A new report from the medical professionals' body includes the PSA test as one of 40 medical treatments that may be unnecessary for many men. But Prostate Cancer UK makes clear that the test is still the best first step for diagnosis of prostate cancer, until we develop a more robust test suitable for a screening programme.
Today, the Academy of Medical Royal Colleges released a report which lists forty treatments that they deem bring little or no benefit to patients. The list is part of a campaign to reduce the number of unnecessary medical treatments at choosingwisely.co.uk. The story has been covered widely in the media, including on the BBC.
One of the points made by the report is that 'unless you are at risk of prostate cancer because of race or family history, screening for a specific protein produced by the prostate (Prostate Specific Antigen-PSA) does not lead to a longer life'.
The test has a number of imperfections, but it is currently the best way to indicate whether or not there is a problem with the prostate
How best to use the PSA test as part of the diagnostic process for prostate cancer has been the subject of debate for many years. The test has a number of imperfections, but it is currently the best way to indicate whether or not there is a problem with the prostate.
Prostate Cancer UK agrees with the UK National Screening Committee that a population-wide screening programme for prostate cancer using the PSA test would cause more harm than good, due to the inaccuracies of the PSA test. It can miss some cancers and also leads to treatment of cancers which would not have caused a man any harm in his lifetime.
However, until research that we and others are funding produces a better form of testing, we must ensure the PSA test being used to the best of its ability.
Men over 50 should be entitled to a PSA test if they want one, and should never be turned away
Karen Stalbow, Head of Policy, Knowledge and Impact at Prostate Cancer UK, said: “Prostate Cancer UK agrees with the UK National Screening Committee that the PSA test is not an appropriate test for a UK-wide population wide screening programme.
“But until we have a test that can enable effective risk-based screening, the PSA test is the best first step towards a diagnosis of the disease. It is our view that all men over 50 should be entitled to a PSA test if they want one, and should never be turned away if they still wish to have one after discussing the pros and cons with a doctor. We also suggest that healthcare professionals discuss the test with men from the age of 45 if they are at higher risk due to being of Black ethnicity or having a family history of the disease.
“For this reason, it is crucial that all men are made aware of the risks of prostate cancer, and that we also continue to fund research to find the more accurate tests of the future.”
In March, Prostate Cancer UK released a set of statements representing the consensus view of hundreds of health professionals to help primary health care professionals use the PSA test more effectively for men without symptoms of prostate cancer.
UPDATE (20.04.17): Since this article was published, we have successfully campaigned to have the Academy of Medical Royal Colleges amend their recommendations to more accurately reflect the increased risk for Black men or men with a family history of the disease, and the difference between population-wide screening and testing individuals using the PSA test.
A five-year early-stage study of high-intensity focused ultrasound resulted in tumour progression being halted in men with intermediate-risk, localised prostate cancer. But more evidence is needed to prove its benefits hold up against existing treatment options and for all men with the disease.