Prostate screening backed for high-risk men

Screening Study shows PSA tests work better on patients with genetic mutation linked to higher prostate risk.

Regular PSA screening in men whose genes put them at a higher risk of prostate cancer may lead to earlier diagnosis, research suggests.

A UK study showed PSA tests predicted prostate cancer more effectively in men with high-risk BRCA mutations than in the general population.

There is currently no national prostate cancer screening programme because evidence of the benefit of PSA tests is limited.

Cancer genetics expert and former GP Dr Andrea Pithers backed PSA tests for men with BRCA mutations. But screening older men for the mutations and following up with PSA tests would be tough, she added.

'BRCA testing is a lengthy process itself, involving counselling and with huge implications for the family,' she said. 'It's a lot of work for a GP to take on.'

However, Dr Pithers said it made good sense to offer PSA testing to men with a family history of breast, ovarian or prostate cancer.

Mutations in the BRCA1 gene increase men's prostate cancer risk seven-fold, while changes to BRCA2 double it.

In the study, researchers analysed data from 300 men aged 40-69. A total of 205 men with BRCA1 or BRCA2 mutations and 95 non-carriers were offered annual PSA testing. Of these, 24 who had elevated PSA levels were given a follow-up biopsy.

Tests revealed that a higher proportion of mutation carriers had prostate cancer than non-carriers, with diagnosis rates of 3.9 per cent and 2.1 per cent respectively. This translates to a predictive value of 48 per cent for those with the mutations, compared with 24 per cent among non-carriers.

Ed Yong, Cancer Research UK's head of health evidence and information, said: 'This study suggests we could limit the number of men who under-go unnecessary treatment by targeting PSA testing at very specific groups.'

The UK National Screening Committee will issue its next review of the evidence for PSA screening in March 2011.

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