Brenda Marsh reports:
Prostate cancer is the most common cancer in men in the UK, accounting for about 25% of all new diagnosed cancer cases in men. In 2005, over 34,000 men here were diagnosed with the disease and some 10,000 men die from prostate cancer.
Although the country has a very active breast screening service, and recently introduced a bowel screening service, there is no similar prostate cancer screening for the population. The reasons are well explained and made available to the public by the Department of Health and the National Health Service (NHS).
In 1968 J Wilson and G Junger of the World Health Organisation developed ten principles that should govern a national screening programme, which are: The condition is an important health problem; its natural history is well understood; it can be recognised at an early stage; treatment is better at an early stage; a suitable test exists; an acceptable test exists; there are adequate facilities to cope with detected abnormalities; screening is performed at repeated intervals when the onset is insidious; the chance of harm is less than the chance of benefit and, finally, the cost is balanced against benefit.
The UK National Screening Committee recommended that a prostate cancer screening programme should not be introduced in England. Why? It was decided that a prostate cancer screening programme would actually fulfil only the first condition – i.e. the disease is an important health problem. ‘When considering population screening programmes the benefits and harms must be carefully assessed, and the benefits should always outweigh the harms,’ the NHS states. ‘All screening programmes cause some harm, which could include false results, unnecessary anxiety and treatment of early disease that would not otherwise have become a problem.’
However, seeing considerable requests for the PSA test from men worried about prostate cancer, the Government introduced the Prostate Cancer Risk Management Programme, to promote ‘informed choice’, i.e. it aims to provide men considering a PSA test with clear and balanced information about the benefits, limitations and risks associated with the test. To this end, the NHS Cancer Screening Programmes and Cancer Research UK produced evidence-based material to be distributed in a pack to general practitioners (GPs). The pack contains a summary, booklet (The PSA test and prostate cancer: Information for primary care), Cancer Research UK Prostate CancerStats sheet, and a leaflet specifically for the male patient (PSA Testing for Prostate Cancer), which can be torn from the pack and handed to a patient after a GP consultation. The patient takes it home to consider fully whether he wants PSA test. If he does, he is then tested.
This initiative operates in England, but it is understood that Scotland and Wales are planning to issue similar information.
As yet, no data has been collected to assess the numbers of men being tested for prostate cancer, nor is the effect of the Prostate Cancer Risk Management Programme known. However, in an independent study (in England and Wales) the rate of PSA testing in general practice showed that around six in 100 men with no prior diagnosis of prostate cancer were tested, though less in areas of socially deprived areas and areas with greater numbers of black and Asian populations.
The overall rate of PSA testing showed a significant increase between 1999 and 2002.
The Department of Health (DoH) is also funding ongoing prostate cancer research projects. These include the large-scale randomised controlled ProtectT Trial, which is evaluating the effectiveness of treatment for clinically localised prostate cancer detected by PSA-test screening. With National Cancer Research Institute (NCRI) members, the DoH is also funding the NCRI Prostate Cancer Collaboratives. Another innovative study aims to create and test a new non-invasive treatment for prostate cancer — the technique uses MRI to locate the cancer and high intensity focused ultrasound (HIFU) to destroy the cells in situ. Finally, further funding goes to a study into the use of MRI to improve radiotherapy planning for prostate cancer.