Prostate cancer screening could ‘save countless lives’

A program of targeted prostate cancer screening for men at highest risk could “save countless lives”, former prime minister Rishi Sunak told the BBC.

Prostate Cancer Research, of which Sunak is a patron, published a report on the costs and benefits of such an initiative. It will target black men and/or people with a family history of prostate cancer aged 45–69 years.

Sunak said he was “convinced of the urgency” of introducing such a program, which he believed would be affordable and feasible.

But some medical experts are skeptical about the value of screening, arguing that there is a risk that patients will be unnecessarily treated for cancer.

Prostate Cancer Research estimates the screening program, which would include an MRI, a PSA (prostate specific antigen) blood test and a biopsy, would cost £25 million a year – or around £18 per patient – similar to bowel and breast cancer screening.

It is estimated that 20% of eligible men, of whom there are an estimated 1.3 million in the UK, will be invited annually, for a participation rate of 72%. According to the charity, diagnostic activity (scans and biopsies) will need to rise by 23%, with only a slight increase in NHS staffing levels.

The prostate is a walnut-shaped gland at the base of the bladder that grows naturally with age, but can sometimes become cancerous when cells grow out of control. Prostate cancer in its early stages may be asymptomatic.

Asked whether he could have done more while in Downing Street to promote the need for prostate cancer screening, Sunak said testing was now more reliable thanks to the use of MRI.

“I had family and friends who were affected by it – luckily they didn't die – but it kind of made me realize why it's so important to get infected early – doctors are so brilliant at treating you now if you get it early.”

Sunak said men, including himself, are often embarrassed to discuss health problems: “That's why a proactive program of targeted screening can make a difference and help save lives.”

In England alone, more than 58,000 men will be diagnosed with prostate cancer in 2024, up 9% on 2023, according to the latest figures National Prostate Cancer Audit show.

Meanwhile, one in four black men will be diagnosed with prostate cancer, compared with one in eight white men and one in 13 other men, according to the Prostate Cancer Study. Men are also more than twice as likely to develop cancer if they have a family history.

The UK National Screening Committee is currently reviewing its decision five years ago not to recommend routine screening. According to media reports, he may stick to his current position.

Urologist Professor Noel Clarke, representing the British Association of Urological Surgeons, told participants in the national audit that while it was encouraging that more men were being diagnosed and treated earlier, “we must also address the inequalities identified by the audit so that age or postcode never determines the quality of care men receive.”

Oscar-winning film director Sir Steve McQueen, whose father's death from illness led him to seek more information about it, agrees.

“I find it very, very difficult to think that just because people have certain privileges that they should be treated differently. It's unfair,” he told BBC Radio 4's Today programme.

He added that increasing prostate cancer screening could help “even out” the situation.

Sir Steve was himself diagnosed with prostate cancer in 2022 but made a full recovery.

“I had the potential to detect this cancer, but my father did not. We now have the potential to cure so many men from it without even knowing they have cancer,” he said.

Olympic cycling champion Sir Chris Hoy, who has prostate cancer, advocates earlier screening.

He wants to lower the age limit for requesting a PSA blood test. Currently, it is not usually prescribed to men under 50 years of age without symptoms.

However, the PSA test is controversial. Levels may increase for reasons unrelated to cancer, such as infections, leading to false-positive results. Critics say it could lead to unnecessary treatment and side effects.

According to the report's authors, the benefits of introducing targeted screening for groups most at risk outweigh the financial and logistical costs.

Professor Hashim Ahmed, head of urology at Imperial College, says more research is needed to determine the potential value of screening.

“The problem is that we can often find a disease that doesn't need to be treated, and we end up doing harm… and my concern at the moment is that the harm-benefit equation isn't quite right.”

Potential side effects of prostate cancer treatment include incontinence and erectile dysfunction.

Patient voices help shape the discussion. During a recent visit to the prostate cancer clinic at Guy's Hospital in London, Sunak met 66-year-old David Bateman.

He was diagnosed with cancer at age 59 after asking for a PSA test and being told the cancer had spread to his pelvis.

Since then, Mr. Bateman has undergone chemotherapy, radiation therapy and hormonal treatment, but has not been cured. It supports screening of those who are potentially vulnerable.

“This is very important to me because my sons – they are 38 and 40 – I want them checked as soon as possible. If I had been tested at age 50, I am sure I would not be in the position I am in today,” he said.