Prostate cancer blood test could save thousands more lives, charity says

“Dangerously outdated” NHS prostate cancer guidelines must be overhauled to save thousands more lives, a charity has demanded.

GPs are not allowed to tell men who have no symptoms but are at highest risk that they can request a blood test which looks for hormone changes linked to the disease.

This is due to concerns that the prostate specific antigen (PSA) test is not reliable enough and can lead to men having unnecessary biopsies – which can lead to sepsis in rare cases – or needless treatment for low-risk cancers.

However, a major study suggests the test’s risk-benefit ratio should be urgently reevaluated.

It found that the introduction of new biopsy and scanning techniques had dramatically reduced the risk of harm for men flagged by the PSA test.

READ MORE: Prostate cancer breakthrough as new test can detect it in 15 minutes

Prostate Cancer UK is calling for guidelines to be updated so that GPs can proactively raise the test with men at highest risk of prostate cancer, including Black men and those with a family history.

The charity’s director of research Dr Matthew Hobbs said: “Current guidelines mean it’s up to men to ask about a PSA blood test.

“That practice is undoubtedly driving late diagnosis of prostate cancer, and massive inequality across the UK.

“Historically, the evidence that PSA testing saved lives was weak and there was strong evidence that testing caused harm.

“Now, the situation has changed. Modern techniques already being used as standard across the NHS have massively reduced the number of men who suffer harm. Guidelines must catch up.”

The Prostate Cancer UK-led study analysed data from 16,000 men going through the diagnostic process at 16 hospitals.

Researchers compared the current data with estimates for historical diagnostic processes which did not include newer technology.

Since 2019, multiparametric MRI scans (mpMRI) that combine multiple MRI techniques to create detailed images of the body have been recommended before biopsies. If scan results are abnormal then patients are sent for biopsies.

And use of transperineal guided biopsies – which carry a lower risk of infection than older methods – has risen in recent years.

The study estimated that for every 10,000 men who have a PSA test today, 1,610 would be flagged as having a raised PSA level.

Of those, 467 would end up being diagnosed with clinically significant prostate cancer, while 111 would be diagnosed with low-risk, clinically insignificant cancer.

Meanwhile, 381 would have a normal MRI and be discharged without a biopsy and 651 would get the all-clear after a biopsy. Seven would contract sepsis during the process.

The analysis found that the newer methods meant fewer men were now exposed to unnecessary biopsies, contracted sepsis, or experienced “overdiagnosis” for low-risk cancers.

Overall, risk of harm following a PSA test today was found to be 79 per cent lower than under previous clinical pathways. This means that around 100,000 fewer men a year now experience harm, researchers said.

Writing in the ESMO Real World Data and Digital Oncology journal, the team said their work “represents an important step toward reevaluating the harm-to-benefit ratio of prostate cancer screening in the modern era”.

Urologist and study author Nick Burns-Cox said: “This is a really important piece of research, because it measures the real experiences of patients treated in NHS hospitals, and makes a strong case for updating UK guidelines.

“It is also fantastic news for men and their families as it shows how dramatically harm has fallen in the ways we diagnose prostate cancer, even compared to just a few years ago.

“This means thousands of men avoiding unnecessary, invasive tests and spared the worry of an unnecessary diagnosis.”

The UK’s National Screening Committee is considering the case for targeted screening of men at highest risk of prostate cancer Prostate Cancer UK is asking that their review incorporates this new research alongside other similar evidence.

The £42million TRANSFORM trial is also under way to identify the best method for use in a national screening program.

An NHS spokesperson said: “The NHS is committed to using proven and effective cancer screening techniques which can benefit patients, and if there are updates to UK screening guidance, we will work closely with the government to enact these.

“The ongoing joint government and Prostate Cancer UK TRANSFORM trial is an important step in building the evidence around prostate cancer screening, and we await its outcome and the UK National Screening Committee’s recommendation.”

A Department for Health and Social Care spokesperson said: “We have inherited a broken NHS. Prostate cancer patients are waiting too long for treatment, and we are determined to change that.

“We are investing £16 million to find new ways to catch prostate cancer in men as early as possible, giving them the best chance of survival.”

Allowing GPs to discuss test would be a huge step in the right direction

Allan Roper, 73, was successfully treated for prostate cancer but fears his son is at risk. The grandfather-of-two said: “My dad had prostate cancer, so I knew I had a higher chance of getting it myself.

“When I was diagnosed, I was offered a standard biopsy or a place on a trial where I could have an MRI scan and the new trans-perineal biopsy.

“I chose the trial and that saved my life; the standard biopsy showed no cancer, but the scan and new type of biopsy found I did have cancer.”

Retired health and safety manager Allan’s cancer was caught early in 2014 and treated, leaving him cancer-free for the last six years.

But he worries about son Adrian, who is in his 40s. Allan, of Hook in Hampshire, added: “I’m always reminding him to talk to his doctor about prostate cancer.

“For me, having the guidelines change so that GPs can start discussing prostate cancer testing with men like me and my son would be a huge step in the right direction. It would mean I wouldn’t worry so much about him having to start those conversations himself.

“I could rest easy knowing that he would be spoken to by a doctor, and that any cancer would more likely be found early and dealt with.”