The Case for PSA Screening: A Step Towards Saving Lives

Commentary by Dr. Donald Greig

As we finally conclude our Movember series, albeit extending slightly into December on prostate health, we find ourselves at a pivotal moment in the conversation about PSA screening. In previous newsletters, we explored the complexities and potential downsides of mass population screening, including concerns about overdiagnosis and the associated risks of treatment. However, new findings from a groundbreaking European trial involving 162,000 men have dramatically shifted this narrative. The compelling evidence now supports routine PSA screening for men over 50, demonstrating that regular prostate-specific antigen (PSA) blood tests can reduce prostate cancer deaths by 13% over two decades. This statistic is not just a number; it represents thousands of lives saved and underscores the urgent need for a national screening program in the UK.

Unpacking the Trial Findings

The European Randomized Study of Screening for Prostate Cancer (ERSPC) is one of the most extensive and robust studies of its kind, showing that by offering regular PSA tests, we can catch prostate cancer early when it is most treatable. The trial revealed that for every 456 men screened, one death from prostate cancer was prevented. This finding places prostate screening on par with existing NHS programs for breast and bowel cancer, highlighting its potential to significantly impact public health.

Despite historical concerns about the risks of overtreatment and side effects like erectile dysfunction and incontinence, experts are now asserting that the benefits of screening outweigh these risks. Professor Nick James from the Institute of Cancer Research emphasizes that modern treatment techniques have improved, substantially reducing the side effects associated with earlier interventions. This evolving perspective is crucial as health officials, including the UK National Screening Committee, prepare to make decisions on implementing a nationwide screening program.

Addressing Overdiagnosis and Treatment Concerns

Of course, the trial also acknowledged the challenges associated with PSA screening, including the potential for overdiagnosis—where men are diagnosed with cancer that may never have caused harm. However, it's important to note that only one in four men with elevated PSA levels actually has cancer. Modern advancements, such as MRI scans and targeted biopsies, can help mitigate these risks by providing clearer insights into which cases require treatment and which do not.

The data demonstrates that the number of men diagnosed with prostate cancer was 30% higher in the screening group, raising concerns about unnecessary interventions. Yet, the rise in diagnoses also indicates that more cancers are being caught at an early, treatable stage. This nuanced understanding reinforces the need for a thoughtful approach to screening, where the aim is not only to detect cancer but to ensure that treatment is reserved for those who truly need it.

A Call for Action

As the UK faces around 55,300 new prostate cancer cases and 12,200 deaths annually, the call for a national screening program has never been more urgent. The backing from high-profile figures, including politicians and celebrities, adds momentum to the movement for proactive screening. With the evidence now clearer than ever, it is essential that the UK National Screening Committee considers these findings seriously as they weigh the benefits of implementing a population-wide screening initiative.

In conclusion, the compelling new evidence from the ERSPC trial reinforces the notion that routine PSA screening can save lives. As we advocate for informed decision-making in men's health, let’s push for a future where proactive screening becomes the norm, empowering men to take charge of their health and reducing the mortality associated with prostate cancer. By embracing early detection, we can pave the way for healthier outcomes and a brighter future for men across the UK.

Let’s continue this conversation, break the stigma, and ensure that every man knows his options. Regular screenings can be life-saving—make sure to talk to your healthcare provider about getting screened. 💪

#Movember #ProstateCancer #PSAScreening #MensHealth #EarlyDetection #NHS #HealthCare #ProstateAwareness #ScreeningSavesLives

Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.

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Trial finds prostate cancer screening for over 50s would save thousands

Article by Eleanor Hayward

After a simple blood test to measure prostate-specific antigen levels, a biopsy can determine whether cancer cells are present

Prostate cancer screening for all men aged over 50 would save thousands of lives in Britain, a trial has found.

A study involving 162,000 men in Europe found that offering regular prostate-specific antigen (PSA) blood tests reduced deaths by 13 per cent over two decades by helping to catch the disease early, when it is treatable.

The reduction in death rates was similar to that seen from NHS screening programmes for breast and bowel cancer and shows that the benefits of prostate screening are greater than previously thought.

The “compelling new evidence” is being taken into account by health officials as they prepare to announce a contentious decision on whether to launch an NHS prostate screening programme.

Experts said there was now “little doubt” that screening saves lives. Concerns remain that it leads to “overtreatment” of harmless prostate tumours, resulting in life-changing side-effects such as erectile dysfunction and incontinence.

Men aged 50 to 69 took part in the trial

Prostate cancer is the most common cancer in Britain, with about 55,300 cases and 12,200 deaths a year. Celebrities and politicians including David Lammy and Rishi Sunak have backed a campaign to introduce an NHS screening programme.

The new results come from the European randomised trial of screening for prostate cancer (ERSPC), one of the largest and most robust screening studies ever conducted.

It evaluated the long-term benefits of offering men simple blood tests to measure levels of PSA, a protein that can be raised in men with prostate cancer.

Some 162,000 men aged 50 to 69 from eight countries were recruited to the trial, nearly half of whom were invited for a PSA blood test every four years, with the rest acting as a control group.

Over a 23-year follow-up period, the screening group had a 13 per cent lower risk of dying from prostate cancer. One death from prostate cancer was prevented for every 456 men who were invited for the routine blood tests.

David Lammy, the deputy prime minister, has backed a national screening programme

The UK National Screening Committee, the expert body that advises the NHS, is meeting next month to decide recommendations on a new national screening programme.

Historically, the harms of PSA testing have been thought to outweigh the benefits, but the study could help tip the balance in favour of screening, particularly for high-risk men.

Under NHS guidelines, all men aged over 50 can ask their GP for a PSA test, even if they have no symptoms, and black men, who are at higher risk, can ask for one from the age of 45. However, GPs cannot offer the test proactively.

Professor Nick James, professor of prostate and bladder cancer research at the Institute of Cancer Research in London, said the analysis “further strengthens the evidence base in favour of PSA-based prostate cancer screening”.

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

“The numbers needed to screen and treat to prevent a death are also in line with these other diseases. What is more, the trial probably underestimates the benefits that could be achieved due to opportunistic PSA testing occurring in the control arm.

“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.”

Screening helps to catch cancer at an early stage before symptoms have begun, when it is easier to treat. The trial showed the number of men given a diagnosis of prostate cancer was 30 per cent higher in the screening group. Not all of them had harmful tumours and the number given a diagnosis of “low-risk” cancer was twice as high in the screening group as the control arm.

The study also found “considerable harms” from screening including “unnecessary testing, biopsies, overdiagnosis and subsequent overtreatment”. Only one in four men with raised PSA levels had cancer, meaning thousands went through unnecessary biopsies, which can be harmful, after the blood test.

Experts say these risks can be mitigated through modern techniques such as robotic surgery or offering MRI scans alongside PSA tests to minimise overdiagnosis.

David James, director of the Prostate Cancer Research charity, said: “This landmark 23-year follow-up, one of the most significant global studies of prostate cancer screening to date, confirms a sustained reduction in deaths from prostate cancer with PSA testing, alongside an improved balance between benefits and harms.

“The reduction in mortality from prostate cancer screening is now comparable to that achieved through breast and bowel cancer screening, yet prostate cancer remains the only major cancer in the UK without a national programme.

“With modern MRI and targeted biopsies further reducing overdiagnosis, this is compelling new evidence. It is essential that the UK National Screening Committee and the government take it into account as they consider introducing a national screening programme.”

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said the study showed that PSA screening “prevents more deaths than previously thought, while overdiagnosis — and its associated harms — has fallen”.

He said: “This is exactly the kind of high-quality evidence that the National Screening Committee needs to consider in its upcoming review, especially for groups who might get more benefit than the ‘average man’ screened in the ERSPC trial, such as black men and men with a family history.”

He said that more research was needed to refine the best screening approach, which is being investigated in Transform, a £42 million trial.

The research was published in The New England Journal of Medicine and led by Professor Monique Roobol, of the Erasmus Medical Centre in Rotterdam.

Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.