Most men should not be screened for prostate cancer, says UK expert body

A prostate cancer screening program for all men in the UK is not justified, according to a hugely influential group of experts.

Instead, they say only men with specific genetic mutations that lead to more aggressive tumors should be eligible.

This would exclude black men, who have twice the risk, and men who run the disease through their families.

Sir Chris Hoy, who has terminal prostate cancer, said he was “disappointed and saddened” and Cancer Research UK said it supported the committee's expert recommendations.

This is a defining moment after more than a year of intense campaigning and lobbying involving former prime ministers, celebrities and charities.

The UK National Screening Committee, which advises governments across the UK, has rejected screening in all but one rare case.

Prostate cancer is the most common cancer in men and kills 12,000 people across the UK every year.

Instinctively, it seems that disease screening should be a simple solution – test for cancer, treat it and save lives.

However, this is a much more complex issue.

Screening will be based on a blood test, followed by a prostate scan and biopsy.

But it can miss deadly cancers and identify those that never need treatment.

Many prostate cancers grow so slowly that you'll have to live until you're 120 to 150 years old before they become a threat, so they don't need treatment, the National Screening Committee said.

Their recommendations are based on a balance between lives saved by early detection of cancer and treatments that leave patients unable to control their bladder or maintain an erection whose cancer may not have killed them.

The UK National Screening Committee recommends:

• There is no screening program for all men as it is 'likely to do more harm than good'
• no screening of black men due to 'uncertainty' about exposure due to lack of clinical trials on black men
• no screening based on family history
• but screening should be offered every two years to men aged 45 to 61 if they have certain genetic mutations called BRCA variants.

These were not unanimous opinions, the committee said, as there was “strong consensus” on each of these recommendations.

BRCA variants increase the risk of developing certain types of cancer and famously led actress Angelina Jolie to have her breasts removed.

About three in 1,000 men have BRCA variants, but many won't find out unless they have family members who are known carriers.

The National Screening Committee was asked to explain why it did not recommend testing more men for the disease.

Professor Freddy Hamdy, who is also a urological surgeon at Oxford, told me: “The diagnosis of prostate cancer in a healthy man is an extremely devastating event and can have a very significant impact on quality of life for many years.

“This cannot be done lightly and men need to be well counseled and informed before it snowballs.”

“Before you know it, you're on the operating table having your prostate removed – and we see examples of this all the time,” Professor Hamdi said.

The decision of the selection committee is not the last word. Today marks the start of a three-month consultation before the committee meets again and makes its final recommendations to ministers in England, Wales, Northern Ireland and Scotland, who will each have to make their own decisions about prostate screening.

Wes Streeting, England's health secretary, responded that he wanted screening “provided it was supported by evidence” and that he would “carefully” consider the evidence before giving final advice in March.

Responses to screening recommendations were divided. Cancer Research UK said it was “good news” that screening was being considered for men with defective BRCA genes, and that it “supports the committee's conclusion” that screening may do more harm than good for other groups of men.

Sir Chris Hoy said he was “extremely disappointed and saddened” and called tests for men with BRCA variants a “very small step forward” that was not enough.

“I know first-hand that by sharing my story after I was diagnosed two years ago, many, many lives were saved. Early screening and diagnosis saves lives,” he said.

Laura Kirby, chief executive of Prostate Cancer UK, said she was “deeply disappointed” and that the decision would “come as a blow” to tens of thousands of men.

Prostate Cancer Research said the decision was a “serious error that ignores current evidence” and a missed opportunity for black men and people with a family history.

A large clinical trial called Transform has now begun to try to fill data gaps about how screening can be done safely among other groups, including people with a family history and black men.

Professor Hashim Ahmed, who led the study, said the recommendations were based on “solid work” and that while some men would be disappointed, he believed the right decision had been made.

“There is a small benefit … but the harms of diagnosis, testing and treatment greatly outweigh those benefits,” he said.

Cancer Research UK used the latest data from the UK National Screening Committee to calculate the effectiveness of screening.

They say that if you test 1000 men aged 50 to 60 years:

Twenty eight: Will be diagnosed with prostate cancer.

Two: Lives will be saved.

Twenty: Will be “overdiagnosed,” meaning that a slow-growing tumor that does not require treatment will be found.

Twelve: Men will then likely have to undergo treatments such as surgery or radiation therapy, which will not benefit them and may cause harm, including the inability to control their bladder or maintain an erection.