The evidence behind prostate cancer screening – including the latest large trial of prostate cancer screening with the prostate-specific antigen (PSA) test – shows no difference in prostate cancer mortality after 10 years, according to a review published in the BMJ last week. Neither the US Preventive Services Task Force nor Public Health England recommend population screening as there is little evidence that screening would reduce deaths from prostate cancer.
However, both countries suggest that decisions about prostate cancer testing should involve discussion with individual patients of the potential benefits and harms of testing.
Prostate cancer deaths are common and now exceed breast cancer deaths in the UK, in part because the ageing population makes prostate cancer more common and in part because of advances in the treatment of breast cancer.
Men will continue to come to their general practitioners asking for a test, and their experiences vary greatly from GPs who simply offer the test with little discussion to those who decline, advising that the test has little or no value.
So what should doctors say?
Writing in the BMJ, Martin Roland, emeritus professor of health services research at the University of Cambridge, David Neal, professor of surgical oncology, University of Oxford, and Richard Buckley, patient living with prostate cancer, say patients need individual discussions about the benefits and harms of testing.
They discuss the problems of false positive and false negative test results and show how they can be included in conversation with patients trying to decide whether or not to have the PSA test. They also discuss recent advances in the use of mp-MRI and active surveillance, which have the potential to reduce the harms of testing.
Finally they suggest research priorities for the £75m prostate cancer research funding recently announced by the UK Prime Minister.
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What should doctors say to men asking for a PSA test? Martin Roland, David Neal, Richard Buckley. BMJ 2018; doi.org/10.1136/bmj.k3702. 05 September 2018
Media queries: Lucy Lloyd, Communications, Primary Care Unit
Image: Martin Roland, 2017