Rethinking decisions about prostate cancer screening

Prostate cancer screening has been a hot topic in the prostate cancer world for many years. The arguments for and against are sometimes scientifically based, but often suspiciously influenced by personal values. But now there is a clear shift underway. The disease claims the lives of around 2,000 Swedish men every year, most of them detected too late to be treated.

The last time this issue was addressed was in 2018, when the National Board of Health and Welfare, SoS, decided not to recommend screening as follows:

“Crucial to the recommendation is that the benefits of prostate cancer screening using PSA tests alone clearly do not outweigh the negative effects.”

In essence, one can agree that the PSA test is too non-specific and leads to over-diagnosis and unnecessary treatment. But the SoS stated at the same time that new studies are expected in the near future, and that the question will then be tested again. To boost development, regions were also urged to prepare by reviewing their diagnostic activities. The government at the time stood behind it and allocated funds to encourage regions to get started. The decision document concluded as follows:

“This is a step towards screening.”

Since then, as SoS predicted, Swedish and international studies have shown that the weakness of the PSA test can be overcome. If suspected cancer is first examined with an MRI camera, cancer patients who need treatment will be screened for more benign cancers.

So where are we after six years? More than half of our 21 regions have started the so-called Organized Prostate Cancer Testing (OPT), while others are still on their way. One region, Värmland, has long experience with large-scale operations. One region, unfortunately ours, abstained altogether for some reason. Once again, we see an example of how very different regions treat our patients. Remarkably, Haaland is the worst offender, despite its usually high ambitions in healthcare.

Now, in its new cancer strategy, the European Union has also made the following call:

“Countries are invited to assess the feasibility and effectiveness of organized screening programmes based on the state of knowledge and the extent of opportunistic (land-based) screening.”

At the annual meeting of European Urologists in April, the issue of screening was a big topic. The Swedish model with the occupied Palestinian territories attracted a lot of attention, and more countries are now following suit. There has been a clear swing in the direction of replacing arguments against screening with the question of how screening should be done.

We at the CaPriN Patients Association call on the region to reconsider its position and start pilot activities as above.

CaPriN Council through

Bengt Ake CarlssonChairman of the Board of Directors CaPriN

Connie NielsenCaprin's secretary

Kali WallerHealth Care Policy Spokesperson, Prostate Cancer Society