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A widely used screening test for prostate cancer overdiagnoses insignificant cases while still missing some of the most aggressive cancers, the largest study of its kind has revealed.
The trial, which included more than 400,000 British men aged between 50 and 69, tested the effect of a blood test for prostate-specific antigen (PSA), which is typically used to decide when to send men with urinary symptoms for further testing.
Half of the study participants received one invitation for a PSA test. After 15 years, there was little difference in the number of men who died from prostate cancer, whether they had the test or not, according to the research published in the Journal of the American Medical Association on Saturday.
An estimated one in six cancers detected through a single PSA screening were overdiagnosed and would not have gone on to cause problems.
Professor Richard Martin, lead author and Cancer Research UK scientist at the University of Bristol, said: “The main takeaway is that the small reduction in prostate cancer deaths using the test to screen healthy men does not outweigh the potential harms.”
Nearly seven men in 1,000 in the group who were invited for screening died of prostate cancer, compared with nearly eight men in 1,000 in the group that did not.
Some men were receiving invasive treatment that they did not need many years earlier than they would have done without the screening. However, he noted that the test also failed to detect some types of cancer that require treatment.
Martin added: “We need to find better ways to detect aggressive prostate cancers, so we can treat them earlier.”
Pointing to the risks of unnecessary treatment, Cancer Research UK said that over-diagnosis could have a “negative psychological impact”, and treating prostate cancer could also cause physical side effects, including the possibility of infection after a biopsy. Erectile dysfunction, bladder and urinary problems. Bowel problems.
The research charity noted improvements in diagnosis and treatment of the disease in the years since the start of the latest trial, conducted by the universities of Bristol, Oxford and Cambridge. These included the introduction of a magnetic resonance imaging (MRI) before the biopsy was performed.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, said such changes had “made the procedure safer and more precise” but better evidence was needed to understand their full impact.
He added that the results of the latest trial were “very important” because they support similar results from a previous study conducted in eight European countries and published in 2019.
He added that the charity had launched a £42 million trial “so that every man with aggressive prostate cancer can get an early and accurate diagnosis”.
Prostate cancer kills 12,000 people a year, making it the second biggest cancer killer of men in the UK. There is currently no national screening program for this disease.
