Screening for prostate cancer

Prostate cancer is the most commonly diagnosed cancer in UK men excluding non-melanoma skin cancer, with over 64,000 new cases and 12,000 deaths annually. This disparity between incidence and mortality has fuelled debate about over-diagnosis and the value of screening. The UK National Screening Committee has advised against population prostate-specific antigen (PSA) screening, citing uncertainty regarding benefit and harm. However, a risk-based PSA screening algorithm that adjusts PSA levels to multiples of the median for the same age and incorporates age-specific risk demonstrated good screening performance (detection rate of 90% for a false-positive rate of 2%). The European Randomized Study of Screening for Prostate Cancer shows a 16% reduction in prostate cancer mortality with PSA screening, comparable to reductions achieved in bowel cancer screening. The addition of pre-biopsy multi-parametric magnetic resonance imaging (MRI) screening reduces unnecessary biopsies and over-diagnosis while maintaining detection of clinically significant disease. Together, risk-based PSA testing combined with multi-parametric MRI would prevent an estimated 13 prostate cancer deaths per 1000 men screened every 5 years from age 55, with 9 deaths prevented for every man treated unnecessarily.