So, the UK national screening committee has looked at the evidence and decided that the Prostate-Specific Antigen (PSA) test isn't good enough to underpin a national screening programme for prostate cancer. Job done then; the issue of the rights and wrongs of PSA testing is now settled and will gently fade away. I think not. It's far too important and controversial to be nailed on the basis of the committee's narrowly focused review.
The committee's decision was right, at this stage. The PSA test is not highly specific or reliable and it can't distinguish between aggressive and slow-growing prostate cancers. The risk of using it in a national screening programme is that many slow-growing cancers would be identified, leading to men having to live with the anxiety of a cancer diagnosis – and some potentially having unnecessary radical treatment. But the critical flipside, which is heavily underplayed in the screening committee's announcement, is that for some men with an aggressive but symptomless prostate cancer, a raised PSA level may be the only earlier indicator of cancer at a time when it can be successfully treated.
PSA testing is a two-way street. It has pros. It has cons. But until an improved test is developed, it is the best we have and we need to use it intelligently. The balance of benefits and risks of PSA testing should be a decision that every man over 50 is able to make for himself. A decision based on good, balanced advice. A decision he makes through a conversation with a well-informed health professional.
Here, we come to the scandalous reality. The government, through its Prostate Cancer Risk Management Programme (PCRMP) says that every man over 50 who doesn't have symptoms of prostate cancer is entitled to ask his GP for a PSA test. Yet, 70% of men aged 50-70 don't even know that the test exists, let alone their right to request it – men are effectively denied the right to make a choice. And if you think that's bad, it gets even worse for men from less affluent backgrounds who are much less likely to be aware of the test, or even of the disease itself.
Moreover, three out of four GPs are unaware that these guidelines exist and, shockingly, 15% of GPs do not support the right of men without symptoms to have access to the PSA test, even after these men have considered its pros and cons and decided that they want a test. I have been one such man; I had to overcome resistance from my own doctor. Although only anecdotal evidence, we do regularly receive complaints to our helpline from men who feel they were denied the test.
The government has shown absolutely no inclination to take active steps to make men aware of the choice to which they should be entitled – a choice that might save their life. This massive men's health inequity cannot be allowed to continue. The government must grasp this issue and provide proper leadership. It is not good enough to use the existence of the PCRMP as some form of defence: if vast swathes of men are unaware of the programme, how does its existence help them?
The time has come for a new approach. Men over 50, younger men with a family history of prostate cancer and higher-risk groups, such as African-Caribbean men, must be put firmly in the driving seat and empowered to decide whether they want a test – it is not for government or health professionals to make this decision on their behalf. New models should be trialled for reaching out to men – and we at the Prostate Cancer Charity plan on launching a new campaign to achieve this. This can include a GP surgery-based approach where men are invited to a discussion about prostate health and the PSA test, a walk-in clinic, and a roving roadshow targeted at places that men meet.
Changes in men's awareness and of their right to make an informed choice is vital, and a key step in attacking the tragic loss of 10,000 men's lives to prostate cancer every year in the UK.
