PSA Screening: Our Position

The Prostate Cancer Charity recognises that there are many people who strongly support the introduction of a national screening programme based on the PSA test. The Charity, whilst respecting these views, does not itself support the introduction of a Screening Programme with the PSA test at the present time, due to the lack of robust evidence that doing so will save men's lives. However, we understand that there is a difference between what is ‘appropriate’ to offer to a population and the choices an individual may wish to exercise for himself.
We strongly believe that men should have the chance to weigh up the decision to pursue a PSA test for themselves. To do this they need to know that the PSA test exists, that they have a right to ask for it and that they have a right to receive balanced advice on its advantages and limitations. All men are individuals with different priorities, responsibilities, family background, medical histories, ages, and attitudes to risk. No ‘one size’ decision will fit all. We are absolutely clear that men should be put in the ‘driving seat’ and equipped to make their own decisions on these important issues.
We will press Government and research institutions to increase funding and to accelerate research designed to find a more precise test able to distinguish between aggressive and slow growing prostate cancer - to be used as the basis for an effective national screening programme.

The key to our position is ‘information’.

We believe that making the PSA test available to men within a routine Screening Programme implies strongly that it is effective in saving lives. It also implies that taking part in a Screening Programme would definitely benefit the vast majority of men. Using the PSA test in the same way as, for example, cervical smears, implies that the PSA test is similarly effective. We all wish this were true, but the evidence for this level of certainty does not yet exist.
The Prostate Cancer Charity believes that using the PSA test in a Screening Programme could act as a disservice to men. It would obscure disclosure of the uncertainties about the test, and the variable nature of prostate cancer. Being offered a PSA test through a Screening Programme would distract most men from asking appropriate questions about the test, and the cancer, and encourage them to assume that only benefits can arise from taking part, and that the risks are minor.
There are risks associated with being screened for prostate cancer. Many men would undergo treatment for prostate cancers detected through a screening programme. Had they never been screened, the cancer itself may never have caused significant pain, discomfort or symptoms in their lifetime. The treatments for the condition are not without side effects. The ones which cause most concern are urinary incontinence and impotence. Thus the side effects of treatment could be worse than the potential impact of the cancer itself.
The Prostate Cancer Charity believes that the PSA test does have merit. Some men may be alerted to a potentially life threatening condition and we do not want to exert influence to prevent them from having the opportunity of a PSA test.

However, we also recognise the contradiction within these statements. Some men may be alerted to a life threatening condition but others will experience the side effects of treatment for a condition which, had they remained unaware of it, would never have caused them any major problems. It is impossible, at present for medical science to tell an individual man with confidence which category he will fall into.
The Prostate Cancer Charity acknowledges that many men will find it difficult to reconcile the uncertainty about the PSA test with decisions ‘for’ or ‘against’ having one.

However, we also firmly believe that men are not helped to make an informed choice if we minimise the level of uncertainly and lack of clarity because it would be more 'comfortable'. Men cannot make an informed choice if they believe that issues are straightforward and uncomplicated and their attention is not drawn to the uncertainties of the PSA test when used as a screening test.

The active engagement of men with their own health needs is not encouraged by suppressing information about the PSA test. This is why we believe men need to know about the PSA test and what it could mean for them.
We do not actively campaign against population screening with the PSA test.
We will support screening men for prostate cancer when an effective screening technology is developed, or robust research evidence shows that men’s lives are saved by the current test. We believe that the evidence should continue to be reviewed and the case for screening constantly re-evaluated.
Scientists, doctors, policy makers and some patient groups continue to argue about the benefits of prostate cancer screening using the PSA test. Even if a Screening Programme is introduced - based on the PSA test or any other more effective test - decisions about screening should be made by each man himself. To do that they need information.
We will monitor uptake amongst men for the new national screening programme for bowel cancer, when it is introduced. It will contain useful lessons for us in how men respond to the opportunity for cancer screening.

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