Targeted prostate cancer screening could save countless lives, says Sunak

According to a report commissioned by former Prime Minister Rishi Sunak, a targeted prostate cancer screening program in the UK could "save countless lives." The proposed scheme would focus on men at the highest risk, specifically Black men and those with a family history of the disease, aged 45 to 69.

Cost and Logistics of the Proposed Scheme

A study by Prostate Cancer Research, of which Sunak is a patron, outlines the costs and benefits of a targeted screening service. The program, which would include a PSA (prostate-specific antigen) blood test, an MRI scan, and a biopsy, is estimated to cost £25 million a year, which is about £18 per patient. This cost is comparable to existing screening programs for bowel and breast cancer.

The charity estimates that the program would reach 1.3 million eligible men in the UK annually, assuming a 72% uptake rate. It predicts a 23% rise in diagnostic activities (scans and biopsies) but only a modest increase in NHS staffing.

Racial Disparities in Prostate Cancer

The push for targeted screening is largely driven by significant racial disparities in prostate cancer diagnosis. The latest National Prostate Cancer Audit reveals a concerning trend:

• One in four Black men will be diagnosed with prostate cancer.

• In contrast, the rate is one in eight for White men.

• For men of other ethnic groups, the diagnosis rate is one in thirteen.

Men with a family history of the disease are also at a higher risk.

Controversy and Concerns

While supporters like Sunak and Olympic cyclist Sir Chris Hoy advocate for earlier testing, some medical experts are skeptical. The PSA test is controversial because levels can rise for reasons other than cancer, such as viruses, leading to false positives. Critics argue that this can result in unnecessary treatment, with side effects that include incontinence and erectile dysfunction.

The UK National Screening Committee is currently reviewing its five-year-old decision not to recommend routine screening, though media reports suggest it may maintain its current position. Professor Hashim Ahmed, Chair of Urology at Imperial College, points out that while screening can find diseases, it can also lead to the treatment of conditions that would not have caused harm, thereby causing "injury."

Personal Stories and Calls to Action

The discussion around screening is being heavily influenced by personal stories. Sir Steve McQueen, the Oscar-winning director, was inspired to advocate for awareness after his father died from the disease. Sir Steve himself was diagnosed in 2022 but made a full recovery. "I had the opportunity to find this disease but my father did not," he said, emphasizing that increased screening could help "equalize" the situation.

Similarly, David Bateman, a 66-year-old patient at Guy's Hospital, believes that earlier screening would have changed his outcome. Diagnosed at 59 after the cancer had already spread, he said, "I am positive I wouldn't be in the situation today if I had been screened at 50." He now urges his sons, aged 38 and 40, to get checked as soon as possible.