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There has been a lot of debate about whether or not to introduce a national screening programme for prostate cancer. Men’s health campaigners argue that this could improve the quality of life and reduce premature death among males, much as the national screening programme for breast cancer has improved treatment and survival rates for women. 

Health professionals cite the lack of a reliable method of detecting prostate cancer in the early stages as the reason that there is no national screening programme in place. Prostate cancer is the second most common cause of cancer deaths in men in the UK, resulting in about 12,000 deaths per year.

The risk of developing prostate cancer increases with age, and most men are diagnosed after the age of 50. About 75 per cent of the men diagnosed will go on to live for ten or more years, but the treatment can cause unwanted side effects including erectile dysfunction (ED), and bladder and bowel incontinence. 

Cancer Research UK explains that for cancer screening to be useful, it needs to reliably pick up cancer that needs treatment in the early stages; overall it must do more good than harm for the participants; and it must be something that people are willing to partake in. 

There is a method of diagnosing prostate problems, known as the prostate specific antigen (PSA) test. However, currently health experts do not believe that the PSA test is reliable enough to be used as part of a national screening programme. 

This is because a raised PSA level can be the sign of other conditions including a benign enlarged prostate and a urine infection. The test can also miss prostate cancers, because it can occur in men with normal PSA levels. However, the test is widely available to men over the age of 50 if they request it through their GP.

Bristol University reports on the largest study to date that investigated the use of the PSA test as a means of detecting prostate cancer. Known as the CAP trial, it was carried out jointly by researchers at the universities of Bristol, Oxford, and Cambridge, and involved over 400,000 men between the ages of 50 and 69. 

Around half of the participants were invited to have a single PSA test as part of the trial, and the whole group was monitored for the following 15 years. The researchers found that seven out of every 1,000 men in the group who had the PSA test died from prostate cancer, compared to nearly eight out of 1,000 men in the group who didn’t have the test.

This small improvement in the detection of prostate cancer was offset by the finding that about one in six of the cancers were overdiagnosed. This can result in unnecessary treatment, causing emotional distress, and unpleasant side effects that can reduce the quality of life, including ED and incontinence. 

The authors therefore concluded that the benefits of a universal PSA test for men do not outweigh the potential for harm. Men who have undergone prostate cancer treatment may need counselling and medication to help them regain their sexual function. In some cases, they may be offered treatment such as Viagra or tadalafil, the trade name for Cialis.  

Professor Richard Martin, lead author and Cancer Research UK scientist at the University of Bristol, said: 

“Our studies have been measuring the effectiveness of the PSA test with hundreds of thousands of men for 15 years. The key takeaway is that the small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the potential harms.”

“This results in some men going on to have invasive treatment that they don’t need, many years earlier than without screening, and the test is also failing to spot some cancers that do need to be treated. We need to find better ways to spot aggressive prostate cancers, so we can treat them early.”

The main symptoms of prostate cancer do not usually present themselves in the early stages of the disease, so it can be difficult to detect and treat. When the disease has spread to the later stages, the main symptoms include persistent back or bone pain; fatigue; and unexplained weight loss.