Prostate cancer screening: Final guidance recommends against testing all men

The UK National Screening Committee (UKNSC) has issued final guidance recommending against a nationwide prostate cancer screening program using PSA blood tests, stating it would cause more harm than good. The committee estimates that screening could lead to unnecessary treatments, including incontinence and erectile dysfunction in men who do not require treatment. However, the UKNSC advises that men with BRCA2 genetic mutations and a family history of breast, ovarian, pancreatic, or prostate cancer should undergo screening every two years between ages 45 and 61. This group faces a significantly higher risk of developing aggressive prostate cancer, with 21 to 35 out of 100 men affected before age 80. The final recommendation differs from the draft, which included men with BRCA1 mutations, as recent studies showed a lower prostate cancer risk associated with BRCA1 compared to BRCA2. The committee also ruled out screening for other high-risk groups, including Black men, due to insufficient evidence that benefits would outweigh harms. Professor Sir Mike Richards, chairman of the UKNSC, emphasized that while screening may slightly reduce prostate cancer deaths, it does not improve overall survival. He noted that distinguishing between harmful and harmless cancers remains difficult, leading to overdiagnosis and unnecessary treatments despite advancements like MRI scans. The UKNSC will collaborate with NHS organizations to refine methods for identifying and inviting eligible men for screening. The guidance aims to balance public demand for screening with the risks of overdiagnosis and treatment-related complications.