Evaluating whether Prostate Cancer UK’s risk checker is a help or hindrance to prostate-specific antigen testing policy: a mixed-methods study

There are several concerns with this research paper, whose authors are mostly employees of Prostate Cancer UK (PCUK) (1). They describe various activities in terms of surveys, focus groups, and interviews, and say that their online "risk checker" tool can help "reach men at high risk of prostate cancer and support them in making an informed choice about the PSA test".

Their study rests on the assumption that testing is an overall benefit: and that the on-request system for PSA screening, as currently operating in the UK, is unfair, as not all men know about it. They cite a paper in support of their claim that the current UK system leads to health inequalities, but it is test volume that is referred to, not outcomes related to morbidity and mortality: authors say "the effects of disparate rates of PSA testing on health outcomes are still unclear" (2). It is not good enough to claim that screening is successful based on the volume of tests.

The study assumed that the online prostate cancer risk tool, designed and hosted by PCUK, was valid and effective. This advises all black men over 45, and all men over 50, to speak to their GP about their risk. This is not in keeping with UK National Screening Committee recommendations which clearly states that "Screening is not recommended for this condition" (3). This may change in the future, but if it does, it should be part of an organised, audited, and resourced programme which gives independent information to men about the risk of harm and potential impact on mortality and morbidity. PCUK do not refer men to independent NHS information (4). Nor has PCUK accounted for the workload on primary care as a result of their advice — not recommended by the NHS — in launching their campaign. It would be helpful if PCUK were to recommend what work GPs should stop doing to fit this in, and what patients PCUK recommend should be deprioritised on the basis of the increased workload resulting from their advice. While their title asks whether their "risk checker" is a "help or hindrance", an examination of systemic harms was not completed. Given that PCUK was using a non independently validated 'risk checker' at odds with the UK NSC advice, and write that ethics approval was "not required", it would be helpful to know which ethics committee gave this opinion.

1) Evaluating whether Prostate Cancer UK’s risk checker is a help or hindrance to prostate-specific antigen testing policy: a mixed-methods study
Natalia Norori, Chiara de Biase, Yui Hang Wong, Sadie Robson Crabtree, Matt Cox, Esther Appleby, Andrew Seggie, Rachel Brown, Amy Rylance
BJGP Open 26 June 2024; BJGPO.2024.0040. DOI: 10.3399/BJGPO.2024.0040
2) Vickers A, O' Brien F, Montorsi F, Galvin D, Bratt O, Carlsson S et al. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit BMJ 2023; 381 :e071082 doi:10.1136/bmj-2022-071082
3) UK National Screening Committee. Adult screening programme. Prostate cancer. https://view-health-screening-recommendations.service.gov.uk/prostate-ca...
4) PSA testing and prostate cancer: advice for men without symptoms of prostate disease aged 50 and over. https://www.gov.uk/government/publications/prostate-specific-antigen-tes...