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

A screening programme for prostate cancer 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 tumours should be eligible.

That would rule out black men who have double the risk and men who have the disease running through their families.

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

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

The UK’s National Screening Committee – which advises governments across the UK – has said no to screening in all but one rare circumstance.

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

It instinctively feels like screening for the disease should be a simple decision – test for cancer, treat it and save lives.

However, it is a far more complex issue.

Screening would rely on a blood test followed by scans of the prostate and a biopsy.

But this can miss deadly cancers and detect those that never need treatment.

Many prostate cancers grow so slowly you would have to live to 120-150 years old before they were a threat – so they do not need treating, the National Screening Committee said.

Their recommendations are based on the balance between lives saved by finding cancers early, and treatment that leaves patients unable to control their bladder or maintain an erection, whose cancer was not going to kill them.

The UK National Screening Committee recommends:

• no screening programme for all men as it is “likely to cause more harm than good”
• no screening for black men due to “uncertainties” around the impact due to a lack of clinical trials in black men
• no screening based on family history
• but screening should be offered every two years for men between the ages of 45 and 61 if they have specific genetic mutations – called BRCA variants.

These were not touch-and-go opinions as there was a “strong consensus” on each of these recommendations, the committee said.

BRCA variants increase the risk of certain cancers and, famously, led the actress Angelina Jolie to have her breasts removed.

Around three in 1,000 men have BRCA variants, but many will be unaware unless they have family members that are known carriers.

The National Screening Committee was asked to explain why they had not recommended that more men be tested for the disease.

Prof Freddie Hamdy, who is also a urological surgeon in Oxford, told me: “The diagnosis of prostate cancer in a healthy man is a hugely disruptive event – with potential to affect quality of life, very significantly, for many years.

“It cannot be done lightly, men need to be really well counselled and informed before the ‘snowball’ starts.

“Before you know it, you are on the operating table having your prostate removed – and we see examples of that all the time,” Prof Hamdy said.

The screening committee’s decision is not the final word. Today is the start of a three-month consultation before the committee meets again and gives its final advice to ministers in England, Wales, Northern Ireland and Scotland who will each have to make their own decision on prostate screening.

Wes Streeting, Health Secretary in England, responded saying he wants screening “provided this is backed by evidence” and that he would examine the evidence “thoroughly” ahead of the final advice in March.

Responses to the screening recommendations have been divided. Cancer Research UK said it was “good news” that screening was being considered for men with faulty BRCA genes and that they “support the committee’s conclusion” that screening could cause more harm than good for other groups of men.

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

“I know, first hand, that by sharing my story following my own diagnosis two years ago, many, many lives have been saved. Early screening and diagnosis saves lives,” he said.

Laura Kerby, the CEO of Prostate Cancer UK, said she was “deeply disappointed” and that the decision will “come as a blow” to tens of thousands of men.

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

Sir Stephen Fry, who is an ambassador for the charity, said “men in the UK deserve so much better” and added “I hope the country sees sense.”

A huge clinical trial – called Transform – has now started to try to fill gaps in the evidence on how screening could be safely rolled out to other groups, including those with a family history and black men.