Good Health can reveal exclusively that the first prostate cancer screening program in Britain is launching today to cut the disease’s mortality rate.
Up to 12,000 men in the South of England will be tested for the disease over the next year or two, as part of a scheme that might be extended across the United Kingdom if it proves effective at detecting ‘hidden’ malignancies in men without symptoms.
The males will have a prostate-specific antigen blood test to detect elevated levels of the PSA protein. Increased PSA levels may suggest the existence of prostate cancer cells.
The PSA test is often only administered to men who exhibit suspected prostate cancer symptoms (such as frequent urination or blood in the urine) or who have a strong family history of the illness.
The project, which has received approximately £750,000 in funding from NHS England, is managed by Surrey and Sussex Cancer Alliance, an organization comprised of NHS doctors, charities, and cancer sufferers that oversees cancer care in the two counties.
All males aged 50 to 70 within the new program’s catchment region will be invited to their local GP office for a PSA test.
Priority will be given to individuals who are most likely to be at risk, such as those of Afro-Caribbean descent (at greater risk since they have more genetic abnormalities that predispose them to the disease) and men with a close relative who has also been diagnosed. These groups will target guys over 45 years of age.
The Alliance is collaborating with over fifty primary care practices in the region to identify individuals who will be offered PSA testing.
Professor Stephen Langley, director of urology at the Royal Surrey County Hospital in Guildford and clinical lead for the Surrey and Sussex Cancer Alliance, states, “We aim to save the lives of many men.”
Early prostate cancer detection results in a high cure rate of up to 90 percent.
‘However, once it has spread to other parts of the body, it is typically incurable.
And we must address the impact of the Covid-19 pandemic, as referrals for suspected prostate cancer in our region have dropped to 60 or 70 percent of the normal rate due to men being unable to visit their doctors.
We have a responsibility to assist guys who may have cancer but are unaware of it.
In the United Kingdom, prostate cancer affects over 47,000 men annually and kills nearly 12,000.
There is a considerable chance of survival if it is detected early before it has progressed beyond the prostate. However, in approximately 10% of instances, cancer has already progressed to other organs by the time it is detected, and the chances of surviving beyond two years are limited.
Chemotherapy or a reduction in testosterone levels, a hormone that promotes the growth of prostate cancer cells, is used to inhibit the growth of the tumor in these individuals.
One of the reasons why each year thousands of men are diagnosed with prostate cancer only after it has spread is because, in the early stages, few men exhibit the known symptoms, such as frequent urination, difficulty urinating, a weak urinary flow, or blood in the urine or sperm.
In 2017, when he was diagnosed with prostate cancer, actor and comedian Stephen Fry stated he had no symptoms of sickness. Later, he stated, ‘I was somewhat stunned; I had no indications indicating anything was wrong. Thankfully, it was diagnosed early, making it easier to cure.’
PSA readings that are elevated may be indicative of the existence of prostate cancer cells. This may also be caused by a urinary tract infection, an enlarged prostate, strenuous activity, or having sex within the preceding 48 hours.
As a result, the PSA test has not been deemed precise enough to support its use in a nationwide prostate cancer screening program comparable to those for breast and cervical cancer in women.
The UK National Screening Committee, which advises the government on which diseases to screen for frequently, has previously ruled out adopting the PSA test for a statewide screening program because it is unreliable.
Thousands of men with high PSA levels would be subjected to painful biopsies (small tissue samples are extracted from the prostate to look for a tumor) if a nationwide program went forward, even if they did not have cancer or had a slow-growing tumor that was highly unlikely to kill them.
Some prostate tumors are aggressive and develop quickly, whereas others advance so slowly that the patient nearly always dies of something else before the tumor becomes an issue.
These two types are often referred to informally as “tigers” and “pussycats.”
Under the Surrey and Sussex trial program, men with elevated PSA levels will only receive a biopsy if they have also undergone an MRI scan (which creates comprehensive images of the prostate) to determine whether it is cancer, its size, and whether it is likely to spread.
Professor Langley explains, “PSA is not an ideal exam, and it has received a negative reputation over the years.”
In terms of detecting early cancers, it is about as successful as breast cancer screening, according to several major studies.
The European research on prostate cancer screening, a long-running inquiry examining the effectiveness of PSA testing, found that it cut deaths by as much as 22% over a period of 11 years, according to results published in The Lancet in 2014.
Professor Langley says, ‘Men in our pilot project will only have a biopsy if the MRI scan results warrant it.’ We hope to distinguish not only that the elevated PSA is due to cancer, but also to distinguish the tigers from the pussycats at an early stage, thereby reducing the rate of unnecessary biopsies by up to 30 percent.
One in eight men will develop prostate cancer during their lifetime.
Men participating in the program will be required to submit a urine sample to rule out an infection that could result in a falsely elevated PSA reading.
If they then have elevated PSA values — above 3ng/ml — they will be directed directly to their local hospital instead of having to return to their primary care physician for an MRI referral.
“We are expediting the process so that these males are referred for fast examination within two weeks,” explains Dr. Ed Bosonnet, director of primary care for Medefer, a digital healthcare startup participating in the project.
Eventually, it is hoped that men will be able to perform both urine and PSA tests at home, using a blood test similar to that used for diabetes. The plan is for them to then record their readings on a website.
The Director of support and influence at Prostate Cancer UK, Chiara de Biase, stated that the organization is very supportive of this project, which will aid early prostate cancer identification by targeting people at the highest risk.
Since the beginning of the pandemic, there are still thousands of males who have not come forward for a diagnosis. This is the type of effort that we would be eager to promote throughout the rest of the country to assist in locating these individuals and detecting additional malignancies sooner.
