Why don’t we screen all men for prostate cancer?

As a society we’re all programmed to fear cancer. Despite everything we've achieved in finding, treating and curing cancer, it still has the power to stop us in our tracks. So, when something like a screening programme comes along promising to catch it early, of course we want to grab it with both hands.   

But with prostate cancer, we need to have a different conversation – one that's honest about where we are and hopeful about where we're heading.  

What is a screening programme?

Screening programmes aim to find early signs of cancer in people who don’t yet have any symptoms.  

They invite all suitable people to have a test to find out if they are at risk. In the UK there are screening programmes for breast, cervical, bowel and lung cancer. Finding cancer early means it could be treated in time to get rid of it before it causes any problems. 

In comparison, prostate cancer is currently the only major cancer without a screening programme.

Why isn’t there a screening programme for prostate cancer?

Unlike all the other cancers, a screening programme that finds every prostate tumour isn't necessarily our goal. 

That's because, although many prostate cancers are life-threatening, some small prostate cancers are harmless and can be left alone.  

A screening programme that finds every prostate cancer, no matter how significant, would give many men diagnosed with these cancers the anxiety of knowing they need to commit to a lifetime of monitoring. For some men, that anxiety would drive them to choose unnecessary, potentially harmful treatments. 

This means a screening programme for prostate cancer is a balancing act. 

It needs to be able to find the most harmful cancers early enough for doctors to do something meaningful about them, while avoiding harming men whose cancers were never going to cause them any problems.  

Why don’t we use PSA blood testing to screen for prostate cancer?

The PSA blood test is the first test men have for prostate cancer. It measures the amount of a protein, called prostate specific antigen, released by prostate cells into the blood.  

If the prostate has cancer, it’s likely there will be a faster increase in the number of cells in the prostate, causing PSA levels to rise more dramatically. 

There's strong evidence from multiple large-scale clinical trials that a simple PSA blood test can spot the early warning signs of prostate cancer, and reduce the number deaths from the disease by up to 20 per cent. 

But the PSA blood test is not a test for prostate cancer.  

PSA is released by healthy prostate cells as well as prostate cancer cells, and it’s normal for PSA levels to gradually increase as the prostate enlarges with age.  

This means the PSA blood test can be helpful at telling us there’s something going on in the prostate, but it’s not accurate or sensitive enough for us to use as a screening test by itself. 

That's why, even though PSA-based screening has been tested and shown to save lives, it hasn’t been approved by the UK’s National Screening Committee.  

This is where new MRI imaging comes in. 

Why do we use MRI for prostate cancer?

Before 2019, men with a high level of PSA in their blood were sent straight for a biopsy, which could cause pain and bleeding, and came with a risk of serious infection. These biopsies could also miss the cancer, leading to repeated biopsies with further risks of infection and uncomfortable side-effects. 

We helped to fund research that showed having mpMRI scans beforehand could safely rule out many of these biopsies as unnecessary, as well as improving the accuracy of those that were needed, making them more likely to detect the cancer the first time. We also worked closely with the NHS to make sure the innovative technique was rolled out across the country. 

Meanwhile, we’ve supported several hospitals to transition to transperineal biopsies, where the needle is inserted into the perineum rather than the rectum, giving a lower risk of infection. 

Today, NHS data shows that developments in MRI scanning and biopsy techniques have led to a massive 79 per cent reduction in harms during the diagnostic pathway – meaning that diagnosing prostate cancer is safer and more accurate today than ever before. 

When will there be a screening programme for prostate cancer? 

We’ve made our case to the UK National Screening Committee that these recent improvements in diagnosing prostate cancer may have finally tipped the balance in favour of screening for men at highest risk of the disease.

The Screening Committee agreed to review that new evidence and later this year, we will find out if their careful review does show if it’s now time for a screening programme – you can read more about the three potential outcomes. 

How should we screen men for prostate cancer?

This is where TRANSFORM, our £42 million clinical trial, comes in.  

Whichever way the UK National Screening Committee decides, we want the best, safest, most accurate approach possible that saves the most lives. 

TRANSFORM is designed provide the crucial scientific evidence that will lead us to that – paving the way to a truly world-leading screening programme that saves thousands of lives every year. 

Through TRANSFORM, we're building something bigger than ‘screening as soon as possible’ - we're creating the foundation for a future where every man at risk gets exactly the right care at exactly the right time.  

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