Prostate screening ruled out by NHS

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The Independent Online
Mass screening for prostate cancer, similar to NHS programmes for breast and cervical cancer, has been effectively ruled out after researchers concluded that a current test is unreliable, and unlikely to make any impact on death rates.

The findings of a major review announced by the NHS Centre for Review and Dissemination yesterday, has angered some senior doctors who say it downgrades a disease that kills 8,500 men each year, and suggests there are no benefits attached to early diagnosis.

Roger Kirby, a consultant urologist at St George's Hospital, south London, said yesterday: "It is sending the wrong message... Early prostate cancer can be cured. Late prostate cancer is incurable."

However, Dr Jonathan Waxman, director of the Prostate Cancer Charity, welcomed the report as "balanced and sensible". He said it would deter "wildcat surgeons chopping people up to no avail. There is no evidence that [surgery] does any good and the complications can be very serious". About 70 per cent of men who undergo surgery suffer impotence and 40 per cent, urinary incontinence.

About 12,500 men in the UK develop prostate cancer each year. It is a malignancy of the gland at the base of the bladder which produces secretions to nourish sperm. The average age of diagnosis is 70 but increasing numbers of men in their 50s are being diagnosed. Environmental factors, particularly diet, are thought to be responsible.

Some men develop symptoms including a burning sensation, blood in the semen or urine, weak or interrupted flow of urine. However, these may also be a sign of benign prostatic hypertrophy, a gradual enlargement of the prostate, which occurs in most men as they get older. Other men may have no symptoms.

A controversial blood test, known as the PSA (prostate specific antigen), became available15 years ago and its widespread use in the US throughout the late1980s and 1990s has lead to concern about epidemic levels of the disease.

PSA measures the level of a protein produced by all prostate cells. In general, a reading of four indicates cancer is unlikely, with the probability of disease increasing with a rising count up to 22. Over 22, cancer is highly likely. As men age, their prostates grow larger and the count rises any way - but a dramatic rise is indicative of cancer.

However, the PSA test is notoriously unreliable: some men with high counts are cancer-free while others with a low count may have the disease. In one American study, only 40 per cent of men with prostate cancer had high PSA counts. Other men with high counts have very slow growing tumours unlikely to cause any symptoms in their lifetime.

In addition, there has been no reliable evaluation of the effect of early treatment on the death rate. Meanwhile screening can result in physical and psychological harm, from testing, biopsies, and treatment which may be unnecessary or useless.

The NHS Research and Development Health Technology Assessment Programme commissioned two major reviews of prostate cancer research in the UK and abroad, and the evidence convinced them that at a cost of pounds 3,000 per case diagnosed, a national screening programme, or even routine tests for middle- aged men, was not justified at present.

Prostate cancer has, in recent years, joined the list of "celebrity" diseases, with a number of high-profile sufferers and victims - General Norman Schwarzkopf has been diagnosed as a sufferer and the rock star Frank Zappa died of it.

In Britain, Tory MP Sir Julian Critchley, has written movingly of his experience of the disease, diagnosed four years ago when he was 62. He appears to have beaten it but says the "Sword of Damocles" hangs over him.