A blood test on request for prostate cancer should be scrapped because it is harming men, according to experts.
Men in the UK over the age of 50 can get a ‘blood test on request’ through the NHS, following discussion with their GP.
This test looks for a protein made by the prostate gland called prostate-specific antigen (PSA), which may be higher in men with cancer.
But experts want this approach to be scrapped, as allowing men to request a PSA test risks them having unnecessary treatment such as prostate surgery, which can lead to lifelong incontinence and erectile dysfunction.
Men in the UK over the age of 50 can get a ‘blood test on request’ through the NHS, following discussion with their GP
That risk is particularly high for men over 70 who are diagnosed with prostate cancer after requesting a PSA test, according to an article in the British Medical Journal.
Most of these men may actually have been better off remaining undiagnosed and untreated.
They are old enough to live out their years with prostate cancer, if it is not aggressive, as any tumours would never grow large enough to cause illness.
Therefore the international experts recommend scrapping the test-on-request system.
Instead, they suggest having prostate cancer screening for healthy men – similar to mammograms for healthy women which check their risk of breast cancer.
In this scenario, with PSA tests provided in a nationwide screening programme, only men aged 50 to 70 would receive the blood tests.
The only exception would be a small number of high-risk men over 70, such as those with a family history of prostate cancer or a genetic mutation in the BRCA gene which raises the risk of developing prostate cancer.
Alternatively, if screening is not adopted, the experts say PSA tests should no longer be available in request through GP surgeries, but only through a urologist, for men with urinary symptoms, which would exclude the worried well – with a possible exception for high-risk men.
Experts say PSA tests should no longer be available in request through GP surgeries, but only through a urologist, for men with urinary symptoms, which would exclude the worried well – with a possible exception for high-risk men
Professor James Catto, a co-author of the article from the University of Sheffield, said: ‘Men who request PSA tests and are diagnosed with prostate cancer tend to be more affluent and engaged in managing their health.
‘We see a surge in demand from men like this looking for PSA tests when celebrities like Bill Turnbull and Stephen Fry talk about prostate cancer, and that leads to overdiagnosis.
‘But those who die from prostate cancer are the men who are least likely to ask for a test, so this system isn’t working.
‘Also, although men in the UK are less likely to be given unnecessary treatment than in other countries, we want to minimise this risk by avoiding men being diagnosed with slow-growing cancers they probably don’t need to know about after an unnecessary PSA test.’
Men aged 70 to 90 are twice as likely as men in their fifties to get a PSA test on request in the UK.
This age group will make up a large proportion of the estimated 10,000 men in the UK ‘overdiagnosed’ with prostate cancer, who could simply have lived with it without it posing any threat to their day to day functioning or lives.
Up to half of men diagnosed with prostate cancer from a PSA test would never have noticed it otherwise, according to the article.
But the diagnosis puts them on a medical pathway, starting with an uncomfortable biopsy and potentially leading to drugs which cause fatigue and loss of libido.
If their prostate is removed using surgery, or treated using radiotherapy, they can have bladder and bowel incontinence or erectile dysfunction as a result.
If screening were adopted, only half of men, at the lowest risk of the disease, would need a PSA test only three times in their life, evidence suggests.
The rest of the men in the UK would get tested between every two and four years.
As currently happens in the UK, they would only get a biopsy if an MRI scan given after the PSA test suggested they might have prostate cancer.
Responding to the study, Chiara De Biase, from Prostate Cancer UK, said: ‘It’s clear that the current system which requires men to request a PSA blood test for prostate cancer is flawed – but without a national screening programme, it’s the best we have.
‘That’s why Prostate Cancer UK has developed a risk checker to help men make an informed choice as to whether to get tested.’
Professor Nick James, from The Institute of Cancer Research in London, said: ‘I agree with the authors and strongly support the implementation of a risk-based approach to PSA testing at a national level.
‘There is an urgent need for a more equitable and targeted screening strategy, which could help address existing health disparities.’
WHAT IS PROSTATE CANCER?
How many people does it kill?
More than 11,800 men a year – or one every 45 minutes – are killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.
It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain.
In the US, the disease kills 26,000 men each year.
Despite this, it receives less than half the research funding of breast cancer and treatments for the disease are trailing at least a decade behind.
How many men are diagnosed annually?
Every year, upwards of 52,300 men are diagnosed with prostate cancer in the UK – more than 140 every day.
How quickly does it develop?
Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS.
If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it is diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.
Tests and treatment
Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge.
There is no national prostate screening programme as for years the tests have been too inaccurate.
Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.
Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.
But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not fool-proof.
Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks.
Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org