| Little Evidence Prostate
Screening Saves Lives
The prostate cancer death rate in the US has fallen
since screening became more common, but that does not prove such
tests are needed, a study argues.
Since screening became widespread in the US, mortality rates
have fallen four times more than in the UK.
But writing in the respected Lancet Oncology, a UK team said
many other factors could be at play.
These include different treatment programmes for US men, and
discrepancy over how deaths are reported.
Many men over 80 have evidence of prostate cancer when they
die, but it can be unclear whether this or other conditions killed
them - leading to different accounts on death certificates.
Until studies pin down the exact role of screening in decreasing
prostate cancer mortality, "we can only continue to speculate",
if prostate screening saves lives.
Prostate cancer screening took off in the US in the early 1990s,
and by 2001, nearly 60% of men over 50 said they had undergone
the test in the previous 12 months.
By contrast in the UK, between 1999 and 2002, an estimated 6%
of men aged 45-84 had been tested.
At the beginning of the 1990s, mortality rates for the two countries
were broadly similar. But after this period, the rate of decline
in the US - at 4.17% per year, was almost four times that of the
UK, at 1.17% per year.
But other changes were occurring in the treatment of men with
prostate cancer in the US, the team led by Simon Collin noted.
These included the use of a particular hormone treatment in
older men and more aggressive treatment of those with an advanced
form of the disease.
Prostate cancer is the most common cancer in men in the UK,
but the NHS has shied away from offering screening.
This is because the test is seen as notoriously inaccurate:
although 10-15% of men will have high enough PSA levels to warrant
carrying out a prostate biopsy, only 2-3% will require any treatment.
The majority will have undergone unpleasant, invasive and potentially
costly investigations for no reason.
John Neate, head of The Prostate Cancer Charity, said the findings
of studies from Europe and the US looking at whether the test
really was saving lives were keenly awaited.
Although not always the case, a spokesperson from the NHS cancer
screening programmes said: "All screening programmes are based
on an assessment that more good than harm will be achieved through
"Until there is clear clinical evidence to show real benefit
can be gained from routine prostate screening, the NHS will not
be inviting men who have no symptoms for prostate cancer screening."