Prostate cancer screening could be rolled out across the UK after major research suggested the benefits may outweigh the risks.
Currently, there is no national programme inviting men without symptoms to undergo checks, although those over 50 can request them on the NHS.
But the UK screening committee is to review the evidence and is being urged to consider a study which suggests that changes in medical practice have vastly reduced the potential harms of such programmes.
On Wednesday, cancer experts said they were hopeful that routine checks will be introduced, suggesting that the latest findings may have “tipped the seesaw” in favour of screening.
Prostate cancer is the most common cancer among British men, with 52,000 diagnoses a year and 12,000 deaths.
Screening - which normally involves offering prostate-specific antigen (PSA) tests to all men over the age of 50, and younger men in particular risk groups - has already been found to cut deaths from the disease by around 20 per cent.
But the UK has held off introducing screening checks, because PSA tests are notoriously unreliable, resulting in too many men undergoing needless biopsies, invasive procedures which can in themselves cause harm.
The analysis by Prostate Cancer Research UK found that modern techniques, introduced in the past three years to target follow-up checks more narrowly, have reduced these risks by two-thirds.
The charity said the latest evidence, combined with other trials from the UK and Europe, “points towards an ever-stronger case for screening”.
Risk of needless biopsies has fallen
Until 2019, men with high levels of PSA in their blood were sent straight for a biopsy, which came with a risk of serious infection and could sometimes miss the cancer, resulting in repeated procedures.
But recent changes in medical practice mean men with suspected disease are now increasingly sent for mpMRI scans which can safely rule out more than one-quarter of cases.
In addition, new targeted biopsy techniques with a lower risk of infections such as sepsis, backed by Nice last year, have been introduced.
The Prostate Cancer UK analysis, being presented at a conference of the American Society of Clinical Oncology in San Francisco, found that the risk of needless biopsies has fallen by almost 64 per cent thanks to the changes, with cases of sepsis falling by more than half.
Before the changes, around 13.2 per cent of biopsies following a PSA test could have been avoided - with no disease found, or cancer which was so “insignificant” it did not need treatment.
Analysis combining real-world data suggests this dropped to around 4.3 per cent.
This amounts to a 67 per cent reduction in harm during the diagnostic process – amounting to 902 fewer men harmed for every 10,000 PSA tests carried out.
Until now, the case for routine screening has also been weakened by the number of men ending up being diagnosed and treated for slow-growing cancers which would never have caused them harm.
But the new analysis which involved a collection of clinical trials, and real-world data from 16 NHS trusts in London and the South East, found that the number of men receiving a diagnosis of “clinically insignificant cancer” fell by 77 per cent since the changes.
Dr Matthew Hobbs, lead researcher on the analysis and Director of Research at Prostate Cancer UK, said: “We’ve known for some time now that testing more men reduces prostate cancer deaths, but there have always been concerns about how many men would be harmed to achieve this. However, our evidence shows that screening may now be a lot safer than previously thought.
“That’s why we are so pleased that the committee is going to review the evidence once more. It’s important that they consider this study and actual outcomes from the real-world NHS data and we hope they will find that we’ve reduced harm enough to be ready to launch a screening programme for prostate cancer.”
The UK National Screening Committee is considering proposals to extend screening to cover all men over 50 or to target measures on those at the highest risk of the disease. The proposals will also look at the case for more limited screening, which could focus on those with a first-degree relative diagnosed with prostate, breast or ovarian cancer, or on particular ethnic groups - such as black men - where the risk is far higher.
A Department of Health and Social Care spokesman said: “The UK National Screening Committee has received a set of proposals relating to screening for prostate cancer. It will explore these further and consider how best to take them forward.”
Ros Eeles, professor of oncogenetics at the Institute of Cancer Research and honorary consultant at the Royal Marsden NHS Trust, said: “The study shows very interesting data which support the shift towards the investigation of how to implement prostate screening.”
“European studies of using the blood marker PSA to direct screening have shown a reduction in mortality, but the concern has been overdiagnosis, including detection of some cases which would never have caused harm, and potential harms of overtreatment.
“However, we know that about a quarter of cases will be aggressive and cause deaths. There is therefore a need to identify techniques that will tip the balance of screening from risk to benefit.”
