Olympic legend Sir Chris Hoy has sparked a national cancer debate as to whether men with no symptoms should be routinely offered the prostate specific antigen (PSA) test
GP data has revealed a postcode lottery over whether symptomless men are offered a blood test to check for prostate cancer.
Olympic legend Sir Chris Hoy has sparked a national debate as to whether men with no symptoms should be offered the prostate specific antigen (PSA) test. New research funded by Cancer Research UK looked at GP records of 9,800 men in England diagnosed with the disease since 2018 and revealed just one in five patients were offered a PSA test and diagnosed despite having no symptoms.
The NHS is reviewing its own prostate cancer guidance after Sir Chris launched his campaign for more men to be proactively offered tests and at an earlier age. Currently men over 50 can ask for a PSA test from their NHS GP. If levels are raised they will receive further tests and scans.
The six-time Olympic cycling gold medallist, who revealed in November that he has terminal prostate cancer, has branded this approach “dangerously outdated”. Sir Chris argues that GPs should be instructed to have proactive conversations with those at higher risk – such as black men and people like him who have a family history of the disease – because many have the disease but no symptoms.
Professor Gary Abel, from Exeter University, who led the study, said: “We were surprised by the extent of the variation we saw between practices, which speaks to the ongoing lack of clarity around prostate cancer screening in the UK. We know that men from deprived areas are at highest risk of developing late-stage prostate cancer and were less likely to be investigated. It is hard to know what to do when the evidence isn’t clear but a more consistent approach to testing people without symptoms is needed to help redress this imbalance.”
Around 55,000 men are diagnosed every year with what is now the most common cancer in Britain. More than 12,000 men die from the disease every year. Almost 100% of men diagnosed at stage 1 are still alive five years later compared to 48% of those diagnosed at stage 4.
The UK National Screening Committee, which advises the government, is reviewing prostate cancer guidelines and a trial is under way to devise the first national screening programme. The problem is that the prostate specific antigen (PSA) test, currently used by the NHS when people have symptoms, is not accurate enough as a general population screening test on its own because it flags too many false positives.
Exeter University led the study which included collaborators from the universities of Manchester, Newcastle, and University College London. Lead author Dr Sam Merriel, lecturer at the University of Manchester and a practicing GP, said: “Referral from GPs is currently the main route by which men are diagnosed with prostate cancer. The PSA blood test is the only test available for this purpose and has some well-known limitations.
“Inconsistencies in local, regional, and national guidance mean it is really down to individual GPs to make decisions on which patients to test, how often to test, and what PSA thresholds warrant urgent referral for suspected cancer. These inconsistencies may be contributing to the variation in whether GPs are detecting prostate cancer in patients who do not have symptoms.”
The current PSA test measures the amount of prostate-specific antigen in your blood. PSA is a protein produced by the prostate gland but in some people it can be raised despite them not having prostate cancer. Men over the age of 50 are able to request a PSA test from their GP, where they have made an informed decision on the risks and benefits for them. However GPs are not instructed to have proactive conversations encouraging symptomless men who are at greater genetic risk to have a test.
Currently PSA testing is routinely used when men have urinary symptoms but opinions are divided on whether it should be used where no symptoms are present. The UK National Screening Committee currently recommends against giving all men the PSA test calculating it will “over diagnose” too many men will likely die from something else long before their slow growing tumour would have ever caused them harm.
Finding these slow-growing cancers through screening can lead to surgery with potential side effects like erectile dysfunction and urinary incontinence. More accurate blood testing for more biomarkers are currently going through clinical trials and will be assessed for possible use on the NHS in future.
Until this latest study a common assumption had been that the majority of men with prostate cancer have no symptoms but the study showed symptomless men made up only one in five of those who get diagnosed.
Naser Turabi, director of evidence at Cancer Research UK, said: “This study highlights variation in the detection of prostate cancer through PSA testing in men with no symptoms. The possibility of a cancer diagnosis can be extremely worrying, so we understand why some men ask for the PSA test. However the evidence shows that it can cause more harm than good for men who have no prostate cancer symptoms.
“The UK National Screening Committee is constantly reviewing the best evidence and doesn’t currently recommend screening for prostate cancer. We’re determined to find better ways to detect and treat prostate cancer and we will continue to fund research to improve our understanding and help save lives.”
The findings are published in the British Journal of General Practice. Click HERE to visit the Prostate Cancer UK website and check your individual risk in just 30 seconds.