by The global statistics are scary. Prostate cancer is the fourth most common cancer in all population groups, the second most common cancer in men worldwide, and is the top priority in Europe, where a third of the men dying from cancer will die due to prostate cancer.
It is the most frequently diagnosed cancer in men in 112 countries and the most common cause of cancer in men in 48 countries. By 2040, almost three million new cases of prostate cancer per year, more than double 2022 and the mortality rate will increase by 85 percent.
In view of the numbers, it is no surprise that global measures for men’s health (GAMH) require a worldwide initiative to combat the threat and use the World Health Organization (WHO) to introduce measures that cover all phases of prostate cancer, “from prevention to palliative care”.
Director Peter Baker warns of a “tsunami of cases”.
“The health system will overwhelm. The financial and human costs will be massive. We now have to act to do what we can do to prevent this,” he says.
The problem with the current tests in Great Britain
Nevertheless, international actions have been uncoordinated and piece by piece.
Part of the problem lies in historical test protocols based on PSA blood tests (prostate-specific antigen). Studies have shown that studies can reduce the mortality rates through early detection, but are also vulnerable to false results, which leads to unnecessary biopsies, overdiagnosis and subsequent over -treatment. For this reason, many health authorities in the industrialized nations are currently following the way “informed choice” in which men can request tests, but they are not proactively offered as part of a national strategy.
In Great Britain, each man can ask for a PSA blood test, but these are not actively encouraged because the NHS agree that “results can be unreliable”.
And even if tests are available, not everyone is aware of what leads to inconsistencies in the recording. According to prostate cancer research, tests are usually mainly absorbed in Great Britain by trained, wealthy and healthy people. The charity organization also refers to inconsistent care and advice offered by GPS.
In Great Britain, prostate cancer tests are not systematic, there is no process, “says David James of prostate cancer research – David Rose
“Tests are not systematic,” says David James, director of patient projects and influence on prostate cancer research. “There is no process.”
Like with The Telegraph Campaign, the charity organization demands the introduction of a system that actively informs men and recommends that they are tested at a certain age.
Studies in other nations are currently investigating how such a system would work.
And the good news is that the screening protocols have changed significantly in the past five years and relieves some of the fear and inaccuracy associated with previous models.
James explains: “An increased PSA score would lead to a trans-rectal biopsy, but since PSA can be increased as prostate cancer for other reasons, many men have biopsies that they do not need, and biopsy is not a particularly beautiful process, and there is a risk of complications such as sepsis.”
The introduction of MRI scans was a game channel.
“An MRI is now between a PSA test and a biopsy and filters many men who would otherwise have had a biopsy,” continues James.
In fact, MRI scans can even determine the clinical importance of a tumor, which means that some men may only have to be monitored on an “active surveillance protocol” instead of subjecting more radical interventions.
Biopsy protocols have also changed and are now carried out via the perineum (the skin area between the anus and the scrotum), which significantly reduces the risk of infection. Lifestyle and family medical history are also used to inform the risk.
This progress is now being used to inform a best practice model for tests and screening, which will be taken over internationally in the coming years.
What other countries do
Europe: Experimental screenings
The EU is a leader in the development of screening programs by financing a project by the European Association of Urologists named Lob-Uuu project. The aim is to improve the early detection of prostate cancer in various Member States.
The project operates pilot programs in Ireland, Lithuania, Poland and two areas in Spain (Galicia and Manresa). These should test different screening strategies and see what works best.
Lithuania: Invitations to PSA tests between 50-69
Lithuania had a history of systemized prostate tests before the Lob-U project. Active screening has been carried out since 2006. As part of his program, men receive 50 to 69 years and people with a family history of certain cancer invitations from the health system to carry out a prostate check. It is free and is offered every two years. The system has been refined over time. PSA threshold values and biopsy rates have dropped, which reduces the overdiagnosis.
“The program recognizes around 2,800 new cases of prostate cancer every year and is therefore important,” explains James. “It is the best example that I know.”
70 percent of men between the ages of 50 and 74 took part in the prostate cancer program at least once in the first 10 years of screening. This is impressive when you look at yourself in Great Britain: In particular, a study with 212,039 men between the ages of 40 and 69 in Great Britain showed that 62,022 (29 percent) explained that they have ever carried out a PSA test.
Czech Republic: PSA offered between 50 and 59
Last year, the Czech Republic started a nationwide five-year PSA-based screening program, in which men between the ages of 50 and 59 are offered a PSA blood examination by their GPS. Based on the results of this test, the GP will be pursued in four years in four years, in two years, in two or if necessary, an MRI scan and a transfer to a urologist.
Sweden: Advanced blood tests
The screening on prostate cancer in Sweden is through informed election, but the government supports several organized prostate cancer test studies (OPT), in which all men aged 50 years have been invited to a letter to tests. These programs use PSA blood tests, followed by an MRI that is necessary. If an MRI shows suspicious areas, a prostate biopsy is carried out to check cancer. By the end of 2024, 16 of the 21 regions of Sweden had started the option and, together, invited around 256,000 men, with an average admission of around 43 percent.
Since 2022, the Stockholm3 blood test has also been included in the national guidelines. It combines PSA, additional protein biomarkers and genetic markers to better predict the risk of aggressive prostate cancer, improve accuracy and reduce unnecessary MRI examinations compared to PSA alone.
In the 1990s, Sweden also carried out the Gothenburg study, in which it was found whether the screening of men on prostate cancer using the PSA blood test could reduce the number of deaths from the disease. 20,000 men aged 50 to 64 took part. Half was invited to PSA tests every two years, and half was not examined, but could ask for tests if they wanted. The attempt showed that men who were regularly checked were around 40 percent lower to die from the disease than men who were not.
USA: Discussions with the health service provider
As in Great Britain, the United States operates an elective prostate cancer screening system. In 2018, the US Task Force (USPSTF), a Federal Expert Panel, decided that National Screening guidelines issue that prostate tests should be an individual decision that was made after a joint discussion with a health service provider.
The American Urological Association (AUA) and the American Cancer Society (ACS) recommends to start discussions with 50, with previous screening (45 or 40) for people with higher risk such as black men, people with family history or genetic mutations such as BRCA2.
James explains that some health insurers in the United States will finance and promote the examination to reduce future costs.
“You can be more proactive in offering PSA tests and offering newer” reflex “tests in which additional tests are carried out to further examine a slightly increased PSA mirror to determine whether a biopsy or MRI is required,” he says.
Australia: PSA installed in studies
In Australia there is no organized prostate cancer screening program prescribed by the government. However, PSA tests are often integrated into health examinations, especially in men over 50 or people with a family history of prostate cancer.
The latest proposals from the prostate cancer foundation of Australia include a “strong recommendation” for GPS to initiate talks about PSA tests and to test tests for all men between the ages of 50 and 69 every two years. The charity also recommends a national campaign on public education, which focuses on understanding risk factors and early detection.
