CHAPS

We are delighted to have provided Prostate Cancer (PCa) Screening for the Province and to include the results within the CHAPS/TACKLE/MASONIC Prostate Cancer Screening Project. At the events in Twickenham and Harrow we screened a combined total of 474 men and present the statistics below.

With 50,000 new cases every year, PCa is now the commonest cancer in the UK. We have no national NHS screening programme despite clear evidence that screening over 20 years with regular PSA tests can halve the PCa death rate. That would reduce our death rate from 12,000 to 6,000 a year! Although the NHS Prostate Cancer Risk Management Programme entitles men over 50 to have a PSA test, many requests are refused and GPs are advised not to test “till symptoms arise” – too late for screening!

This Project is backed by the European Association of Urology, Manchester University for genetics and health economics and access to Imperial College Healthcare NHS Trust for the most advanced prostate MRI and biopsy facilities available.

This Project’s aim is to prove that a UK, risk-based, PSA screening programme can be run at scale, with substantial benefit and statistical validity. Recruitment has been rapid and alternative access to PSA tests never more timely. Covid caused a 54% fall in new cases and PCa diagnoses are still not up to pre-pandemic levels! The importance of this initiative therefore needs no further emphasis.

Event Statistics –

Discussion –

These results are broadly in line with current statistics from around the country.

Of the 39 (8.3%) abnormal Amber (14) and Red (25) results, it can be estimated that approximately 10 will have an underlying cancer and of these, half will be aggressive. In simple terms, these two testing sessions will save about 5 lives. However, this is only part of the story.

One in eight UK men will develop PCa in their lifetime. Most of these will develop in the 89 ( 18.8%) men with normal “Green” results but identified as High Risk. If these men continue regular screening into their 70s, initially annually for 3 years, we can expect to identify many more cancers at a curable stage.

249 (52.5%%) men were identified as at Low Risk and only need a PSA test at 3 yearly intervals unless urinary symptoms arise.

A small number of elderly men with low PSAs, in this case 19 (4.0% ), can be reassured that they will never develop a life-shortening PCa and need no further PSA tests.

It was hoped to do a detailed comparison of this year’s results with those obtained at the 2 centres in 2017 but the GFCT database only holds the crude statistics as follows: Normal Green: 470 (87.7%); Abnormal 66 (12.3%): Amber 27 (5.0%); Red 39 (7.3 %).

It is not possible to draw firm conclusions from this but the proportion of abnormal results this year at 8.3% exactly matches overall findings in 2021/22.

This breakdown and risk assessment represents how organised, scheduled programmes can reduce the death rate from PCa by up to 50%, not merely by a few percentage points as achieved by one-off and random PSA tests.

Conclusion –

Although the NHS has excellent diagnostics and treatment of men with early stage PCa, we have poor public awareness and low screening rates. Consequently, our PCa death rate is amongst the worst for a developed country – 22nd out of 27 European countries.

This Project aims to demonstrate that PCa screening can be done at scale in the UK and achieve the success rates seen in Europe and the USA. It identifies early on men at risk for whom screening frequency should be intensified whilst reducing over- screening for the majority of men who are at low risk. It is therefore to be hoped that the Province will continue within the Project to achieve these long-term benefits.

Chris Booth, FRCS, FRSA,
Clinical Director
10th March, 2022

NOTE – Chris Booth will be the speaker at the forthcoming PGO Club, details HERE