Screening for prostate cancer can lead to a reduction in the risk of dying from the disease, a landmark study has found.
Results from a European-wide trial, published in 2009, have shown that screening for prostate cancer can reduce deaths from the disease by 20%.
Experts disagree on the usefulness of the PSA (prostate-specific antigen) test, the main test for prostate cancer. This is why there is no national screening programme for prostate cancer in the UK.
The test could save your life if it detects the early signs of cancer, but a wrong diagnosis could cause unnecessary anxiety and treatment.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) started in the 1990s to evaluate the benefits of PSA testing.
The study involved 182,000 men from seven countries, aged between 50 and 74, who were randomly allocated whether or not to be offered PSA screening.
“The ERSPC provides the first convincing proof that screening can lead to a reduction in the risk of death from prostate cancer,” says cancer specialist Dr Chris Parker.
Over-diagnosis
But screening is not without risks. The research found that screening was associated with a “high risk of over-diagnosis” of prostate cancer.
To save one life from prostate cancer, the study showed that 48 men would have to be treated.
This means many men would be diagnosed with prostate cancer that would otherwise not have been detected or required treatment.
“The majority of PSA-detected prostate cancers are harmless,” says Dr Parker.
Men considering going for a PSA test need to decide, based on their personal circumstances, whether the benefits outweigh the harms.
An information sheet for men considering a PSA test is available for download (PDF, 115kb).
A positive diagnosis can lead to anxiety and is often followed by treatment, with its risks to sexual, bladder and bowel function.
Black men and those with a family history of the disease are at greater risk and might have more to gain from screening.
“It is in some ways a lifestyle choice,” says Dr Parker. “If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense.
“If, on the other hand, you are more accepting of your ‘allotted span’, and are keen to preserve normal sexual and urinary function, then you may decide not to have the test.”
Way forward
Dr Parker says the way forward should be to develop better ways of screening to reduce the risks of over-diagnosis and unnecessary biopsies.
He says the PSA test should be used in combination with other indicators, such as age, ethnicity and family history, to assess an individual’s risk of prostate cancer.
In addition, being diagnosed with prostate cancer should not automatically lead to treatment, says Dr Parker.
Regular check-ups to monitor the cancer and check that it isn't becoming aggressive, known as active surveillance, could spare many men from unnecessary treatment.
NHS screening
There is currently no organised screening programme in the UK for prostate cancer.
For more on the latest policy position, go to the UK National Screening Committee’s prostate cancer section.
A informed choice programme has been introduced to help men decide whether or not to have the PSA test.
The prostate cancer risk-management programme (PCRMP) gives men with no symptoms information on risks and benefits of the PSA test to help them decide whether or not to take it. Your GP will have an information pack to help you decide.
An online decision aid, called Prosdex, provides information, including real-life stories, to help make a decision on whether or not to have the PSA test.
