Debate Surrounds Proposed Targeted Prostate Cancer Screening for High-Risk Groups
A new study is bolstering the argument for a targeted prostate cancer screening program, particularly focusing on men at higher risk, but the proposal isn’t without its critics. researchers believe a program could be both cost-effective and beneficial to the UK as a whole, without overburdening the National Health Service (NHS).
Dr. James, a lead researcher on the study, identified key high-risk groups as “black men aged 45 to 69, men with relevant family history of prostate, breast or ovarian cancer of the same age group and people with certain genetic mutations.” He expressed optimism that the National Screening Committee (NSC) and the government will approve a screening program, citing the demonstrated positive socioeconomic impact.
However, consensus within the prostate cancer research community remains elusive. Naser Turabi, Director of Evidence and Implementation at Cancer Research UK, described the evidence supporting targeted screening as “very unclear,” noting ”a lot of conflicting evidence.” He highlighted the complexities surrounding risk factors for black men, stating the increased incidence is “probably a mixture of environmental and genetic factors.” A key concern is the potential for over-diagnosis, as black men naturally exhibit higher levels of prostate-specific antigen (PSA), the marker used in the PSA test.
Turabi cautioned against broadly categorizing all black men, emphasizing the diversity within the group. “Black itself is a social category, which is different from thinking about ancestry,” he explained.”It’s possible…that some of the genetic risks for people of African ancestry are applied to a subset of what we would describe as black men.” He also pointed to a lack of sufficient genomic data regarding men of African ancestry.
Rhian Gabe, a professor of biostatistics and clinical trials at Queen mary University of london, echoed this sentiment, stating, “I don’t think there’s a huge amount of evidence for black men because, regrettably, I don’t think we’ve got enough research that includes black men in it. And that’s something we’re trying to address.”
Professor Gabe is co-leading the Transform trial, a £42m screening trial funded by Prostate Cancer UK, designed to identify optimal screening methods. This 20-year trial aims to include a substantially higher proportion of black men – one in ten participants – than previous studies, to address the current evidence gap. “that’s why we’re aiming to get a high number of black men in our study, as we really need that evidence and we really want to give them the prospect to participate in our research,” she added.
Harveer Dev, an academic urologist at the Early Cancer Institute, University of Cambridge, believes the conversation surrounding prostate cancer screening has already shifted, nonetheless of the NSC’s eventual advice.”I think, societal feeling towards this subject needs to be taken into account, if not entirely dictating the decision, at least in part,” he stated.
