“Screening Program Denied—What’s Your Take?”

The PSA test is not accurate enough to be used as a screening tool. It is great for monitoring a known case of prostate cancer, not least of all because it is then a series of tests, and you are looking at trends not specific values.

Screening in a low risk group with an inaccurate test is very wasteful of resources. Screening in a high risk group with the inaccurate test is a lot more productive. Screening either group with an accurate test is very good.

Here is a bit of maths for people interested in why screening can be bad in a low risk group and good in a high risk group.

*The percentage for accuracy and prevalence in the groups are for illustrative purposes, they are not genuine figures*

Assume the PSA test gives 10% false positives, and you screen 100 young (low risk) men with a 1% chance of having PCa you will get 11 positive results, but 10 times as many are being treated (further investigated) for no good reason, compared to the 1 person with cancer.

Now give the same test to a high risk group, say men with BRCA genes. let's say 30% of men in that group have PCa . If you test 100 men you will get 37 positive results (30 genuine and 7 false from the healthy 70 people). In this case you are still over treating 19% (=7/37) of your patients.

In the other group you are over treating 1000% (=10/1) of patients.

To put it another way it costs 50 times more to save one life if you screen the low risk group compared to the high risk group.

We need a more accurate test, and failing that we need to screen only high risk groups.

Hi Darren.

My dad had prostate cancer. So did me and my younger brother. I have two sons, both in their earlier forties. I've warned them they may be at higher risk. 

I'm not sure whether they will get tested or not. Knowing them as I do, I doubt, even if screening had been approved, it would affect their testing decisions.

I doubt that they'll be much of a debate on a prostate cancer forum of which way we should go. Somewhere along the line, we'll probably hear "If it just saves one life, it'll be worth it.", and you cant really argue with that.

You mentioned the more susceptible group including those with a family history of breast cancer and ovarian cancer. Ironically, I think they've just scrapped ovarian screening as it was deemed ineffective and only had a 16% uptake. Breast and bowel cancer screening uptakes are much higher at about 65%. However, research consistently shows that men are not as less likely as women to seek any medical attention including participation in screening programmes. Even if prostate cancer screening was introduced, I suspect the majority of men will not participate. 

Personally, I can see the advantages and disadvantages of screening. Prostate Cancer UK supports screening, Cancer Research UK doesn't. 

https://news.cancerresearchuk.org/2024/04/06/prostate-cancer-screening-save-lives/#:~:text=But%20currently%20the%20UK%20National%20Screening%20Committee,the%20benefits%20do%20not%20outweigh%20the%20harms.

In my opinion, the argument is in the balance. However, I doubt whether Wes Streeting will overule the National Screening Committee's decision. Call me a cynic if you want, but PSA screening isn't a vote winner, and although it could be argued that in the long term it may save NHS costs, it will be very expensive in the short term.

On a personal note, Darren, I admire the hard work and support that you've given to our charity's campaign for screening. I was very moved by your speech to the NSC. You must feel disappointed, that at this stage, your heartfelt plea, appears to have fallen on deaf ears.

Good luck, mate.👍

Edited by member 29 Nov 2025 at 15:29  | Reason: Add link