These men are at high risk for prostate cancer – so why aren’t they being screened?

As reports surface that the UK’s national screening committee are set to reject proposals for any national prostate screening programme, experts warn that the decision, if followed through with, puts Black men and those with a family history at risk.

The government’s National Screening Committee, which makes recommendations on what national health screening programmes should be rolled out in the NHS, is set to publish a decision on a programme for prostate cancer.

However, sources close to the decision have said the NSC is set to say no to proposals for a new programme, including a programme for those at the highest risk. The NSC’s review will look at the cost-effectiveness and also whether a screening programme may do more harm than good.

While some experts say there is enough evidence to support a screening programme for those most at risk, others have argued that current testing methods are still not accurate enough and could lead to “over-treatment” for men who may not actually require it.

Around 63,000 cases of prostate cancer in the UK are reported each year, with an estimated 12,000 men dying from the disease every year.

Most recent research shows Black men are twice as likely to die from the disease, and more likely to be diagnosed with it, alongside men with a family history. Around 1 in 4 Black men will get prostate cancer. The third group who would benefit from a targeted approach is men known to carry a gene such as BRC A1 or B RCA 2.

On Tuesday, Prostate Cancer Research published a report on the impact on the NHS of a prostate cancer screening programme published this month, which estimated that the cost of rolling out a screening programme for Black ethnicity and men with a relevant family history would cost around £25 million a year.

The research found that the costs involve a 23 per cent increase in the number of PSA tests, MRIs and biopsies delivered and an increase in uplift in NHS worker roles from 0.01 per cent–0.4 per cent.

The report, which backs a targeted screening programme, said it would “reduce entrenched inequalities for Black men, those with a family history of prostate cancer and those in areas with high levels of deprivation.”

Chiara De Biase, Director of Health Services, Equity & Improvement at Prostate Cancer UK has warned that the country has reached a “tipping point”.

She told The Independent: “Prostate cancer is the last major cancer without a screening programme, and we need to change now. Prostate Cancer UK submitted evidence to the UK National Screening Committee back in 2022 showing that modern diagnosis is safer and more effective than ever, which we strongly believe has tipped the balance in favour of targeted screening for men at the highest risk of prostate cancer - Black men and those with a family history.

"Whatever the committee decides, our current desperate situation requires urgent action.”

The charity is calling on the government to invest in awareness campaigns and to change “dangerously outdated NHS guidelines.”

In February last year, researchers at the University of Essex suggested they had identified novel genetic mutations which could explain why Black men are at a higher risk of developing prostate cancer compared to White men. Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer.

And men over the age of 50 can ask their GP for a PSA test, even if they do not have symptoms.

The NSC decided, following a review in 202,0 that screening would not be recommended in the UK as the prostate-specific antigen (PSA) tests then available were not accurate enough. The committee launched a new review last year.

In April this year, Health Secretary Wes Streeting said her was in favour of a national prostate screening programme for men at high risk of the disease, should the committee recommend it.

Prof Nick James, Professor of Bladder and Prostate Cancer Research, Institute of Cancer Research (ICR), said in response to the reports on the upcoming screening committee: “The case for PSA screening for prostate cancer gets increasingly strong. The previous concerns around overdiagnosis and overtreatment can be mitigated by use of MRI pre biopsy which eliminates the needs to biopsy at least 50 per cet of men. Of those that we know, biopsy we can target the relevant areas of the prostate. If men are diagnosed with a clinically low risk prostate cancer, they can be monitored and the pre-biopsy MRI gives us an accurate baseline for further monitoring.”

“The National Screening Committee is reportedly set to reject blanket PSA screening, despite the changes in data since this was last reviewed.

“Part of the concern around PSA screening is the need to increase MRI capacity. Solutions exist that could do this. For example, we can now do a shorter sequence taking 10 minutes with no need for iv contrast. This removes the need for a doctor in the procedure and is amenable to AI based reporting.

However, some researchers have suggested that current tests might still not be good enough for a screening programme.

Responding to the Prostate Cancer Research report, Willie Hamilton, professor of primary care diagnostics (cancer), University of Exeter, said: “We need to make progress on prostate cancer, but screening isn’t necessarily the best way forwards. The current screening tests are not very good. We know that Black men have on average, higher PSA values than White men, so more will be subject to a ‘positive’ screening test result, yet the raised PSA may not represent life-threatening disease.”

He added: “Prostate cancer is present in many men and will do no harm to many of those. So, diagnosis is not always helpful as it can cause unnecessary psychological harm and physical harm, from biopsies. We also need to consider the pressure on the NHS. A 23 per cent increase in PSA tests, MRIs and biopsies is a massive additional workload in a climate where the NHS is struggling to operate.”