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Concerns grow over prostate cancer screening

25 September 2009: The long-standing debate over whether or not the prostate specific antigen (PSA) test should be used to screen for prostate cancer continues on after a new study questioning its sensitivity is published.

 

The study, published in the British Medical Journal, examined the sensitivity of the PSA test as a screening tool for prostate cancer in over 1,500 Swedish men. Although the test could indicate prostate cancer, the researchers concluded that it was not sensitive enough to be used as a screening test.

For a test to be used to screen for a disease, it must be able to give specific values that can accurately say if a disease is present or not. The researchers found that the PSA test was unable to give precise enough cut-off values needed before a screening test can be introduced in a given population.

Screening tests that aren’t sensitive enough can result in people being mistakenly diagnosed and treated for a condition they do not have, or their condition may go undiagnosed. This can cause serious physical and emotional distress.

Dr Sneh Khemka, Bupa International’s medical director, said: “This study adds fuel to the contentious issue of population-wide prostate cancer screening. It goes some way to uncover the limitations of the PSA test, and is a stark reminder to us all that imprecise screening tools can cause untold suffering and distress to people. A more robust test that takes into account other factors, such as disease bio-markers, needs to be developed before population-wide screening can be considered.”

Dr Khemka was quick to reassure men who have already had the test and received a positive PSA result: “The PSA test has been, and remains, a good indicator for prostate cancer. It is a useful diagnostic tool and can be instrumental in helping doctors decide which therapies and treatments are most suitable for a patient.”

Key facts

The prostate gland is located just below the bladder and surrounds the urethra (the tube for passing urine). It produces a fluid that mixes with sperm during ejaculation.

Prostate-specific antigen (PSA) is a protein found in fluid in the prostate. A low level of PSA is usually found in blood, however, higher levels in the blood can indicate prostate cancer.

Worldwide, more than 670,000 men are diagnosed with prostate cancer each year. The highest rates are in the USA, Australia, New Zealand, Western and Northern Europe. The lowest rates are in East and South Central Asia.

The cause of prostate cancer isn’t fully understood at present, but you are more likely to develop it if:

  • you are over 50
  • you have close relatives who have had prostate cancer
  • you are African-Caribbean or African-American
  • you are overweight
  • you eat a diet high in fat
  • several women in your family have had breast cancer – an inherited faulty gene can increase your risk of prostate cancer

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