate cancer needed to be treated. |
In 2010, when the UK National Screening Committee in England last reviewed the issue, it again decided screening should not be introduced. | In 2010, when the UK National Screening Committee in England last reviewed the issue, it again decided screening should not be introduced. |
But Prof Hans Lilia and colleagues from Lund University in Sweden and the Memorial Sloan-Kettering Cancer Center in the US say there is a strong case for routine PSA testing and that men in their late-40s are prime candidates. | But Prof Hans Lilia and colleagues from Lund University in Sweden and the Memorial Sloan-Kettering Cancer Center in the US say there is a strong case for routine PSA testing and that men in their late-40s are prime candidates. |
To prove it, they looked back at a study carried out between 1974 and 1984 involving 21,277 Swedish men aged 27-52. All the men had donated blood samples at the start of the study. The researchers used these stored samples to run PSA tests. | To prove it, they looked back at a study carried out between 1974 and 1984 involving 21,277 Swedish men aged 27-52. All the men had donated blood samples at the start of the study. The researchers used these stored samples to run PSA tests. |
Armed with the results, they then checked to see if the PSA reading predicted what had happened to the men in terms of clinical outcomes - ie had those with high/positive PSA results gone on to develop prostate cancer. | Armed with the results, they then checked to see if the PSA reading predicted what had happened to the men in terms of clinical outcomes - ie had those with high/positive PSA results gone on to develop prostate cancer. |
A high PSA was linked with an increased risk of prostate cancer. | A high PSA was linked with an increased risk of prostate cancer. |
The researchers then checked the results to see if there was a best age at which men should be screened. | The researchers then checked the results to see if there was a best age at which men should be screened. |
Balance of risks | Balance of risks |
Screening too young - below 45 years of age - detected too few deadly cancers. | Screening too young - below 45 years of age - detected too few deadly cancers. |
And delaying screening until after a man's 50th birthday missed too many. | And delaying screening until after a man's 50th birthday missed too many. |
Screening men at the age of 45-49, however, spotted nearly half (44%) of the cancers that went on to be deadly. | Screening men at the age of 45-49, however, spotted nearly half (44%) of the cancers that went on to be deadly. |
In the study, 1,369 of the men had prostate cancer, 241 had advanced disease and 162 died from it. | In the study, 1,369 of the men had prostate cancer, 241 had advanced disease and 162 died from it. |
They say all men should be offered a PSA test in their mid-to-late 40s. Those with a high result would return for frequent screening and checks (and treatment if necessary), while those with normal results could wait until their early 50s for their next PSA test. | They say all men should be offered a PSA test in their mid-to-late 40s. Those with a high result would return for frequent screening and checks (and treatment if necessary), while those with normal results could wait until their early 50s for their next PSA test. |
"At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime," they say in the British Medical Journal. | "At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime," they say in the British Medical Journal. |
"This is likely to reduce the risk of over-diagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis," they say. | "This is likely to reduce the risk of over-diagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis," they say. |
Dr Anne Mackie, Director of NHS Screening Programmes at Public Health England, said they reviewed evidence for screening on a three-yearly basis to make sure that the programmes offered by the NHS are based on the best and most up-to-date information available. | Dr Anne Mackie, Director of NHS Screening Programmes at Public Health England, said they reviewed evidence for screening on a three-yearly basis to make sure that the programmes offered by the NHS are based on the best and most up-to-date information available. |
She said they would consider the findings of the BMJ study. | She said they would consider the findings of the BMJ study. |
"We are currently in the process of a scheduled review for a screening programme for prostate cancer and will make a recommendation towards the end of 2013," she said. | "We are currently in the process of a scheduled review for a screening programme for prostate cancer and will make a recommendation towards the end of 2013," she said. |
The Prostate Cancer UK said more research efforts should be channelled into finding a better screening test for the disease. |