Yazar: James

Only “a few thousand” men with a dangerous genetic variant and a family history of cancer are recommended to undergo prostate cancer screening through a blood test, according to the final guidelines released by scientific advisers in the UK. The National Screening Committee has stated that for all other groups, the potential harms of screening outweigh any benefits. Now, it’s important to note, testing healthy men can indeed save lives from prostate cancer, but it can also lead to treatments that leave them dealing with severe side effects, such as loss of bladder control or difficulties in achieving erections. So, it’s a real double-edged sword.

The final call on this matter will be up to health ministers across England, Wales, Scotland, and Northern Ireland. The prostate, situated just below the bladder, plays a crucial role in male anatomy, contributing to seminal fluid production and influencing urine flow. Prostate cancer stands as the most prevalent cancer among men, tragically claiming around 12,000 lives annually in the UK alone.

Now, prostate screening typically involves a blood test measuring prostate-specific antigen (PSA) levels, and depending on those results, an MRI scan may follow. According to a thorough review by the National Screening Committee, out of every 1,000 men screened in their 50s, only two lives would be saved from prostate cancer over the next 15 years. However, this comes at a cost—20 men would be informed they have a cancer that would never necessitate treatment. Some prostate cancers are so slow-growing that a man would need to live to be between 120 and 150 years old before they posed any real threat.

Imagine living with the psychological weight of a cancer diagnosis for the rest of your life, knowing that you might never have needed treatment in the first place. Out of those 20 men, about 12 would likely undergo unnecessary treatment, which could harm their prostate, potentially affecting their sexual health and even leading to incontinence, meaning they might need to wear pads for leaking urine. “Once prostate cancer is found, we still can’t reliably determine which cancers require treatment and which do not – and the treatments available can cause long-term harm,” explained Prof Sir Mike Richards, chair of the screening committee and himself a prostate cancer patient.

The committee’s final recommendations state that screening should not be extended to most men. The only exception is for those with a BRCA2 gene variant and a family history of breast, ovarian, pancreatic, or prostate cancer, where the benefits of screening appear to exceed the risks. BRCA2 plays a vital role in DNA repair, and certain mutations can make cancers more common and deadlier. Eligible men in this high-risk category are advised to receive a PSA blood test every two years from ages 45 to 61. This limited screening will apply to just a “few thousand” men each year. Some of these men are already receiving informal screenings through NHS genetics clinics because of their family backgrounds.

The screening committee has committed to continually assessing new evidence. This could potentially lead to broader screening programs in the future, including new tests for prostate cancer that may better identify those who genuinely require treatment, AI tools, and insights from the ongoing Transform trial which aims to address uncertainties regarding prostate cancer in Black men. While the heightened risk for Black men regarding prostate cancer is evident, it’s still unclear whether these cancers are more aggressive, which could influence whether the NHS should expand screening.

Sir Mike expressed hope that “new evidence, better tests, and a deeper understanding of prostate cancer will pave the way for wider screening in the future,” though he emphasized the need for solid evidence first. The review follows a vigorous campaign involving charities and notable figures like Olympian Sir Chris Hoy, who is battling terminal prostate cancer, along with former Prime Ministers David Cameron and Rishi Sunak. Prominent personalities like actor Stephen Fry and footballer Les Ferdinand have also voiced their support on an issue that resonates with many men.

Interestingly, the final advice has narrowed the scope of screening even more than what was proposed last November when men with both BRCA1 and BRCA2 mutations could have qualified. Chiara De Biase from Prostate Cancer UK expressed her deep disappointment with the recommendations, stating, “We know that a mass screening program could save thousands of men’s lives. While we acknowledge the current evidence does not convincingly support screening all at-risk men, this decision feels like a step backward, limiting recommendations to a smaller group.”

Ultimately, the fate of prostate screening will rest in the hands of ministers in the UK’s devolved governments. Sir Mike is scheduled to meet with the new health secretary James Murray on Monday to discuss these recommendations. Dr. Ian Walker, executive director of policy at Cancer Research UK, emphasized, “Screening decisions must be guided by the current evidence, with programs introduced only when benefits clearly outweigh the harms, including unnecessary and invasive overtreatment. We urge the UK Government to accept the recommendation.”

As we watch the developments in this ongoing situation, one can’t help but wonder what the future holds for prostate cancer screening and the thousands of men potentially affected by these decisions…

Kaynak: Orijinal Haber