National committee to advise against routine NHS prostate cancer screening

The UK National Screening Committee (NSC) is set to advise against routine NHS prostate cancer screening – but said there is evidence screening should be considered for men with faulty BRCA genes.

It said that the findings of a model of whole-population screening for prostate cancer mean that this approach is ‘not recommended’.

Using currently available tests, routine prostate cancer screening for all men is ‘very unlikely’ to be cost-effective and it is ‘not clear whether it would result in more good than harm’, the committee said.

Of the targeted screening strategies considered, the findings of the model suggest that screening for prostate cancer in men with known BRCA1/2 gene mutations is the approach ‘most likely to do more good than harm’ and the NSC will now consult on a draft recommendation for this screening strategy.

The modelling found that the most ‘cost-effective’ strategy for screening men with a confirmed BRCA1/2 gene mutation is screening every two years, from age 45 to age 61.

Currently, any man aged over 50 can request a PSA test from their GP, but the NSC previously said it does not recommend a screening programme as the test is ‘not accurate enough to detect prostate cancer that needs treatment’.

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The committee last examined the body of evidence in 2020, recommending against introducing a national screening programme as, at that time, ‘the potential harms outweighed the benefits’.

However, it came under increased pressure in recent months to reconsider PSA testing policy, particularly after Sir Chris Hoy’s announcement that he had been diagnosed with terminal cancer.

Earlier this year, there had been heightened speculation over the updated recommendations from the NSC, and the committee looked at modelling of a range of options, including a more targeted approach.

The committee commissioned the Sheffield Centre for Health and Related Research (SCHARR) to develop an updated 2025 prostate cancer screening modelling study.

The SCHARR report predicts the potential impact of various screening strategies, including population screening and targeted approaches aimed at high-risk groups including black men, men with a family history and men with a BRCA gene variation.

Approximately one in 300 people in the population have an alteration in one of the BRCA genes.

The NSC has now opened a 12-week public consultation to ask individuals and organisations to provide feedback on this study and on the wording of a draft recommendation based on its findings.

The committee said: ‘The model is more conclusive about the balance of benefits and harms compared to cost of screening men with a known BRCA1/2 gene mutation.

‘It is estimated that the offer to screen this group would result in less overdiagnosis compared with usual care.

‘This is because men with BRCA1/2 mutations may develop more aggressive cancers and so the benefits to screen would outweigh the harms when compared to the general population or other risk groups.’

The committee makes recommendations to ministers and the NHS across the four nations of the UK, based on an ‘assessment of high-quality, peer-reviewed evidence’ on whether screening for a certain condition would do more good than harm at reasonable cost.

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Strategies being considered

The screening strategies that the UK NSC is consulting on and will seek views on:

• against population screening for men (at any age)
• against screening for black men
• against screening for men with a family history
• in favour of screening men with a known gene variant of BRCA1 and BRCA2

The strategy that the UK NSC is in favour to consult on and pursue is screening for men with variants of the BRCA1 and BRCA2 genes every 2 years, from age 45 to age 61. However, we welcome comments on all strategies considered.

It is proposed that the UK NSC should seek stakeholder views on whether to pursue a targeted screening strategy in men with higher genetic risk.

Dr Ian Walker, executive director of policy at Cancer Research UK, said: ‘It’s good news that prostate cancer screening is being considered for men with faulty BRCA genes, which increase a man’s risk of developing an aggressive type of the disease.

‘The UK National Screening Committee’s analysis shows that screening this group will save lives. We support the committee’s conclusion that for other groups of men, there isn’t currently enough high-quality evidence that screening would do more good than harm – it can miss dangerous cancers and detect ones that don’t need treatment.’

Professor Ros Eeles, professor of oncogenetics at The Institute of Cancer Research, London, said: ‘We’re very pleased to see that the National Screening Committee has recommended that PSA testing for men who carry BRCA1 and BRCA2 mutations is introduced.

‘This recommendation is based on research led by my team at The Institute of Cancer Research, which showed that these men face a significantly higher risk of developing prostate cancer and are more likely to experience aggressive forms of the disease. PSA testing picks up cancers at an earlier stage, when they are easier to treat – which will ultimately save lives.

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‘However, the five-year data from our IMPACT screening trial show that cancers are picked up each year that these men are tested in BRCA2 carriers, and in all but one of the 5 years in BRCA1 carriers. We therefore recommend annual screening, rather than every two years – to avoid the risk that an aggressive cancer could be allowed to grow unchecked for a whole year.’

Earlier this year, Pulse found that a quarter of GPs are ‘strongly supportive’ of the NHS introducing prostate cancer screening, but many highlighted issues with current PSA testing.

This article was first published by our sister title Pulse