Caution should be exercised to support prostate cancer testing in asymptomatic men

Inviting people who do not have symptoms to be tested for prostate cancer is currently not recommended and should be treated with caution, as for most men the benefits are small and uncertain and there is clear harm, experts warn. BMJ today.

NHS England teamed up with Prostate Cancer UK earlier this year to find 14,000 men who are estimated not to have started prostate cancer treatment due to the pandemic. However, experts warn that prostate cancer screening is not currently recommended by the British National Screening Committee.

The National Institute for Health and Care Excellence (NICE) advises GPs that “testing should not be offered to asymptomatic people,” although a patient who has been informed of possible harms and benefits may request a test.

The campaign encourages men to use “risk control” and, if concerned, talk to their GP about possible next steps, including a prostate specific antigen (PSA) test.

But in the UK and US, routine PSA screening is not recommended because research has shown that the test can at best prevent one death from prostate cancer for every 1,000 patients tested in 10 years.

PSA testing also carries the risk of overdiagnosis – healthy men are diagnosed and treated unnecessarily for slow-growing and harmless tumors.

While acknowledging that the campaign’s message is in line with the established principle of allowing patients to decide for themselves on PSA testing and that risk control provides some valuable information, the authors say they encourage all asymptomatic men over the age of 50 to book an appointment with general practitioner for discussion. their risk “seems to deviate from this cautious approach” and also has implications for resources.

The fact that the campaign supports the detection of asymptomatic disease could lead people to believe that the NHS supports screening, experts say.

In the United Kingdom and the United States, asymptomatic men can opt for a PSA test after exploring their options with their doctor. However, experts suggest that reaching a common decision on the value of the PSA test is complex and time consuming.

“GPs and patients need practical, up-to-date guidance on PSA testing, including recommended evidence-based tools and resources to support shared decision-making,” the authors write.

“If a risk control tool is to be promoted as part of an early detection strategy, it must be evidence-based and properly evaluated.”

Better ways to detect prostate cancer earlier are being evaluated, but in the meantime “efforts must continue to focus on rapid diagnosis of symptomatic patients and evidence of the clinical and cost-effectiveness and safety of any national screening program,” they conclude. .