A straightforward blood test every five years is sufficient to screen low risk men for prostate cancer, recent research has shown.

The PSA blood test checks the extent of prostate-specific antigen, a marker for prostate cancer. In Europe, only Lithuania routinely screens men for prostate cancer based on their PSA levels, because the test has historically been seen as insufficiently reliable.

The German study, presented on the European Association of Urology (EAU) Congress in Paris today [April 6, 2024], involved over 12,500 men aged between 45-50 collaborating in the continuing PROBASE trial, which is testing different prostate cancer screening protocols.

The research has also been accepted for publication in European Urology.

PROBASE is recruiting men aged 45 and splitting them into three groups based on their initial PSA test. Men with a PSA level of under 1.5 nanograms per millilitre (ng/ml) are deemed low risk and followed up with a second test after five years. Men with a PSA level between 1.5-3 ng/ml are deemed intermediate risk and followed up in two years. Those with a PSA level over 3 ng/ml are seen as high risk and given an MRI scan and biopsy.

Of over 20,000 men recruited to the trial and deemed low risk, 12,517 have now had their second PSA test at age 50. The researchers found that only one.2% of those (146 in total) had high levels of PSA (over 3 ng/ml) and were referred for an MRI and biopsy. Only 16 of those men were subsequently found to have cancer – just 0.13% of the overall cohort.

The EAU recommends that men must be offered a risk-adapted strategy (based on initial PSA level), with follow-up intervals of two years for those initially in danger, by which they include men with PSA over 1 ng/ml. The brand new findings suggest that the screening interval for those at low risk may very well be for much longer with minimal additional risk.

By raising the bar for low risk from 1 ng/ml to 1.5, we enabled 20% more men inside our cohort to have an extended gap between tests and only a few contracted cancer in that point. With nearly 14 million men aged between 45-50 in Europe, the numbers affected by such a change can be significant. Our study continues to be underway, and we may find that a fair longer screening interval, of seven, eight and even ten years, is feasible without additional risk.”

Peter Albers, Lead Researcher, Professor from the Department of Urology at Heinrich-Heine University Düsseldorf

Prostate cancer screening has historically been a controversial subject, with concerns raised each around false positives resulting in unnecessary invasive treatments and false negatives resulting in cancers being missed. That is regularly changing as a result of MRI scans which might avoid unnecessary biopsies and using ‘energetic surveillance’, where men with early-stage cancer are monitored and only undergo treatment if their disease progresses.

Prostate cancer screening guidelines contradictory and unclear

Current guidelines and policies from European governments and health bodies remain contradictory and unclear, resulting in high levels of opportunistic testing and inequality of access to early diagnosis, in line with further research presented on the EAU Congress. The study reviewed early detection policies across the European Union and carried out focus groups with urologists to discover how guidelines were interpreted in clinical practice.

Dr Katharina Beyer, from the Department of Urology on the Erasmus MC Cancer Institute in Rotterdam, Netherlands carried out the research. She said: “Some country’s guidelines are actively against screening, others are non-committal and just a few, reminiscent of Lithuania, have some type of screening. But in lots of countries, in case you ask for a test, you possibly can get one, sometimes free and sometimes not. Which means that well-educated men, who learn about PSA tests usually tend to be screened and get an early diagnosis, while others with less knowledge are at a drawback.”

This can also be the situation within the UK, in line with Professor Phillip Cornford, from Liverpool University Hospitals NHS Trust, who chairs the EAU Prostate Cancer Guidelines Committee.

Professor Cornford said: “The NICE guidelines here within the UK are incongruous. They are saying there isn’t any evidence that PSA screening is worth it, but at the identical time say any man can ask for a PSA test in the event that they want it. The result’s that well-educated, driven men ask and others, including many Afro-Caribbean men who are literally at higher risk, don’t ask and so prostate cancers get missed.

“There may be clearly a necessity for more organised prostate cancer screening and last November, the UK government and the charity, Prostate UK, announced a £42m research programme to have a look at this. The small print of that ought to soon be made public. Each country might want to design a screening programme that matches their health system and the resources they’ve available. But there continues to be plenty we will learn from other countries and the work underway within the EU. Recent findings, reminiscent of those from the PROBASE trial, can assist us design an appropriate screening programme each within the UK and elsewhere.”