As much as I admire and respect Sir Chris Hoy for drawing attention to prostate cancer, I fear he is wrong to call for younger men to undergo PSA testing for the disease, as he did yesterday.
I also believe that the health secretary, Wes Streeting, responded in a shamefully opportunistic way to Sir Chris’ call, saying he had asked the NHS to look into the case to lower the screening age “as a result of (Sir Chris’s) intervention.” “. offering false hope.
Currently, men aged 50 and over can ask their GP for a PSA test, but Mr Streeting will know that it is not a reliable test; In fact, the PSA test has previously been rejected as a screening tool in the UK because it leads to many men being misdiagnosed and treated, and studies show mixed results on whether screening tests reduce risk. mortality rate from prostate cancer.
Furthermore, as Mr Streeting should know, a major trial called Transform is already looking at the best way to screen men, using the most promising new tests (such as rapid MRI scans and genetic testing).
As much as I admire and respect Sir Chris Hoy (pictured with his wife Sarra Kemp) for drawing attention to prostate cancer, I fear he is wrong to call for younger men to undergo PSA testing to detect the disease, writes DR MARTIN SCURR.
The problem with a blood test for PSA is that levels can increase for a number of fairly benign reasons, not just prostate cancer.
PSA (or prostate-specific antigen) is a protein produced by the prostate gland and its levels can increase after riding a bicycle, for example.
PSA may also be elevated for a day (or three) after sexual intercourse and in patients with a burdened rectum due to chronic constipation.
And the worry is what can happen all too often in these circumstances, something we in medicine call “false positive” results: high PSA levels that lead to (unnecessary and potentially risky) investigations for prostate cancer and anxiety (unnecessary and large), when there is no cancer.
These investigations include a biopsy, in which a needle is inserted through the perineum, the area between the scrotum and anus, and into the prostate to take tissue samples.
This should be done using an MRI to guide you, but in some places ultrasound is used, which is less accurate in what it shows.
Sir Chris is one of Britain’s most decorated Olympians, winning six gold medals.
Perhaps not surprisingly, given the area where it is taken, the biopsy process carries a low but very real risk of infection (affecting between 2 and 6 percent of men biopsied, depending on the study), and any Infection inevitably carries the risk of sepsis. (For prostate biopsies, this can range from 0.3 to 3 percent.)
And up to 75 percent of men with a high PSA undergo this process and are found to be cancer-free; This high false positive rate is why PSA is considered unreliable.
In addition to subjecting healthy men to tests they don’t need due to false-positive results, the PSA test can also be inaccurate and produce “false-negative” results, when a man is mistakenly told that he does not have prostate cancer. .
The reason we still use this unreliable test is that it was all we had (and even then, it wasn’t actually developed as a diagnostic test, but rather to monitor a prostate cancer patient’s response to treatment and detect recurrence).
The other factor we need to consider is the ability of the NHS at this time to address a screening programme; for example, at Chelsea and Westminster Hospital, as I understand it, the current workload is approximately 20 biopsies each week.
The NHS simply does not have the capacity, in terms of staff and machinery, to cope with the enormous workload that would be caused by the faulty PSA test results of so many men.
The priority should be to screen patients at higher risk of prostate cancer, such as men from certain black and minority ethnic groups, and those with a first-degree relative who had prostate cancer before age 60.
Sir Chris was at high risk as both his father and grandfather had the disease, which would have warranted screening from the age of 40.
But in my opinion, not all men need to be screened at that age unless they have a family history. We must take the time and trouble to discriminate.
So, while Sir Chris has my best wishes and hopes, I must politely disagree with his view that the PSA test should be used to screen younger men: it would be a real mistake.
