Weighing up the risks and benefits of prostate cancer screening | Letters

Key Highlights

• I, however, respect the UK National Screening Committee’s recommendation not to screen most men using the prostate specific antigen (PSA) test. The job of the committee was to weigh up the benefits and harms of any available test for routine screening.
• PSA testing, as a first step to diagnose cancer, results in false negatives and a significant number of false positives, meaning it has both low sensitivity and low specificity, making it a poor screening marker.
• PSA screening has been conducted in the US; there are varying estimates that, over three decades, it has resulted in more than 1 million patients receiving treatment (eg surgery or radiotherapy) they did not need. Randomised trials are considered the gold standard in modern medicine.
• Approximations from the European Randomized Study of Screening for Prostate Cancer estimate that PSA-based screening prevents about 1.3 deaths from prostate cancer per 1,000 men screened over 13 years.
• This illustrates the problem of overdiagnosis of low-volume, low-risk cancers that would not cause patients harm.