Prostate cancer screening only for 'a few thousand' high risk men

Scientific advisers have recommended that prostate cancer screening using the prostate-specific antigen (PSA) blood test should be limited to only a few thousand men in the UK who carry a dangerous BRCA2 genetic variant and have a family history of certain cancers. The UK’s National Screening Committee concluded that for all other men, including those at higher risk such as Black men or those with a general family history of cancer, the harms of screening outweigh the benefits. The final decision on implementing these recommendations rests with health ministers across England, Wales, Scotland, and Northern Ireland. Prostate cancer is the most common cancer among men in the UK, causing around 12,000 deaths annually. Screening involves a PSA blood test followed by an MRI if results are abnormal. While screening can save lives, it also frequently leads to overdiagnosis and overtreatment. For example, a major review found that screening 1,000 men in their 50s would prevent two prostate cancer deaths over 15 years but result in 20 men being diagnosed with cancers unlikely to cause harm during their lifetime. Many of these men would undergo unnecessary treatments that can cause significant side effects, including erectile dysfunction and urinary incontinence. The committee highlighted the difficulty in distinguishing aggressive prostate cancers from those that are slow-growing and unlikely to pose a threat. Treatments can cause long-lasting harm, and the psychological impact of a cancer diagnosis can be substantial. Consequently, the committee advised against screening all men, including Black men who face double the risk of prostate cancer, and those with a family history of cancer, as the disease’s prevalence does not sufficiently narrow risk in these groups. The only group recommended for regular screening are men with the BRCA2 gene variant combined with a family history of breast, ovarian, pancreatic, or prostate cancer. These men should be offered PSA testing every two years between ages 45 and 61. This targeted approach aims to balance the benefits of early detection against the risks of overdiagnosis and overtreatment, potentially improving outcomes for those at highest risk while avoiding unnecessary harm to others.