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Concerns grow over prostate cancer screening

28 September 2009

Until we can be certain that we have a prostate cancer test that has a good level of accuracy for everyone, we should remain apprehensive about rolling out population-wide screening.

Dr Karen Woo, associate medical director for Bupa

The long-standing debate over whether or not the prostate specific antigen (PSA) test should be used to screen for prostate cancer continues on after a new study questioning its sensitivity is published.

The study, published in the BMJ, examined the sensitivity of the PSA test as a screening tool for prostate cancer in over 1,500 Swedish men. Although the test could indicate prostate cancer, the researchers concluded that it was not sensitive enough to be used as a screening test.

For a test to be used to screen for a disease, it must be able to give specific values that can accurately say if a disease is present or not. The researchers found that the PSA test was unable to give precise enough cut-off values needed before a screening test can be introduced in a given population.

Screening tests that aren't sensitive enough can result in people being mistakenly diagnosed and treated for a condition they do not have, or their condition may go undiagnosed. This can cause serious physical and emotional distress.

Bupa's associate medical director, Dr Karen Woo, said: "Until we can be certain that we have a prostate cancer test that has a good level of accuracy for everyone, we should remain apprehensive about rolling out population-wide screening.

"This research has identified potential flaws in the PSA test. This questions its accuracy as a screening tool, but not as a diagnostic tool. The PSA test remains instrumental in helping doctors diagnose, monitor and decide on treatments for men with prostate cancer."

Key facts
  • The prostate gland is located just below the bladder and surrounds the urethra (the tube for passing urine). It produces a fluid that mixes with sperm during ejaculation.
  • Prostate-specific antigen (PSA) is a protein found in fluid in the prostate. A low level of PSA is usually found in blood, however, higher levels in the blood can indicate prostate cancer.
  • Worldwide, more than 670,000 men are diagnosed with prostate cancer each year. The highest rates are in the USA, Australia, New Zealand, Western and Northern Europe. The lowest rates are in East and South Central Asia.
  • The cause of prostate cancer isn't fully understood at present, but you are more likely to develop it if:
    - you are over 50
    - you have close relatives who have had prostate cancer
    - you are African-Caribbean or African-American
    - you are overweight
    - you eat a diet high in fat
    - several women in your family have had breast cancer - an inherited faulty gene can increase your risk of prostate cancer

Related information

Read the study

Holmstrom, B. et al. (2009), "Prostate specific antigen for early detection of prostate cancer: longitudinal study", BMJ 2009;339:b3537 doi: 10.1136/bmj.b3537

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