Intended for healthcare professionals

Feature Screening

Is the UK really ready to roll out prostate cancer screening?

BMJ 2023; 381 doi: (Published 17 May 2023) Cite this as: BMJ 2023;381:p1062

Linked Analysis

Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit

  1. Elisabeth Mahase
  1. The BMJ

Proponents and positive news coverage suggest a national programme is “in the pipeline”—but Elisabeth Mahase finds uncertainty, controversy, and a need for more evidence

Late February saw a spate of breathless headlines urging the government to roll out “life-saving” prostate cancer screening in the UK, which is not currently recommended by the National Screening Committee (NSC).

The reports were based on a non-peer reviewed research abstract, and—while a change in advice in the European Union does point towards national screening—some doctors believe further evidence and other assurances are needed before it is implemented in the UK.

In the meantime, experts say that the current UK situation of “informed choice,” in which men without symptoms can get a prostate specific antigen (PSA) test by request, is the worst of both worlds. Others have expressed frustration that government campaigning to encourage these requests goes against NSC recommendations and jumps the gun on any possible change.

Review looming

Prostate cancer is the most common cancer in men, and the third leading cause of cancer death in men in Europe. But despite its prevalence, only two countries in the world—Kazakhstan and Lithuania—have an official population based screening programme.1

The main barrier is the harm-benefit calculation required for any screening programme. In this case, the initial test used to indicate whether someone may have prostate cancer, the PSA test, is unreliable. It can incorrectly suggest someone has prostate cancer when they do not, and it can also miss cancers: around one in seven people with normal PSA concentrations may have prostate cancer.2 PSA screening reduces prostate cancer mortality by detecting aggressive cancers that need treatment—but it may also lead to harm in the form of overdiagnosis and overtreatment, by detecting cancers that would never cause symptoms or shorten life.

In the UK, while any man …

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