Prostate Cancer Screening

Question

Asked by

To ask His Majesty’s Government what assessment they have made of the recommendation from the UK’s National Screening Committee that there should only be a targeted screening programme for prostate cancer, as opposed to population screening.

My Lords, the Government have today accepted the UK National Screening Committee’s evidence-based recommendation to offer prostate cancer screening every two years to men between the ages of 45 and 61 with a BRCA2 gene variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population-wide screening was shown to do more harm than good. We will keep this decision under review and work with organisations to fill the evidence gaps for high-risk groups.

I thank my noble friend the Minister for that Answer; I think that I am pleased with it—I will have to think about it more fully. Given the known risk factor of family history when it comes to the likelihood of being diagnosed with prostate cancer, what are the Government doing to create a more specific definition of the term to enable better targeting of those men most at risk? I know it is important for hundreds of thousands of men up and down the country and their loved ones. My husband died of prostate cancer because it was diagnosed too late, and I have two sons.

I thank my noble friend for courageously continuing to pick up this very important issue. The term “family history” is not well defined in current evidence. Work is under way to define what degree of family history of cancer would carry a significantly increased risk of prostate cancer, and the UK National Screening Committee will build this into its modelling. In the meantime, officials are working with Cancer Research UK and the UK Cancer Genetics Group to see if interim guidance can be developed with experts to support GPs in making clinical judgments when asked about PSA testing by men with a family history.

I completely understand Cancer Research UK’s point about overdiagnosis leading to invasive treatment, with devastating effects, along with unnecessary anxiety and stress. There are inequalities in treatment, and more needs to be done to ensure that every man who is diagnosed receives the best treatment options possible. Does the Minister feel it would help to have a public awareness campaign—I know there have been some, but perhaps more—on how to notice the symptoms that people may have, particularly those in the Afro-Caribbean community, who are quite often let down as far as prostate cancer is concerned?

The noble Baroness is absolutely right to bring inequality into this discussion. The statistics are stark. That is why the Government are today announcing an investment of £18 million in TRANSFORM stage 2, which will take a particular interest in Black men. Eligible Black men include those aged 45 to 74 having come through the stage 1 process. There is a list of criteria that I cannot go into in detail on now, but it is worth looking into. There is also money set aside for capital spend to look at strengthening access to focal therapies, which are less invasive. So much research still needs to be done, and the noble Baroness is absolutely right to raise the particular issue of inequality.

My Lords, the proposed limited screening programme is a disappointment to many campaigners. It is clear that the key to screening is accurate ways of testing, so what further investment are the Government planning to help develop more precise prostate cancer screening tests other than PSA?

I can only repeat what I said in my earlier answer: all the research into this that is continuing as part of the ongoing programme will be taken into account; it is critical that that is the case. I have forgotten the first part of the noble Baroness’s question.

It was about testing for PSA.

I do not have the specific answer to that, but we have to make sure that GPs in particular have the best guidance possible on picking up the signs they need to take care of, on the advice they give to people coming in, and on looking at the most appropriate way forward, whether it be testing or making sure that patients get access to the right treatment, should that be deemed essential.

My Lords, I pay tribute to the noble Baroness, Lady Royall, for championing this issue. Today’s announcement that Black men will be offered prostate cancer screening in the TRANSFORM trial is very welcome, given that Black men are around twice as likely to develop prostate cancer and die from it. So I have two quick questions. First, only last week, the Government backed a recommendation that did not include them for targeted screening, so, out of interest, can the Minister share with the House what new evidence came to light since then and led to today’s welcome announcement? It is not a trick question; I am just trying to understand that gap in evidence. Secondly, when will eligible Black men be invited to stage 2 of the trial?

We hope to get the trial up and running within the next year; we really are ready to go. I will have to write to the noble Lord on the specific detail for his first question—I do not have that to hand—but everyone wants to get moving on this. It has been a long time coming, and we are delighted that we have the go-ahead today to move forward.

My Lords, coming back to the Question from the noble Baroness, Lady Royall of Blaisdon, it is disappointing that the screening committee did not approve of screening for people with a strong family history, particularly of breast cancer, which the Minister mentioned, as BRCA genes are also associated with prostate cancer. So the screening committee might be asked to look at the evidence of family linkage to see whether that should not be included in “high risk”. By the way, coming to a better test than PSA, there is the promise of a saliva test with a higher specificity developed by Marsden cancer research institute. That is going to trial, and it may help.

The noble Lord is my go-to person for additional information in this area, and his knowledge is helpful in this debate. My understanding—he will obviously correct me afterwards if I am wrong—is that there is a much more defined relationship, in the research that has been done into breast cancer, in the likelihood of familial pass-on. That is exactly what this research has been set up to do: to look at whether there are the same patterns with prostate cancer, which have not yet been identified.