PC Screening

Hi excavator unfortunately the link asks for a trial subscription on my iPad, so not able to see it.  I think men should have a PSA test and recorded on their file routinely, then any subsequent change can be picked up.  I understand the negative impact of mass screening but changes in PSA to an individual are important indicators.

That's a shame, I didn't realise that as I have a subscription.

Here's a cut and paste, hope that works better.

Here, two leading figures from either side of the debate put forward their arguments.

Harms outweigh the benefits

Professor Sir Mike Richards, chair of the national screening committee

I would be very keen to recommend a screening programme for prostate cancer if I knew that it would save a significant number of lives without harming a considerably larger number of men. That is my position as chair of the UK national screening committee, which makes recommendations to ministers in the four UK countries. It is also my position as an individual who has had prostate cancer and undergone robot-assisted laparoscopic prostatectomy.

My colleagues on the committee and I have looked at the evidence on the benefits and harms of screening for prostate cancer in great detail. We have experts on screening, a geneticist, an ethicist, a health economist and a patient representative on the committee. We also consult widely with clinicians, academics, charities and patient groups. The evidence simply does not support a
population-wide screening programme at present.

Let me be clear about what the evidence actually shows. For every 1,000 men screened, two fewer are likely to die from prostate cancer, after 15 to 20 years. However, we need to be cautious about those two lives saved, as the data from the trials shows that overall survival is no different between those who were screened or not screened. Most people die of causes other than prostate cancer. This may be difficult to explain, but it is what the trials show.

Now consider the harms. For every 1,000 men screened there will be around 20 who will receive a cancer diagnosis, but whose cancer would never have caused a problem in their lifetime. They will, however, be subject to the anxiety of knowing they have a cancer. Around 12 of the 1,000 men will undergo treatment that can cause harm, without getting any benefit. The harms of prostatectomy or
radiotherapy include debilitating incontinence and erectile dysfunction, which can last for the rest of their lives. These harms can occur despite the best modern techniques, though research into new approaches is continuing.

To improve the balance between benefits and harms, it is important to separate out those men whose prostate cancers are likely to lead to death from those who would not experience any problem in their lifetime. Unfortunately, we cannot always do this reliably.

I understand why most men who have had prostate cancer diagnosed through screening believe that this has saved their lives. However, the evidence shows that for many men this is not the case. Individual stories, even in large numbers, do not provide the evidence we need to make rational decisions. The task of my committee is to make recommendations based on the best available evidence.

We have not recommended population-wide screening for prostate cancer because we believe the harms outweigh the benefits. Nor have we recommended screening for men with a family history of cancer or for black men, because we simply do not have sufficient evidence one way or the other for these groups.

We very much hope that ongoing research will provide the evidence we need. We have, however, recommended screening for a small group of men with a BRCA2 genetic abnormality and a family history of relevant cancers, as these men are at much higher risk and suffer more aggressive disease.

This is a start. The national screening committee is committed to going further as soon as the evidence permits. That is why we are keeping the topic open. We understand the public support for screening, but we must stick with the fundamental principle of screening programmes: that they must do more good than harm.

Technology has changed the game

Nick Jones, founder of Soho House Group and prostate cancer survivor

The decision of the UK national screening committee is a bitter disappointment for many men and their families. Despite prostate cancer being the most common cancer in men and killing more than 12,000 people every year, the committee has once again decided against screening for most of those at highest risk.

Black men remain excluded, despite facing around double the risk of developing prostate cancer and being more likely to die from the disease. Men with a strong family history remain excluded too, unless they also carry a BRCA2 gene variant. Even eligibility for men with BRCA variants has been narrowed since the draft recommendation published last year.

The question is why. The committee’s position has long rested on concerns about overdiagnosis and overtreatment and that screening will do more harm than good. Those concerns deserve to be taken seriously. No responsible campaigner is calling for a return to the crude screening approaches of the past.

But medicine has changed dramatically. Over the last decade we have seen major advances in MRI technology that allow doctors to identify clinically significant cancers far more accurately than before. Faster and cheaper MRI scans are increasingly being adopted. AI is now being trialled across the NHS to improve the interpretation of scans and help clinicians identify the men most likely to benefit from treatment.

The same is true for treatment itself. Robotic surgery has transformed outcomes for many patients. Radiotherapy has become more precise and less burdensome. Active surveillance has become a standard and increasingly sophisticated option for men with lower-risk disease, allowing many to avoid treatment altogether while remaining under careful monitoring.

Taken together, these advances fundamentally change the balance between benefits and harms.

Yet reading this recommendation, it is difficult to escape the feeling that the committee is looking backwards while medicine is moving forwards.

Many of the studies that underpin the decision were designed in a very different era. Since then, diagnosis has improved. Treatment has improved. Risk stratification has improved. Patients themselves are better informed and more empowered to make decisions about their care.

Public policy must therefore evolve too. That is why I believe the new health secretary, James Murray, should reject the committee’s recommendation.

He should ask whether the latest advances in diagnosis, imaging and treatment have been properly reflected. He should ask whether enough weight has been given to the realities facing men at highest risk. And he should ask whether Britain is comfortable continuing to tell black men that they face one of the highest prostate cancer risks in the world while offering them no screening programme at all.

James Murray has an opportunity to show leadership. He should send this recommendation back and ask for something better, especially for Britain’s black community and for families who know first-hand the devastating impact of prostate cancer.

If we know who is most at risk, continuing to look the other way is no longer a neutral choice. It is a decision in itself.

Thank you for that Derek, there was something very similar in the Telegraph yesterday and over 600 comments. To be honest after reading some of the comments - from educated people - I was left fuming . It's easy to comment on something that's not affected you - yet!

After reading about 150 comments, I fed the dog, took him for a walk and had a couple of pints to "cool down".

My simple thoughts:

* The PSA test is an indicator.

* The DRE (digital rectal examination is an indicator).

* It's a cancer that in the main affects men over 50.

So if you meet any of the 3 criteria above (never mind if you are black or BRACA2) and yes let's do the PSA test, (the DRE if your GP feels it's needed) let's get you on that MRI table. Let's get a testing plan going.

You can argue there are not enough MRI machines - we have a new Community Diagnostic Centre where I live with plenty of capacity, and don't forget if we invite every man who meets the criteria for a test - there won't be a 100% take up!

YES - my view is biased because IF testing was in place I don't think I would be typing this today - I would be doing something else in my dotage (go on Google it ).

WHY - is Brest and Cervical cancer (and now the scope for Lung Cancer testing is being increased) offered to every woman of a certain age? (sorry ladies but I have to make that comment!).

Ask me why am I bothered - I already have Prostate Cancer and the testing debate wouldn't affect me. I am bothered because I have seen the devastation this cancer causes not only to the men with a diagnosis but to their family and friends. Mentally I am strong and have a supportive wife and family but not everyone has!

So there you have my thoughts - anyone else?  (and this is only about testing - not treatments!)

Best wishes - Brian.