In many countries prostate cancer screening happens ahead of evidence from ongoing trials. In several countries, early opportunistic screening starts with people aged 50. The Americans have recently adopted a lower age limit after two studies found that raised PSA (prostate specific antigen) levels in males in their 40s was linked to prostate cancer.
A team of scientists in the United Kingdom looked at the feasibility of prostate cancer testing, prostate cancer prevalence and characteristics in a random group of men under 50. You can read about this in the British Medical Journal (BMJ).
The study involved 442 men aged 40-45 – they all agreed to PSA testing. 54 (12%) of them had a high PSA result. They were invited to additional testing, involving an ultrasound-guided prostate biopsy, another PSA test, and a digital rectal examination.
Ten cases of prostate cancer were detected – a similar rate to that found in older men, 2.3%. Five of them had tumors that were potentially risky to health, they agreed to have one of three treatment options – radiotherapy, surgery, or active monitoring.
The study revealed that men under 50 will accept prostate cancer testing at a much lower rate than men over 50, the researchers explained. Therefore, greater efforts would be required to optimize uptake in younger men if screening for them were introduced.
If the 2,236,000 males aged 45-49 in the UK underwent PSA screening, the researchers estimate that 272,905 of them would have elevated PSA, of whom 51,449 would have prostate cancer. Treatment would benefit some of those with prostate cancer. However, this has to be weight against the probable distress caused to the 221,456 men with elevated PSA who do not have cancer. Apart from distress, these men also run the risk of undergoing unnecessary treatment and the side-effects that come with the treatments.
The study will inform the debate about PSA thresholds and age limits, say the researchers, but only if prostate cancer screening is proven as effective in ongoing trials. Until we have the results of the ongoing trials, policy should advise clinicians to inform the patients about the benefits, potential harms, and limitations of prostate cancer screening.
Accompanying Editorial
Until the results from ongoing trials are available, policy should advocate informed discussion between clinicians and patients about the benefits, potential harms, and limitations of prostate cancer screening, says an accompanying editorial.
Research
“Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial”
J Athene Lane, Joanne Howson, Jenny L Donovan, John R Goepel, Daniel J Dedman, Liz Down, Emma L Turner, David E Neal, Freddie C Hamdy
BMJ, doi:10.1136/bmj.39381.436829.BE
Editorials
“Screening for prostate cancer in younger men”
Dragan Ilic, Sally Green
BMJ, doi:10.1136/bmj.39385.491424.80
Written by – Christian Nordqvist