In the UK it is estimated there are 52 300 new prostate cancer cases annually. It is the most common cancer among males, with the highest incidence in men aged 75–79 years. Between 2014 and 2035, UK rates are projected to rise by 12%, to 233 cases per 100 000. Prostate cancer is more common in black males than white males, and is least common in Asian males (Cancer Research UK, 2021).
Population screening is the process of identifying apparently healthy people who might have an increased chance of a disease or condition. The screening provider then offers further tests and/or treatment. The aim is to enable choices and reduce associated problems or complications.
Currently, the UK has no screening programme for prostate cancer. The debate on screening is long-standing, as it has not been proven that benefits would outweigh risks. To be effective screening programmes need to use tests that are reliable and able to detect cancers or abnormal changes that could lead to cancer. They need to be valid (to detect all those with disease and identify correctly those free of it) and be acceptable, so people will take them. They must not be dangerous to health and must be cost-effective. Not all screening tests are perfect and some carry risks.
All four UK countries set their own screening policy based on the recommendations of the UK National Screening Committee (UK NSC). Scotland and Northern Ireland each have seven screening programmes (Scottish Government, 2021; Public Health Agency, 2021), Wales eight (Public Health Wales, 2021) and England 11 (Gov.uk, 2022).
Based on its last review of prostate cancer, the UK NSC (2021) decided not to recommend a screening programme for the disease. Currently, no single treatment is definitively better for men with early-stage prostate cancer—the effectiveness of treatments has to be weighed up against side-effects.
The prostate-specific antigen (PSA) test is not a universally successful tool for detecting prostate cancer that needs treatment. PSA can falsely identify men who do not have prostate cancer and miss some cancers, so many men may have to undergo unnecessary and often unpleasant tests and/or unnecessary treatment. It remains unclear if other tests such as an MRI scan, with or without PSA, are sufficiently accurate.
Researchers tested different methods to see if targeted screening of men with family histories of prostate cancer might have a greater impact (Castro et al, 2016). Their results found that prostate biopsy is a feasible, safe approach to screening in this group of men and identifies a high proportion of prostate cancer that requires radical treatment. No major side-effects or complications associated with biopsy were reported, but more studies are necessary to confirm early results. It has been suggested that a national prostate cancer screening programme will be available in 3–5 years.
Nurses have a role to play in current practice regarding public health promotion and prostate cancer, encouraging men to seek help and advice when experiencing symptoms. Specialist nurses possess knowledge of, and take part in, activities contributing to reducing the risk of developing cancer, thus promoting early detection. Specialist nurses are well placed to take an active role in raising the awareness of prostate cancer in the community and on the importance of early detection.
Research is ongoing to find new screening tests and new ways to detect cancers early. This includes prostate cancer screening, lung cancer screening and ovarian cancer screening. These cancer types do not, at present, have national screening programmes.