MEDICINE BALLS
Prostate poser
PROSTATE cancer is the commonest cancer in men in the UK, with an estimated 63,000 diagnoses every year and more than 12,000 deaths. It deserves the attention it gets, but – as is often the case – we have the least data for those most at risk. Black men have a two- to three-times higher risk of prostate cancer diagnosis, but are so under-represented in screening trials that those who make decisions on screening can argue the evidence isn’t robust enough to support it. Yet.
It’s no, again
THE UK’s National Screening Committee (NSC) has again rejected prostate cancer screening for men, other than a targeted programme for those with a confirmed BRCA gene variant. The reason, as before, is that from what we currently know, the harms and costs will likely outweigh the benefits on a population level. This is a draft NSC recommendation anyone can respond to until 20 February.
Any man over 50 or at higher risk because of family history and/or ethnicity can ask their GP for a prostate specific antigen (PSA) test, although GPs’ enthusiasm for it varies. MD has been tested, because at 63 I have some lower urinary tract symptoms. However, I’m also old enough to remember the PSA test being labelled “Promoting Stress and Anxiety”.
The evidence for…
THE best evidence of modest screening benefit comes from the European Randomised Study of Screening for Prostate Cancer (ERSPC), which included 162,236 men aged between 55 and 69 at the time of randomisation and had 23 years of follow-up. This showed one death from cancer prevented for every 456 men screened, and one man had his life extended for every 12 diagnosed and treated.