Dedham professor's NHS prostate screening campaign could save lives

Prostate cancer is, furthermore, the most common male cancer with 50,000 new cases a year. Most men with early prostate cancer don’t have any signs or symptoms.

For Professor Chris Booth, a retired consultant urologist from Dedham, this silent killer is not being taken seriously enough.

Professor Booth and other medical experts and supporters are now tackling what he describes as an “unacceptable position” for UK men with prostate cancer.

Regular NHS screening for prostate cancer is not currently available - yet for years screening has been offered to women to help detect cervical and breast cancer.

However, Professor Booth’s men’s health charity CHAPS has for some time played a huge part in allowing men the opportunity to be screened for prostate cancer.

And it is the impact of this, advances in medical technology and research, and the alarming UK mortality rates that have led him to call for the NHS to change current policy. 

The voluntary National Demonstration Project for England and Wales he has worked on has published its case which sets out how an “innovative” NHS screening programme could work and halve deaths while reducing costs using methods that were successful in previous NHS cancer programmes.

Professor Booth said: “We are trying to get to the point where we want to get this to the Health Select Committee under Jeremy Hunt.

“The current position for UK men and prostate cancer is unacceptable and currently nothing effective is being done about this at a national level.”

The case for screening is being supported by Lord Bernard Ribeiro, a surgeon who served as president of the Royal College of Surgeons of England.

Checks - Paul Tarrant, Provincial Grand Master for Essex, and Gary Hostler, Provincial Almoner at this year's Men's Health Day at Essex County Cricket Ground

Organisations including the Metropolitan Grand Lodge of London and Tackle Prostate Cancer have been compiling evidence to build the case.

In his position paper, Professor Booth argues: “Long term screening programmes in Europe and North America have halved the prostate cancer death rate yet the UK National Screening Committee still opposes a national screening programme for reasons that are outdated and out of touch with current UK clinical practice.”

Presently in the UK it is up to men to proactively seek a PSA test (prostate specific antigen) - a blood test - by attending a screening event such as those hosted by CHAPs, or other organisation, or via the NHS’s “informed choice” called Prostate Cancer Risk Management Programme, for men aged 50 or over who proactively need to ask their GP about screening.

If abnormalities are detected, the man will go for an MRI scan.

The scan was introduced over the last five years and is a much more reliable way to detect cancer than previously - but Prof Booth says there are worrying barriers for men requesting a PSA test.

He said: “There is a traditional reluctance by men to get checked anyway but there is often reluctance of GPs to do the PSA test. It is not inaccurate, and will detect any prostatic abnormality but is not specific to cancer, so men then have to have an MRI.

“In the last five years the MRI was introduced and is a highly accurate determiner between aggressive cancer, non-aggressive cancer, and benign disease [non-cancerous benign prostate enlargement caused by many men’s prostate glands getting larger as they get older].

“Because we can differentiate between these two, we can say to the chaps with non-aggressive cancer, we just need to keep an eye on you.”

About three in four men with a raised PSA level will not have cancer and the test can also initially miss about 15 per cent of cancers and therefore provide “false reassurance” but programmed regular testing overcomes this.

Previously, the process to check for prostate abnormalities was an invasive and uncomfortable biopsy using ultrasound to guide results and which Professor Booth said was less reliable.

The procedure also carried a risk of infection and in rare cases, sepsis, which can be fatal.

However, the PSA screening programme devised largely by Professor Booth addresses this, with back-up by MRI scanning

It argues the PSA blood test, backed up by MRI scanning, is the best option for men aged 40 to 80.

Screening frequency is determined by an individual’s risk, determined by his initial PSA, family history and ethnicity.

Those deemed to be at high risk need PSA screening once a year, medium risk every two years and low risk men every three years.

An abnormal detection of PSA would lead to a fast-track NHS assessment and MRI scan of the prostate gland, either locally or at Imperial College, London.

Organisations helping to build upon the evidence base for this screening programme include other charities and Provincial Masonic Lodges in England and Wales.

The Masonic database shows they have so far screened 17,989 men, finding 229 cancers, as at November 2020.

Using results from other screening charities, the combined database shows 166,000 PSAs tests have been performed, detecting 2,276 cancers, as at October this year.

CHAPs has been hosting regular community-based screening events for some years, including at Colchester United’s home stadium.

It has screened nearly 1,000 men in Essex and Suffolk this year, despite the restrictions of Covid earlier on.

Professor Booth added: “So far we have detected 78 abnormal results and based on an estimate of one in four of these being due to a prostate cancer, we can reckon on having detected about 20 cancers of which at least half will be dangerous and require treatment.”

Other charities, prostate cancer support groups and corporate firms are building on this screening evidence base to present to the Government and National Screening Committee.

Essex MPs including Will Quince, James Cleverley, Giles Watling and Sir Bernard Jenkin have also supported the campaign.

However, calls for a regular NHS screening programme for men have been opposed by the UK National Screening Committee, which after a review of evidence, concluded last October that whole population screening for prostate cancer should not be introduced in the UK.

Its reasons included the effect of PSA screening on cancer specific mortality, compared to no screening, remains “unclear”, and it is not clear whether the benefits of screening programmes “outweigh harms”.

Professor Booth said: “Our national screening committee has placed too much emphasis on outdated evidence, paid insignificant attention to new trial work and seems completely disconnected with current UK practice. Consequently, GPs have not been educated to the fact that the benefits of regular, risk-based screening now far exceed any harms.”

More information about CHAPs and prostate screening can be found at chaps.uk.com.