A major trial has found that prostate cancer screening for all men over 50 would save thousands of lives in Britain.
The study involved data from 162,000 men aged between 55 to 69 from eight European countries over a 23-year period.
The data suggests that a “targeted” approach to screening could be adopted to reduce deaths from the disease and also prevent problems arising from “overdiagnosis”.
After screening 72,000 men, researchers found that one death from prostate cancer was prevented for every 456 men who were screened.
The study, published in the New England Journal of Medicine, also found one death from prostate cancer was averted for every 12 men in whom prostate cancer was diagnosed.
Commentators said the findings are “comparable to that seen with breast or bowel cancer screening”.
As well as a reduction in deaths from prostate cancer, the authors of the study said screening has a “more favourable harm-to-benefit profile than previously estimated”.
“These findings highlight the need for a more targeted strategy for prostate cancer screening that focuses on identifying population subgroups that are most likely to benefit from early detection while reducing unnecessary interventions for those with the highest risk of overdiagnosis,” they wrote.
Cancer screening experts are currently assessing whether the UK should introduce a screening programme for prostate cancer with a decision expected before the end of the year.
Currently, the prostate-specific antigen (PSA) test is a blood test which is used to check for prostate conditions including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS but men may be offered a PSA test if a GP suspects they have prostate cancer.
Men over the age of 50 can ask their GP for a PSA test, even if they do not have symptoms, but officials have faced increased calls for a screening programme to be introduced, and will be weighing up the concerns outlined in the review.
A recent study published in The BMJ also found that prostate cancer blood tests can lead to men being over-tested, while those who need help may be missed.
Commenting on the new study, Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, London, said: “The latest analysis from the ERSPC (European Randomised study of Screening for Prostate Cancer) further strengthens the evidence base in favour of PSA-based prostate cancer screening.
“The overall reduction, with longer follow-up, in risk of death is comparable to that seen with breast or bowel cancer screening.”
He added: “The well-known harms of screening, of overdiagnosis and overtreatment, can be substantially mitigated with technologies such as MRI pre-biopsy and for monitoring.
“The side effects of treatment, such as incontinence, are substantially less with modern surgery and radiotherapy than the rates documented in the trial, further strengthening the case for screening.”
Commentators added that harms linked to screening “remain a critical concern”, including unnecessary testing, biopsies, overdiagnosis and subsequent overtreatment.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, said the trial has shown that “the balance between the benefits and harms of screening with PSA testing is better than previously thought”.
“Although a large number of men were overtreated – a major reason we don’t currently have screening – that number has also reduced in this latest analysis,” he said.
“This is exactly the kind of high-quality evidence that the National Screening Committee needs to consider when making its decision on whether to screen men later this year, especially for men at higher risk like black men and men with a family history.”
Dr Ian Walker, executive director of policy at Cancer Research UK, said that while the long-running study suggests screening using the PSA test could help reduce deaths from prostate cancer, “it also concludes that screening still caused harm”.
“Men in the screening group were more than twice as likely to be diagnosed with low-risk disease compared to those not screened, often leading to unnecessary and sometimes invasive treatment,” he said.
“The authors highlight that screening all men carries a significant risk of unnecessary testing, overdiagnosis and overtreatment, due to issues with the PSA test.”
