Men concerned about prostate cancer should think before asking for a PSA test | Letter

Your article quotes Prostate Cancer UK’s director of health services saying: “More men than ever are learning about their risk, speaking to their GP about the PSA [prostate specific antigen] blood test, and then taking the best next steps” (Prostate cancer becomes most common cancer diagnosis in England, 28 January). However, men should think very carefully and consider the evidence before asking their GP for a PSA test.

In 2018, a review of the available evidence concluded that 1,000 men would have to be PSA-screened to prevent one man from dying of prostate cancer over 10 years, and screening probably did not improve men’s chances of being alive after 10 years. In 2019, a review of the results of the European Randomised study of Screening for Prostate Cancer reported that, after 16 years, 570 men had to be invited for screening to prevent one prostate cancer death. The results of these scientific studies are the reason why the UK does not have a prostate screening programme.

For men who decide to have a PSA test and are diagnosed with cancer, there is then the difficult choice of treatment. Surgery (radical prostatectomy) and radiotherapy are options but so, too, is to be monitored regularly with PSA tests and have no immediate treatment. The only reliable evidence to help a man choose comes from the results of the British ProtecT study that compared these three options in 1,610 men who had been diagnosed by screening. After 15 years, 356 had died, 45 from prostate cancer.

There was no significant difference in the risk of dying, or dying of prostate cancer, between the three treatment options. Three‑quarters of the men in the active-monitoring group experienced growth or spread of the cancer and needed subsequent treatment, but a quarter of the men were alive without having received any form of treatment.
Reginald Hall
Retired urologist, Newcastle upon Tyne