![\"Getty](\"https:\/\/ichef.bbci.co.uk\/news\/480\/cpsprodpb\/3c8c\/live\/5b865ae0-a1e1-11ef-ac1b-fdcb0e142fda.jpg.webp\")
Getty Images<\/span><\/div>\n<\/div>\n<\/figure>\nScreening men born with a high risk of developing prostate cancer, once they reach the age of 45, makes financial sense, a cancer charity says.<\/p>\n
But Prostate Cancer Research also acknowledges more accurate tests would be needed to justify screening all men.<\/p>\n
There is no prostate-cancer screening programme in the UK, unlike those for breast, bowel and cervical cancer.<\/p>\n
Instead, the onus is on men to request a blood test from their GP once they are over 50.<\/p>\n<\/div>\n
More men dying<\/h2>\n<\/p>\n\nThe debate around prostate screening revolves around an imperfect test and the trade-off between finding some men\u2019s aggressive cancers earlier and the harms of diagnosing and treating slow-growing tumours that would never have affected a man\u2019s health or lifespan.<\/p>\n
The case for and against is constantly reviewed in the UK, with the most recent report from the National Screening Committee, in 2020, saying the harms were too great. <\/p>\n
Further updates are expected this year.<\/p>\n
Despite more men dying from prostate cancer than women from breast cancer, there is no reliable test for the disease.<\/p>\n
The blood test men over 50 can request from their GP measures prostate-specific antigen (PSA), released by the prostate, a small gland located below the bladder involved in the production of semen.<\/p>\n
But PSA levels can be high for a variety of reasons – including an enlarged prostate, inflammation or infection, recent vigorous exercise or sex – or remain normal despite cancer.<\/p>\n<\/div>\n
\nAnd there are many different kinds of prostate cancer – not all deadly.<\/p>\n
“There are prostate cancers that are so slow-growing that they will not affect a man’s lifespan,” GP Dr Margaret McCartney says. <\/p>\n
These are found in one in three men over 50.<\/p>\n
“And then you have a small number of very aggressive prostate cancers which do move quickly and cause harm,” Dr McCartney says.<\/p>\n
Follow-up magnetic resonance imaging (MRI) scans and a tissue biopsy can help narrow down which men have cancer and need treatment – but some still end up being treated for something that would never cause a problem.<\/p>\n
“Far more men have tests done to try to work out what kind of prostate cancer it is, than are going to benefit from it – there’s the problem,” Dr McCartney says.<\/p>\n<\/div>\n
Conflicting results<\/h2>\n<\/p>\n\nClinical trials have produced conflicting results about screening. <\/p>\n
One, in Europe, says it saves lives.<\/p>\n
Another, in the UK, shows a more marginal benefit.<\/p>\n
And a third, in the US, says it does not.<\/p>\n
Prof Hashim Ahmed, chair of urology at Imperial College London, says: \u201cWe need to screen 570 men to prevent one death – that\u2019s a lot of men to counsel.\u201d<\/p>\n
Screening means aggressive cancers can be treated before symptoms appear. <\/p>\n
But trials show there are harms to testing large numbers of healthy men – and once a cancer is spotted, even a low-risk one, it needs to be followed up.<\/p>\n<\/div>\n
\nMany men with a low-risk cancer are simply monitored or begin \u201cwatchful waiting\u201d – but a cancer diagnosis and the invasive tests it involves have a psychological impact.<\/p>\n
One in 10 of these men opts for radical surgery rather than live with the anxiety of wondering whether their cancer will grow, Prof Ahmed says.<\/p>\n
But this can leave them unable to maintain an erection – and a third spend the rest of their life needing a pad because they leak urine.<\/p>\n
\u201cAt the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms,” Prof Ahmed told BBC Radio 4’s Inside Health programme.<\/p>\n
“So I would rather avoid finding low-risk disease.\u201d<\/p>\n<\/div>\n\n\n![](\"https:\/\/www.bbc.com\/bbcx\/grey-placeholder.png\")
![\"Getty](\"https:\/\/ichef.bbci.co.uk\/news\/480\/cpsprodpb\/6bf9\/live\/fa14f0b0-a1df-11ef-ac1b-fdcb0e142fda.jpg.webp\")
Getty Images<\/span><\/div>\n<\/div>\n<\/figure>\n\nMuch research in the field has focused on refining the process to minimise the harms of screening.<\/p>\n
And Prof Ahmed is running the Transform trial<\/a>, starting next year, to compare the most promising technologies. <\/p>\nBut the results could be 10 years away.<\/p>\n
In the meantime, Prostate Cancer Research’s report<\/a> says, screening 45-69-year-olds at high risk – black men and those with a family history of the disease or particular gene mutations – would deliver an economic benefit, after factoring in the cost of treatment and the impact on working lives and carers.<\/p>\n“Finding and treating cancers early outweighs the harms of over-treatment by four times,” the charity’s chief executive, Oliver Kemp, says.<\/p>\n
And another charity, Prostate Cancer UK, says the report supports its call to overhaul “dangerously outdated NHS guidance that is leading to too many men receiving a late, incurable diagnoses”.<\/p>\n<\/div>\n
\nProf Frank Chinegwundoh, a consultant urological surgeon at Barts Health NHS Trust, says: “It\u2019s very difficult to weigh up the risks and benefits.” <\/p>\n
But he often sees men who could have been diagnosed earlier – and they can be relatively young, he says.<\/p>\n
“We can do a lot better than we are currently doing,” Prof Chinegwundoh told Inside Health.<\/p>\n
And he says black men – who have double the risk of the disease – should consider having a PSA test at 40, particularly if they have a strong family history of the cancer.<\/p>\n
But earlier this year, concerns were raised black men were at greater risk than other men of being harmed by a cancer diagnosis that did not need to be treated, because they have naturally higher PSA levels<\/a>.<\/p>\n<\/div>\n‘Tough question’<\/h2>\n<\/p>\n\nWhile the arguments rage, what should men do today?<\/p>\n
\u201cIt\u2019s a really tough question,\u201d Prof Ahmed says.<\/p>\n
And the NHS needs to give men better information.<\/p>\n
The trade-off between the risks and benefits of being tested is \u201cvery nuanced, very personal\u201d, Prof Ahmed says, and what is acceptable to one man will be unacceptable to another.<\/p>\n<\/div>\n<\/div>\n
The debate around prostate screening revolves around an imperfect test and the trade-off between finding some men\u2019s aggressive cancers earlier and the harms of diagnosing and treating slow-growing tumours that would never have affected a man\u2019s health or lifespan.<\/p>\n
The case for and against is constantly reviewed in the UK, with the most recent report from the National Screening Committee, in 2020, saying the harms were too great. <\/p>\n
Further updates are expected this year.<\/p>\n
Despite more men dying from prostate cancer than women from breast cancer, there is no reliable test for the disease.<\/p>\n
The blood test men over 50 can request from their GP measures prostate-specific antigen (PSA), released by the prostate, a small gland located below the bladder involved in the production of semen.<\/p>\n
But PSA levels can be high for a variety of reasons – including an enlarged prostate, inflammation or infection, recent vigorous exercise or sex – or remain normal despite cancer.<\/p>\n<\/div>\n
And there are many different kinds of prostate cancer – not all deadly.<\/p>\n
“There are prostate cancers that are so slow-growing that they will not affect a man’s lifespan,” GP Dr Margaret McCartney says. <\/p>\n
These are found in one in three men over 50.<\/p>\n
“And then you have a small number of very aggressive prostate cancers which do move quickly and cause harm,” Dr McCartney says.<\/p>\n
Follow-up magnetic resonance imaging (MRI) scans and a tissue biopsy can help narrow down which men have cancer and need treatment – but some still end up being treated for something that would never cause a problem.<\/p>\n
“Far more men have tests done to try to work out what kind of prostate cancer it is, than are going to benefit from it – there’s the problem,” Dr McCartney says.<\/p>\n<\/div>\n
Conflicting results<\/h2>\n<\/p>\n\nClinical trials have produced conflicting results about screening. <\/p>\n
One, in Europe, says it saves lives.<\/p>\n
Another, in the UK, shows a more marginal benefit.<\/p>\n
And a third, in the US, says it does not.<\/p>\n
Prof Hashim Ahmed, chair of urology at Imperial College London, says: \u201cWe need to screen 570 men to prevent one death – that\u2019s a lot of men to counsel.\u201d<\/p>\n
Screening means aggressive cancers can be treated before symptoms appear. <\/p>\n
But trials show there are harms to testing large numbers of healthy men – and once a cancer is spotted, even a low-risk one, it needs to be followed up.<\/p>\n<\/div>\n
\nMany men with a low-risk cancer are simply monitored or begin \u201cwatchful waiting\u201d – but a cancer diagnosis and the invasive tests it involves have a psychological impact.<\/p>\n
One in 10 of these men opts for radical surgery rather than live with the anxiety of wondering whether their cancer will grow, Prof Ahmed says.<\/p>\n
But this can leave them unable to maintain an erection – and a third spend the rest of their life needing a pad because they leak urine.<\/p>\n
\u201cAt the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms,” Prof Ahmed told BBC Radio 4’s Inside Health programme.<\/p>\n
“So I would rather avoid finding low-risk disease.\u201d<\/p>\n<\/div>\n\n\nGetty Images<\/span><\/div>\n<\/div>\n<\/figure>\n\nMuch research in the field has focused on refining the process to minimise the harms of screening.<\/p>\n
And Prof Ahmed is running the Transform trial<\/a>, starting next year, to compare the most promising technologies. <\/p>\nBut the results could be 10 years away.<\/p>\n
In the meantime, Prostate Cancer Research’s report<\/a> says, screening 45-69-year-olds at high risk – black men and those with a family history of the disease or particular gene mutations – would deliver an economic benefit, after factoring in the cost of treatment and the impact on working lives and carers.<\/p>\n“Finding and treating cancers early outweighs the harms of over-treatment by four times,” the charity’s chief executive, Oliver Kemp, says.<\/p>\n
And another charity, Prostate Cancer UK, says the report supports its call to overhaul “dangerously outdated NHS guidance that is leading to too many men receiving a late, incurable diagnoses”.<\/p>\n<\/div>\n
\nProf Frank Chinegwundoh, a consultant urological surgeon at Barts Health NHS Trust, says: “It\u2019s very difficult to weigh up the risks and benefits.” <\/p>\n
But he often sees men who could have been diagnosed earlier – and they can be relatively young, he says.<\/p>\n
“We can do a lot better than we are currently doing,” Prof Chinegwundoh told Inside Health.<\/p>\n
And he says black men – who have double the risk of the disease – should consider having a PSA test at 40, particularly if they have a strong family history of the cancer.<\/p>\n
But earlier this year, concerns were raised black men were at greater risk than other men of being harmed by a cancer diagnosis that did not need to be treated, because they have naturally higher PSA levels<\/a>.<\/p>\n<\/div>\n‘Tough question’<\/h2>\n<\/p>\n\nWhile the arguments rage, what should men do today?<\/p>\n
\u201cIt\u2019s a really tough question,\u201d Prof Ahmed says.<\/p>\n
And the NHS needs to give men better information.<\/p>\n
The trade-off between the risks and benefits of being tested is \u201cvery nuanced, very personal\u201d, Prof Ahmed says, and what is acceptable to one man will be unacceptable to another.<\/p>\n<\/div>\n<\/div>\n
Clinical trials have produced conflicting results about screening. <\/p>\n
One, in Europe, says it saves lives.<\/p>\n
Another, in the UK, shows a more marginal benefit.<\/p>\n
And a third, in the US, says it does not.<\/p>\n
Prof Hashim Ahmed, chair of urology at Imperial College London, says: \u201cWe need to screen 570 men to prevent one death – that\u2019s a lot of men to counsel.\u201d<\/p>\n
Screening means aggressive cancers can be treated before symptoms appear. <\/p>\n
But trials show there are harms to testing large numbers of healthy men – and once a cancer is spotted, even a low-risk one, it needs to be followed up.<\/p>\n<\/div>\n
Many men with a low-risk cancer are simply monitored or begin \u201cwatchful waiting\u201d – but a cancer diagnosis and the invasive tests it involves have a psychological impact.<\/p>\n
One in 10 of these men opts for radical surgery rather than live with the anxiety of wondering whether their cancer will grow, Prof Ahmed says.<\/p>\n
But this can leave them unable to maintain an erection – and a third spend the rest of their life needing a pad because they leak urine.<\/p>\n
\u201cAt the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms,” Prof Ahmed told BBC Radio 4’s Inside Health programme.<\/p>\n
“So I would rather avoid finding low-risk disease.\u201d<\/p>\n<\/div>\n Much research in the field has focused on refining the process to minimise the harms of screening.<\/p>\n And Prof Ahmed is running the Transform trial<\/a>, starting next year, to compare the most promising technologies. <\/p>\n But the results could be 10 years away.<\/p>\n In the meantime, Prostate Cancer Research’s report<\/a> says, screening 45-69-year-olds at high risk – black men and those with a family history of the disease or particular gene mutations – would deliver an economic benefit, after factoring in the cost of treatment and the impact on working lives and carers.<\/p>\n “Finding and treating cancers early outweighs the harms of over-treatment by four times,” the charity’s chief executive, Oliver Kemp, says.<\/p>\n And another charity, Prostate Cancer UK, says the report supports its call to overhaul “dangerously outdated NHS guidance that is leading to too many men receiving a late, incurable diagnoses”.<\/p>\n<\/div>\n Prof Frank Chinegwundoh, a consultant urological surgeon at Barts Health NHS Trust, says: “It\u2019s very difficult to weigh up the risks and benefits.” <\/p>\n But he often sees men who could have been diagnosed earlier – and they can be relatively young, he says.<\/p>\n “We can do a lot better than we are currently doing,” Prof Chinegwundoh told Inside Health.<\/p>\n And he says black men – who have double the risk of the disease – should consider having a PSA test at 40, particularly if they have a strong family history of the cancer.<\/p>\n But earlier this year, concerns were raised black men were at greater risk than other men of being harmed by a cancer diagnosis that did not need to be treated, because they have naturally higher PSA levels<\/a>.<\/p>\n<\/div>\n While the arguments rage, what should men do today?<\/p>\n \u201cIt\u2019s a really tough question,\u201d Prof Ahmed says.<\/p>\n And the NHS needs to give men better information.<\/p>\n The trade-off between the risks and benefits of being tested is \u201cvery nuanced, very personal\u201d, Prof Ahmed says, and what is acceptable to one man will be unacceptable to another.<\/p>\n<\/div>\n<\/div>\nGetty Images<\/span><\/div>\n<\/div>\n<\/figure>\n‘Tough question’<\/h2>\n<\/p>\n