Prostate Cancer, is it worth screening all males over the age of 50?
Advances in treatments continue to improve the chances of surviving this awful illness and raises the question over should we screen all men over the age of 50.
On the face of it the answer should be - OF COURSE!
But are we aware of all the factors to be considered. Well, thanks Has, we know a lot more about the subject now.
WHY SUDDEN RISE IN NUMBERS?
- Sharp rise driven by awareness campaigns
- 42% Rise in diagnoses in the last decade due to wider screening using PSA test.
- UK National Screening Committee recommended Prostate screening should not be made available using PSA test.
WHAT ARE THE SYMPTOMS OF PROSTATE CANCER
- Urinary frequency- mostly at night
- Urinary urgency
- Difficulty passing urine
- Poor stream (in ability to shoot)- dribbling after passing urine
- Hesitancy
- Blood in the urine or semen
- Erectile dysfunction
WHO IS MORE PRONE TO GET IT?
- Age: Men over the age of 50
- Ethnicity: higher risk for Black men
- Family history: strong family history
- Genetic: Inherited gene changes - BRCA1 and BRCA2 genetic mutations from our mothers breast cancer.
WHO IS MORE PRONE TO GET IT?
- Age: Men over the age of 50
- Ethnicity: higher risk for Black men
- Family history: strong family history
- Genetic: Inherited gene changes - BRCA1 and BRCA2 genetic mutations
REASONS FOR NOT SCREENING ROUTINELY
- PROSTATE CANCER SCREENING DOESN’T SATISFY THE CRITERIA FOR ROUTINE SCREENING
- Natural history of the condition not understood
- No test is available that is easy to perform, interpret, acceptable, accurate, reliable, sensitive and specific- acceptable test with few false positives (specificity) and few false negatives(sensitivity)
- The test or examination should be acceptable to the population
- Acceptable treatment for patients with the disease
- Finally the cost, including diagnosis and the treatment should be economically balanced in relation to expenditure on medical care as a whole
ISSUES WITH ROUTING SCREENING
- There is a lack of evidence about the universal benefits- it may cause more harm than good
- It may lead the identification and or treatment of conditions which would not otherwise have caused death or disability
- Earlier diagnosis may not have positive impact on outcomes and may end up with negative effects
- The test may cause undue stress or side effects
- Unnecessary increase on the work load of NHS workers and overall budget
WHAT MIGHT THE SCREENING INVOLVE IN THE ABSENCE OF A TEST THAT IS HIGHLY SENSITIVE AND SPECIFIC
- PSA- The test on its own is not reliable because men with high PSA level may not have cancer and some men with cancer have a normal PSA level- Positive result may lead to unnecessary treatment for slow growing cancers or harmless tumours resulting in incontinence and erectile dysfunction
- Digital Rectal examination by a clinician
- MRI Scan
- Biopsy
SO WHO SHOULD WE SCREEN
- MEN OVER 50 WITH SYMPTOMS
- MEN OF AFRICAN DESCENT OVER THE AGE OF 50
- MEN WITH STRONG FAMILY HISTORY OF PROSTATE CANCER
- MEN WITH INHERITED BRCA 1- BRCA-2 (from their mother) GENETIC MUTATIONS