DR SCURR: Despite Sir Chris Hoy’s campaign we should NOT screen younger men for prostate cancer – the tests are too unreliable

As much as I admire and respect Sir Chris Hoy for drawing attention to prostate cancer, I fear he is completely wrong to call on younger men to undergo PSA tests to screen them for the disease, as he did yesterday.

I also think that the Health Secretary, Wes Streeting, responded in an embarrassingly opportunistic way to Sir Chris’s call, saying that he has asked the NHS to look into the matter of lowering the screening age ‘as a result of ( Sir Chris’) intervention’. offer false hope.

Currently, men aged 50 or over can ask their GP for a PSA test, but Mr Streeting will know this is not a reliable test. In fact, PSA testing has previously been rejected as a screening tool in Britain because it leads to many men being wrongly diagnosed and treated for the disease – and studies show mixed results on whether screening reduces the death rate from prostate cancer.

Moreover, as Mr Streeting should know, the best way to screen men is already being sought in a major study called Transform, using the most promising new tests (such as rapid MRI scans and genetic tests).

The problem with a blood test for PSA is that the levels can rise for a number of quite benign reasons, not just prostate cancer.

PSA – or prostate-specific antigen – is a protein produced by the prostate gland and which can rise after cycling, for example.

PSA can also be elevated for a day – or three – after sex, and in patients with a strained rectum caused by chronic constipation.

And the concern is what can all too often happen under these circumstances, something we in medicine call “false positive” results: high levels of PSA that lead to (unnecessary and potentially risky) tests for prostate cancer and (unnecessary and major) feelings of anxiety, when there is no cancer.

These tests include a biopsy – where a needle is inserted through the perineum, the area between the scrotum and the anus, and into the prostate to take tissue samples.

This should be done using an MRI scan as a guide, 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, having won six gold medals

It is perhaps not surprising that, given the area where the biopsy is performed, the biopsy process carries a low but very real risk of infection (affecting between 2 and 6 percent of men who have a biopsy, depending on the study) – and any infection inevitably carries the risk of sepsis. (for prostate biopsies this can vary from 0.3 percent to 3 percent).

And as many as 75 percent of men with a high PSA undergo this process and are found not to have cancer – this high rate of false-positive results is why PSA is considered unreliable.

In addition to subjecting healthy men to tests who don’t need them due to false-positive results, the PSA test can also be inaccurate and produce ‘false-negative’ results – where a man is incorrectly told 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 really developed as a diagnostic test, but to monitor a prostate cancer patient’s response to treatment and check for recurrence ).

The other factor to consider is the ability of the NHS to cope with a screening program at the moment. For example, I understand that at Chelsea and Westminster Hospital the current workload is approximately twenty biopsies per week.

There is simply not enough capacity within the NHS, in terms of staff and machines, to cope with the enormous workload that erroneous PSA test results from so many men would lead to.

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 under the age of 60.

Sir Chris was at high risk because both his father and grandfather had the disease, which would have justified monitoring him from the age of 40.

But in my opinion, not every man needs to be screened at that age unless he has such a family history. We must take the time and effort to distinguish.

So while Sir Chris has my very best wishes and hopes, I must politely dissent from his view that the PSA test should be used to screen younger men: that would be a real mistake.