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Personalised screening may be way forward for prostate cancer

Model suggests screening according to age and genetic risk

Ingrid Torjesen

Tuesday, 06 November 2012

A personalised approach to prostate screening – based on a man’s age and their genetic make up – would result in fewer deaths and cost the NHS less than screening all men above a certain age regularly, research presented at the NCRI Cancer Conference in Liverpool has found.

Researchers, funded by Cancer Research UK, developed a theoretical model to compare the effectiveness and cost of two different approaches to prostate cancer screening.

The model found a personalised approach – based on a man’s age and looking for the common genes that increase the risk of prostate cancer – would result in fewer deaths from the disease and cost tens of millions less for the NHS to roll out than screening all men aged 55 to 79 every four years with the PSA test.

The model also showed 50 per cent fewer men would need to be screened and 18 per cent fewer men would be diagnosed with the disease – possibly reducing the problem of over-diagnosis and saving men from unnecessary treatment that can lead to side effects like impotence and incontinence.

Men in the UK are not screened for prostate cancer as part of a national screening programme because the only available test, the PSA test, is not an accurate indicator of whether a man does have cancer and cannot reliably tell if a cancer is aggressive and so needs treatment.

Instead, men who ask for a PSA test are given information by their GP to help them understand the pros and cons before they decide whether they want to go ahead with the test.

Dr Nora Pashayan, a Cancer Research UK clinician scientist at University College London, said: “We don’t have a screening programme for prostate cancer because the benefits are outweighed by the harms. Identifying men who are more likely to develop prostate cancer and targeting them for screening could potentially save thousands of men from overdiagnosis and unnecessary treatment. We’re now refining our model to develop more definite predictions which will then need to be tested in trials to see if this approach will have the effect we predict.”

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “There is great uncertainty about the usefulness of screening for prostate cancer using the PSA test, with many men finding it difficult to weigh up the pros and cons. This research suggests an important way to select men for whom testing may be more worthwhile, which points us in the right direction for the future.”

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