Routine prostate cancer testing ruled out due to ‘clear harms’ and ‘small’ benefit

A panel of international experts has advised against routine testing for prostate cancer for most men because the benefit is “small and uncertain” and there are “clear harms”.

Acknowledging that some men, particularly with a family history of prostate cancer, may be more likely to consider screening, the experts said discussions about possible harms and benefits with their doctors is essential for those men.

Their report, grounded on the latest evidence, is published in the British Medical Journal.

It comes as the National Health Service in England revealed actor Stephen Fry’s prostate cancer diagnosis had caused an “extraordinary” 15 per cent spike in referrals to services there. Fry (61) had urged men of a “certain age” to get themselves tested after he disclosed his diagnosis last February.

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The prostate specific antigen (PSA) test is the only widely used test currently available to screen for prostate cancer. It remains controversial because it has increased the number of healthy men diagnosed with, and treated unnecessarily for, harmless tumours.

Dr Robert O'Connor, head of research of the Irish Cancer Society (ICS), welcomed the experts' consensus report, saying it "further strengthens existing guidance that PSA testing should not be used as a general screen for prostate cancer but may be very useful in confirming a cancer diagnosis and following up on treatment".

Prostate cancer affects about one in seven men in Ireland over their lifetime but the good news is that modern advances mean nine in 10 men will be alive 10 years after their diagnosis and most men can expect to be cured or to die “with the disease rather than from it”, he said.

The PSA test is unfortunately not an effective screen for the disease since men may have cancer and have normal PSA levels (a false negative) and, conversely, have high PSA levels with no prostate cancer (a false positive), he said.

The ICS welcomed the guidance that men should consult with their doctor about whether to have a test or not, he said.

Men and their loved ones can be empowered to make informed decisions on improving their health by being alert to symptoms that might cause concern, such as “waterworks issues”, blood in the urine, groin or bone pain or unexpected weight loss and tiredness, he added.

An international panel of clinicians, men at risk of prostate cancer and research methodologists carried out a detailed analysis of the latest evidence.

Following a review of more than 700,000 men in clinical trials which found, if screening reduces prostate cancer deaths at all, the effect is very small, the panel advised against offering routine PSA screening. Most men will decline screening because of “the small and uncertain benefits and the clear harms”, it said.

Clinicians need not feel obliged to systematically raise the issue with all their patients and should engage in shared decision making for those considering screening, it advised.

Men at higher risk of prostate cancer death, such as those with a family history of prostate cancer or of African descent, may be more likely to choose PSA screening after discussion of potential benefits and harms of testing with their doctor, the authors concluded.