Thousands of men being needlessly treated for prostate cancer

Thousands of men are being needlessly treated for prostate cancer because there is no reliable test for the disease, experts have warned.

A decade-long study involving 415,000 British men lays bare the fundamental flaws of the blood test that forms the cornerstone of the way prostate cancer is diagnosed.

Experts said there is a ‘desperate need’ for a much better way of screening for prostate cancer, in the same way as women are screened for breast cancer with regular mammograms.

Using a ‘prostate specific antigen’ – or PSA – blood test to screen healthy men would not save extra lives, the Oxford and Bristol-led researchers found.

The researchers admitted it remains the only method of testing men who are already showing symptoms.

But they said it should not be routinely used for men with no signs of problems.

Study leader Professor Richard Martin, of Bristol University, said: ‘PSA is currently the only tool we have, but it is a very blunt tool.

‘It detects prostate cancer in men who will not benefit from treatment, but is misses aggressive cancer in men who do need treatment.’

The Daily Mail is campaigning to end needless prostate deaths through better treatments and greater awareness.

Last month official figures revealed rising prostate cancer deaths saw it become a bigger killer than breast cancer for the first time.

This is partly because screening for breast cancer is routine – with middle-aged women invited for scans every three years – which has resulted in falling deaths.

But there is no national screening programme for prostate cancer.

The new study attempted to resolve that by testing whether the PSA test could form the basis of a the first prostate screening programme.

Instead it revealed major shortfalls with the test.

The researchers invited 190,000 healthy men aged 50 to 69 to have the blood test, and then tracked them for another 10 years.

They were compared to another 220,000 men of the same age who could get a PSA test if they asked for it, but were not actively offered one.

The researchers, whose findings are published in the JAMA medical journal, found about a fifth more men were diagnosed with prostate cancer in the screening group.

But this only resulted in needless treatment without actually saving lives.

The number of deaths after 10 years were no different among men who were screened and those who were not – with about three deaths for every 1,000 men in each group.

Experts believe this is because the PSA test picks up slow-growing tumours that would do no harm if left untreated.

And yet the test misses many of the aggressive cancers that require urgent treatment.

The Government-funded project rules out the use of the PSA test for a way of screening healthy men.

Researchers believe 25 per cent of men diagnosed with prostate cancer – nearly 12,000 of the 47,000 diagnosed in Britain every year – are victims of ‘over-detection’ – which means they have been diagnosed with disease that actually requires no treatment.

Most of these men are subjected to gruelling treatment – such as radiotherapy and surgery – involving a high risk of side effects including impotence and incontinence.

Rapid treatment for men with more aggressive forms of the disease is vital, and could be lethal if delayed, with 11,400 men dying each year from the disease.

But the test – and the biopsy that men are offered after the PSA test – are not very good at differentiating between slow and quick-growing tumours.

Scientists are experimenting with using MRI scanners to improve detection, in a series of ‘one-stop shop’ services.

Prostate cancer is difficult to spot early, given that symptoms – pain when urinating and frequent, urgent trips to the lavatory – tend to arise only when the tumour has grown large enough to put pressure on the urethra

But not all hospitals have the right equipment and it still requires a PSA test to begin with.

Professor Martin added: ‘The results highlight the multitude of issues the PSA test raises – causing unnecessary anxiety and treatment by diagnosing prostate cancer in men who would never have been affected by it and failing to detect dangerous prostate cancers.’

Prostate cancer expert Professor Malcolm Mason of Cancer Research UK, which part-funded the work, said GPs need to have very careful conversations with their patients before offering them the tests.

Men with symptoms should continue to get the tests, and any man over the age of 50 can ask for a PSA test, but they should not be given routinely to men with no symptoms, he said.

‘A man has the right to have a PSA test if he wants it,’ Professor Mason said.

‘But men should not have the testing without having the whole picture and all the pros and cons explained to them.

‘In the past when men have gone to their GP they have been told: ‘Oh while you are here should we test your PSA?’

‘That is just wrong and should not happen anymore.’

Heather Blake of Prostate Cancer UK said: ‘Right now the PSA test is the best first step we have to indicate that there might be a problem with the prostate in men who do not have symptoms. 

‘That is why we recommend that men over 50 – and men over 45 if they are black or have a family history of the disease – discuss the pros and cons of the PSA test with their GP so that they can decide if it’s right for them.’

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, added: ‘GPs have long held reservations about the effectiveness of PSA testing based on previous research findings, in particular with regard to potential overdiagnosis and its associated risks – today’s research supports these concerns.

‘It shows that PSA testing is not sensitive enough to either detect the subtle variations between prostate cancers or exclude clinically insignificant cancers.’