LETTER: Successful prostate cancer screening

From Mr E. P. Neil O'Donoghue, FRCS

Sir: The only sensible objective of a screening programme for prostate cancer is to detect early prostatic cancer in those younger men who could otherwise expect a full life but whose lives are at risk ("Catching a killer can do more harm than good", 30 January). There is little point in screening 75-year-olds with heart disease or other infirmities that will limit their survival.

It is also essential to recognise that our current screening tests are relatively insensitive and will not detect microscopic cancers which are compatible with prolonged survival. Those of us who offer curative surgery are (and must remain) selective in our approach. My personal experience of some 200 radical prostatectomies reaffirms the conviction that there is little risk of unnecessary surgery in the UK, but far too often we are faced with patients whose disease is too extensive for cure because the opportunities presented to us for early detection are rejected.

The Department of Health is quoted as saying that "the case for a national [screening] programme has not been established", hence its unwillingness to fund or promote a large-scale study. Current policies towards prostatic cancer may be defended thus, but meanwhile younger men continue to die unnecessarily and painfully of this disease.

Yours faithfully,

Neil O'Donoghue

Consultant Urologist

Prostate Research Campaign UK

Northwood, Middlesex

31 January