Prostate cancer screening likely to reduce deaths but experts remain uncertain due to possible risks
The number of deaths from prostate cancer is likely to be reduced thanks to screening for the disease, but experts have warned there are still risks around overdiagnosis and overtreatment.
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The findings of the analysis described the prostate specific antigen (PSA) test as "imperfect" but could "support a conversation" around screening using it, researchers said.
Cancer Research UK also said the test is "not effective enough".
Prostate cancer is the most common cancer in the UK, with more than 64,000 men diagnosed every year, although screening for the disease remains controversial.
Some experts argue the PSA test – which measures the levels of a protein produced by the prostate – is unreliable and can lead to overdiagnosis.
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In some cases, men with a high PSA level may not have cancer while those with a normal level may have the disease.
Now, in a major new Cochrane review, experts have analysed the results of six trials involving 789,086 patients, five of which shaped the findings.
The men involved spanned from 45 to 80, but were primarily aged between 50 and 70 and the analysis found that, without screening, 16 men per 1,000 would die from the disease.
Screening reduced this by two deaths, to 14 per 1,000 men.
First author Dr Juan Franco described the PSA as "an imperfect test" and stressed there are "many kinds" of prostate cancer.
He added that the test can "detect a lot of benign cancers in men that ultimately would have never had caused any problems and those men who received the diagnosis may receive treatment".
"That could be radiation, surgery, hormone therapy and they may suffer the side effects of those treatments," he said.
However, senior author Dr Philipp Dahm, of the University of Minnesota, said the findings "support a conversation about PSA screening".
"With new data now available, we can now say with moderate certainty that PSA screening reduces prostate cancer deaths in men with a sufficient life expectancy," he said.
"This suggests that for the right patient, someone who is well-informed, has a good life expectancy and understands the full implications of screening, there is now a reasonable evidence base to support a conversation about PSA screening."
Dr Dahm added: "I see a lot of patients that come to me with an elevated PSA, or see a lot of patients in whom prostate cancer has been diagnosed, and then I’m in charge in advising them of treatment.
"I don’t want to take away from what guideline developers will say, but with these results I think more guideline developers may recommend prostate cancer screening for men that have certain characteristics, the most important one being that they have a long life expectancy."
There is currently no screening programme for prostate cancer in the UK, although men over 50 can request a PSA test from their GP.In November, the UK National Screening Committee (UKNSC) said it would not recommend screening using the PSA test because it "is likely to cause more harm than good".
It only recommended that men with BRCA1 and BRCA2 genetic mutations, which puts them at far higher risk of prostate cancer, should be screened every two years, between the ages of 45 and 61.
Reacting to the findings of the Cochrane review, Dr Ian Walker, executive director of policy at Cancer Research UK, said: "This is the most comprehensive study of prostate cancer screening to date and highlights why there isn’t currently a widespread screening programme in the UK.
"Unfortunately, the test currently used to detect prostate cancer is not effective enough.
"Whilst this review does highlight that the test could save one to two lives from prostate cancer for every 1,000 men screened, it also shows that around 30 more men could be diagnosed with the disease.
"Many of whom would never have been harmed by their disease and could go on to have unnecessary treatment with long‑term impacts like the loss of bladder control and erectile dysfunction."