THE NUMBERS of men dying from prostate cancer in the Republic is not going down despite increased screening for the disease, a public health specialist has said.
Dr Alan Smith, a consultant in public health medicine with the National Cancer Screening Service, said this may be because men with the most aggressive forms of the disease are not presenting for screening.
He said screening may be picking up the “milder formers of cancer that stay localised in the prostate gland and that do not spread or kill, and not able to accurately pick up the more aggressive prostate cancer that does kill”.
Dr Smith was speaking in advance of a public meeting on cancer screening at the Royal College of Physicians of Ireland last night.
“The amount of prostate cancer testing that is going on in Ireland is enormous but despite all the testing we are not making any impact on mortality,” he said.
Prostate cancer is the most common cancer in Irish men, with more than 2,400 new cases diagnosed each year. More than 500 men die from the disease in the State every year.
Dr Smith also stressed that he didn’t believe a national population-based prostate cancer screening programme along the lines of BreastCheck to screen women for breast cancer should be put in place. He said it could possibly do more harm than good.
“While population screening for prostate cancer would undoubtedly identify more cancers in men, it is also likely that a population approach to screening would expose the majority of men participating in such a programme to unnecessary harms,” he said.
“Unnecessary biopsies and the complications of treatment can cause side effects including impotence and incontinence,” he added.
Prostate biopsies were “much more technically complex”, for example, than a breast biopsy, he explained. However, he stressed he was all in favour of an individual approach to screening for prostate cancer.
“Prostate cancer screening really belongs at the individual doctor-patient consultation where the patient can discuss with the doctor the pros and cons of the screening test and should they need a biopsy they can discuss the pros and cons of that,” he said.
Men over 40 years should consider, in consultation with their GP, having a PSA (prostate specific antigen) blood test to screen for prostate cancer, he added.
He pointed out that men with raised PSA levels following their blood test would in future be referred to the eight or so rapid access clinics for prostate cancer patients being established by the national cancer control programme. The main risk factor for prostate cancer is advanced age, with 80 per cent of cases occurring in men over 65 years.
The Irish Cancer Society agrees that prostate cancer screening should be provided on an individual patient basis rather than as a national population-based programme. Its helpline number is 1800-380-380.