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Prostate cancer screening breakthrough as harms linked to testing reduced

Prostate cancer screening may be a step closer after a study suggested that harms linked to testing have reduced thanks to advances in medical technology.

Screening for prostate cancer has been heavily debated in medical circles due to potential harms including side effects from biopsies and unnecessary testing for those with no clinically significant cancer.

A new study set out to examine whether the “seesaw has been tipped” in favour of screening.

Researchers from Prostate Cancer UK combined the results of the latest clinical trials and real-world data on the “prostate cancer screening pathway” to examine the risk-to-harm benefit.

Their analysis, presented at the ASCO GU conference in San Francisco, looked at the impact new scans and safer biopsies had on reducing unnecessary harm to patients.

Prostate Cancer UK said that on average 67 per cent fewer men experienced harm during the diagnostic process with the newer techniques compared with older methods.

The authors found for every 10,000 men who had a PSA – prostate-specific antigen – test 463 would be diagnosed with a clinically significant localised prostate cancer, 110 would be diagnosed with a clinically insignificant prostate cancer, and 646 would go through the entire diagnostic pathway with no diagnosis of prostate cancer.

A “maximum” of 38 men would suffer clinical side effects from their biopsy, they added.

“Rates of biopsy-related harm in modern practice are encouragingly low and likely to reduce further,” the conference was told.

The authors said the findings indicated the “seesaw has certainly tipped by these harm reductions”.

Prostate Cancer UK said the UK National Screening Committee, which makes recommendations to the Government, is to re-examine prostate cancer screening.

Dr Matthew Hobbs, lead researcher on the analysis and director of research at Prostate Cancer UK, said: “We’ve known for some time now that testing more men reduces prostate cancer deaths, but there have always been concerns about how many men would be harmed to achieve this.

“However, our evidence shows that screening may now be a lot safer than previously thought. That’s why we are so pleased that the committee is going to review the evidence once more.

For every 10,000 men who had a PSA test, 463 would be diagnosed with a clinically significant localised prostate cancer and 110 would be diagnosed with a clinically insignificant prostate cancer

(Getty Images/iStockphoto)

“It’s important that they consider this study and actual outcomes from the real-world NHS data and we hope they will find that we’ve reduced harm enough to be ready to launch a screening programme for prostate cancer.

“This will only be the first step in stopping prostate cancer being a killer.

“We know that even this modern pathway needs to be improved, and Prostate Cancer UK is committed to funding the research needed to make that happen so we can save as many lives as possible.”

Ros Eeles, professor of oncogenetics at the Institute of Cancer Research and honorary consultant at the Royal Marsden NHS Trust, said: “The study shows very interesting data which support the shift towards the investigation of how to implement prostate screening.

“European studies of using the blood marker PSA to direct screening have shown a reduction in mortality, but the concern has been overdiagnosis, including detection of some cases which would never have caused harm, and potential harms of overtreatment.

“However, we know that about a quarter of cases will be aggressive and cause deaths.

“There is therefore a need to identify techniques that will tip the balance of screening from risk to benefit.

“This useful study has looked at the use of MRI imaging and biopsy techniques which have a lower risk of infection and are showing promise in this area.

“It shows us a rationale for the way forward to implementing a prostate screening programme in the UK.

“The challenge will be to find better markers which indicate the presence of aggressive disease and to refine our use of genetic risk stratification to be able to target new methods of screening to those at highest risk.

“Our team’s research is investigating the role of genetic tests which can better risk stratify populations to target such screening programmes.”

A Department of Health and Social Care spokesperson said: “The UK National Screening Committee has received a set of proposals relating to screening for prostate cancer.

“It will explore these further and consider how best to take them forward.”

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