There is no organised screening programme for prostate cancer but an informed choice programme, Prostate Cancer Risk Management, has been introduced.
Why isn't there a national screening programme for prostate cancer?
All screening programmes cause some harm. This could include false alarms, inducing anxiety, and the treatment of early disease which would not otherwise have become a problem.
When considering population screening programmes the benefits and harms must be carefully assessed, and the benefits should always outweigh the harms.
Until there is clear evidence to show that a national screening programme will bring more benefit than harm, the NHS will not be inviting men who have no symptoms for prostate cancer screening.
In 1968, Wilson and Jungner of the World Health Organisation developed ten principles which should govern a national screening programme. These are:
- The condition is an important health problem
- Its natural history is well understood
- It is recognisable at an early stage
- Treatment is better at an early stage
- A suitable test exists
- An acceptable test exists
- Adequate facilities exist to cope with abnormalities detected
- Screening is done at repeated intervals when the onset is insidious
- The chance of harm is less than the chance of benefit
- The cost is balanced against benefit
To date, prostate cancer screening fulfils only the first condition. See the Health Technology Assessment Programme's monograph Diagnosis, management and screening of early localised prostate cancer: a review for details.
Evidence from a prostate cancer screening trial in Europe, ERSPC, has shown that screening reduced mortality by 20 per cent. However, this was associated with a high level of over treatment. To save one life, 48 additional cases of prostate cancer needed to be treated.
Following research evidence published in 1997 the UK National Screening Committee recommended that a prostate cancer screening programme should not be introduced in England. This policy was reviewed in Dec 2010 but no significant changes were made. It is due to be considered again in 2013/14, or earlier if significant new evidence emerges.
Although evidence does not yet support population screening for prostate cancer there is considerable demand for the PSA test amongst men worried about the disease. In response to this, the Prostate Cancer Risk Management programme was introduced in September 2002.
The PCRM provides high quality information to enable men to decide whether or not to have the PSA test based on the available evidence about risks and benefits. After consideration of this information and in discussion with their GPs, men over 50 who choose to have the test may do so free of charge, on the NHS.