Thousands of men risk being condemned to an avoidable death as government advisors reject calls for a major prostate cancer screening programme

Thousands of men risk being condemned to an avoidable death after government advisors today rejected calls for a major prostate cancer screening programme. 

Health secretary James Murray will meet the chair of the UK National Screening Committee on Monday before deciding whether to follow its recommendation or overrule it.

Charities, patients and MPs say Mr Murray, who only took up his role this month, should ‘show leadership’ and use his powers to defy the bombshell guidance. 

Prostate cancer is the most common cancer in the UK, with 63,000 cases and 12,000 deaths each year – but unlike breast, bowel and lung cancer, there is currently no national screening programme.

The Daily Mail is among those campaigning to end needless prostate cancer deaths and for a national prostate cancer screening programme, initially targeted at high risk men, such as those who are black, have a family history of the disease or particular genetic mutations.

The UKNSC issued draft guidance in November, which said screening should only be offered to around 20,000 men aged 45 to 61 with BRCA1 or BRCA2 gene mutations, which increase the risk of aggressive disease.

This meant that black men – who run twice the risk of developing prostate cancer and of dying from it – and those with a family history of the disease would have been excluded.

Now the panel says even fewer men should receive routine checks than it initially proposed, following a public consultation and consideration of new evidence.

In its final recommendation, published today, the UKNSC says only men aged 45 to 61 who have particular BRCA2 variants combined with a family history of breast, ovarian, pancreatic, or prostate cancer should qualify.

It means a mere 3,000 men will be invited for screening, which will involve taking a blood test every two years to check for a marker of potential prostate cancer known as PSA.

The committee said expanding screening to a wider group could lead to over-diagnosis and over-treatment, exposing men to a risk of impotence and incontinence when their tumour was unlikely to cause them issues in their lifetime.

It has vowed to continue to update its modelling as new evidence becomes available. 

Chiara De Biase, fundraising and health strategy director at Prostate Cancer UK, said: ‘We’re deeply disappointed with this final recommendation from the UKNSC.

‘Without a screening programme for the UK’s most common cancer, we lose more than 12,000 dads, brothers, and partners every single year.

‘We know that a mass screening programme could save thousands of men’s lives, and while we recognise the current evidence does not yet show that screening all men at risk would do more good than harm, today’s decision is a step backwards, narrowing the recommendation to a smaller pool of eligible men.

‘We will rigorously scrutinise the evidence behind this decision and will challenge it where we disagree.

‘We cannot accept the status quo. More must be done to save men’s lives, starting with those at highest risk, including men with a family history and black men.’

David James, director of patient projects and influencing at Prostate Cancer Research, said: ‘For men who are at highest risk of prostate cancer this decision will feel like being left behind.

‘The number of men affected by this recommendation is likely to be even smaller than the Committee had previously indicated.

‘We had hoped that the Committee would recognise the overwhelming case for screening those at highest risk, but it is clear that these men have been let down today.

‘We know who is most at risk of this disease – yet those men are still not being offered screening.

‘Those men are being told to wait, often until it is too late. That is becoming impossible to defend.

‘The Committee has said its model will be kept “alive”, which matters.

‘But now it must move quickly to update that model and revisit this decision before more men are diagnosed too late.’

The decision to exclude almost the entire population of men comes after a major study last year showed prostate screening slashes their risk of dying from the disease by 13 per cent, with one death prevented for every 456 men checked – a figure that is comparable to existing breast and bowel cancer screening programmes.

Of 100 men with a BRCA2 variant, between 21 and 35 of them will develop prostate cancer before the age of 80. 

Professor Sir Mike Richards, chairman of the UKNSC, told a briefing: ‘We absolutely recognise the strong support for prostate cancer screening amongst a large number of people, but also the very real harm that can be caused by the disease, which patients and indeed their families, experience.

‘We do know that screening can reduce deaths from prostate cancer to a small extent, and it does not improve overall survival.’

He said that many men ‘will live full lives’ without the disease causing harm, and screening can ‘only help if it can separate out that harmful disease from the harmless disease’.

‘Once a prostate cancer is found, we still can’t reliably tell which cancers need treatment and which do not,’ Professor Richards said.

‘There’s a spectrum there, and the treatments available for prostate cancer can cause long-lasting harm.’

Prof Richards also said the levels of over-diagnosis in prostate cancer remain high ‘despite advances’ such as MRI scans before a biopsy following a positive PSA test.

The UKNSC said it removed BRCA1 from the final guidance as a result of new data emerging after it published its draft.

Anneke Lucassen, professor of genomic medicine and director of the Centre for Personalised Medicine at the Nuffield Department of Medicine, University of Oxford, told the briefing that previous studies ‘hadn’t been able to clearly separate out’ the risks posed by both the BRCA1 and BRCA2 variants.

She said that two large studies published recently suggest the risk is mainly from BRCA2 and not BRCA1 when it comes to prostate cancer, and that the risk among those with BRCA1 is ‘significantly lower’.

Former prime ministers Rishi Sunak and David Cameron, who has told of his own battle with prostate cancer, had supported calls for a national prostate cancer screening programme targeted at high risk men.

And Wes Streeting, who was health secretary when the committee published its draft guidance, had said he would consider the conclusions ‘carefully’ and thrash out the arguments to ‘reach the right way forward’.

Mr Sunak, a Prostate Cancer Research ambassador, said: ‘This decision will be deeply disappointing to the thousands of brave men who have campaigned for a targeted screening programme to prevent more families from losing a father, a son or a brother before their time.

‘For just 0.01 per cent of the NHS Budget we could have had a targeted screening programme that would have saved lives.

‘The problem we have is that prostate cancer is too often caught too late, with devastating consequences for men and their families.

‘Today, screening is more effective than it has ever been, but the model guiding the Committee’s decision does not reflect these developments.

‘Updating it is essential if we are serious about earlier diagnosis and preventing avoidable deaths.

‘We must take this opportunity to save lives, reduce inequalities and bring prostate cancer screening into line with how the disease is diagnosed and treated today.’

Dr Ian Walker, executive director of policy at Cancer Research UK, said: ‘Prostate cancer remains the second biggest cancer killer of men, so it’s critical that we find more ways to save lives from the disease.

‘Today’s announcement, following an independent expert review, that the currently available evidence doesn’t support a broader prostate cancer screening programme will be disappointing for many people, but the PSA test currently used to detect prostate cancer is not effective enough to support wider screening, as shown in multiple large-scale trials.

‘Screening decisions must be guided by the current evidence, with programmes only introduced when the benefits are shown to outweigh the harms, including unnecessary and invasive overtreatment.’

A Department of Health and Social Care spokesperson said: ‘The Secretary of State will give full and careful consideration to the recommendation from the independent UK National Screening Committee, and will update on the government’s response shortly.’