MEN AGED 50-70 years are most likely to benefit from screening for prostate cancer, newly published guidelines suggest. Muiris Houstonreports.
The Irish College of General Practitioners (ICGP) launched guidelines on prostate cancer screening for family doctors at its annual meeting at the weekend. They confirm that there is still insufficient evidence to support the introduction of a national screening programme for prostate cancer similar to BreastCheck, the population- based screening programme for breast cancer.
But the representative body for family doctors in the Republic recognises that GPs must decide whether to screen individual patients in their practices.
In a section of the new guidelines titled Who should be screened? it advises: "The population most likely to benefit from screening [for prostate cancer] will be men aged 50-70 years who are at average risk and men over 45 years of age who have recognised risk factors [Afro-Caribbean men and those with a first degree relative with prostate cancer]."
The guideline also states that men older than 70 and those with other significant medical problems who have a life expectancy of fewer than 10 years are unlikely to benefit from screening. And it advises GPs to counsel the patient about the benefits and risks of screening for prostate cancer before carrying out a blood test for prostate specific antigen (PSA).
The natural history of prostate cancer is poorly understood. Most prostate tumours are slow growing, but in some cases the disease is aggressive and progresses rapidly to affect other parts of the body.
Recent research suggests that a large proportion of screen-detected prostate cancers will never have significant impact on the patient. But it is estimated that one in eight prostate tumours detected by screening will, if left untreated, result in the patient's death.
Speaking to family doctors in Galway at the weekend, Prof Tom Keane, director of the National Cancer Control Programme, said one of the reasons for poor cancer survival rates in the Republic could be late presentation of the disease. He said this was especially significant for prostate and lung cancer.
In a wide-ranging address, the cancer chief said he was concerned by the "significant access" issue for patients found to have high levels of PSA, the prostate cancer marker, in their blood. "There is good access in Dublin but not in some other parts of the country," he said.
In response, Dr Gerard Cummins, a GP in Co Meath, told the meeting there was an unacceptable six-month delay in getting patients with a highly elevated PSA assessed by specialists in the northeast.
According to the National Cancer Registry, some 2,407 men were diagnosed with prostate cancer in 2005, while more than 500 patients die of the disease here every year. However, the lifetime risk of dying from prostate cancer is 3 per cent.