Prostate Cancer Screening

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Prostate Cancer Screening

Prostate cancer is the most frequently diagnosed cancer in men (after non-melanoma skin cancer). About a third of the cancers are diagnosed at an advanced stage when they cannot be cured, and strategies to diagnose the disease at an early stage by screening and early detection may be important to prevent death from the disease. Testing for prostate specific antigen is a potential screening test but its effectiveness in reducing mortality has not yet been demonstrated.

Our work on prostate cancer includes:

Studying rates of PSA testing and of referral in men with raised PSA levels
A study of the feasibility of screening in men at high risk
Management and analysis of the central database for the European Randomised Trial of Screening for Prostate Cancer (ERSPC)
Observer variation on Gleason grading of prostate cancer
Development of a national EQA scheme for prostatic pathology

Referral rates in men with raised PSA levels

J Melia, S M Moss, P Coulson, D Coleman

Information packs about the Prostate Cancer Risk Management Programme were distributed by the NHS Cancer Screening Programmes to GPs in September 2002. The Programme aims to inform men about the limitations of prostate cancer screening using the PSA test, and to advise on the age related PSA cut off levels for referral to urology. The aim of our study is to investigate whether there have been changes in the referral rates by GPs following the introduction of the Programme.

External Funding: Department of Health

Targeted PSA Screening (TAPS) Study of Familial Prostate Cancer

J Melia, SM Moss, L Johns, A Williams, P Coulson; in collaboration with DP Dearnaley, Urology and Testicular Cancer Unit

The aims of this study were to investigate the uptake rate of screening by the prostate specific antigen (PSA) testing, and the referral rate in male relatives of men already diagnosed with prostate cancer below the age of 65 years. This was a feasibility study which recruited just over 170 relatives, aged 45-69 years. The men were also invited to take part in a psychological study led by Clare Moynihan (Psychological Research Group).

External Funding: Cancer Research UK

Management and Analysis of the ERSPC database

SM Moss, D Coleman, J Hemming, D Muston

In 2003 the CSEU took over the role of management and analysis of the central database of a multicentre European randomised trial of screening for prostate cancer by PSA testing. The trial involves eight countries, and has recruited over 160,000 men in the core age group of 55-59 at entry.

External Funding: EU

Observer Variation in Gleason Grading of Prostate Cancer

J Melia, SM Moss, A Williams, M Waller

Following the detection of prostate cancer, in asymptomatic and symptomatic men, accurate grading of the cancer is essential to decide on patient management, in particular the choice between radical treatments and active management of early stage disease. A prostate cancer pathology panel lead by Dr Connie Parkinson investigated, over a three-year period, methods to reduce observer variation in the grading of biopsy specimens by the Gleason score.

External Funding: Prostate Research UK

Development of a National EQA Scheme for Prostatic Pathology

J Melia, SM Moss, D Coleman, S Kodikara

Increased diagnosis of early stage prostate cancer presents a challenge to pathologists. The CSEU is collaborating with Dr Pat Harnden to develop an External Quality Assurance (EQA) Scheme. The aim is educational, and to examine concordance of pathological diagnosis in England. A pilot scheme with four circulations of slides from prostatic biopsies has been carried out among 40 pathologists, stratified by region.

External Funding: NHS Cancer Screening Programmes