A research team from the Department of Surgery and the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed), has demonstrated that prostate-specific antigen (PSA) screening for men aged 45 and above can significantly reduce the incidence of advanced-stage prostate cancer from 39% to approximately 1%, and lower the mortality rate from 6.14% to 2.85%. The study highlights that implementing risk-stratified screening in Hong Kong is highly cost-effective, providing robust evidence to support the formulation of future cancer prevention and control policies in the city. The study findings were published in The Lancet Regional Health – Western Pacific.
A study from HKUMed demonstrates that prostate-specific antigen (PSA) screening can significantly reduce the incidence of advanced-stage prostate cancer and mortality rate. The research is led by Dr Na Rong (left) from the Department of Surgery, and Professor Li Xue from the Department of Medicine, both under the School of Clinical Medicine at HKUMed. Photo source: HKUMed
PSA screening helps reduce incidence of advanced prostate cancer and mortality
According to the latest data from the Health Bureau, prostate cancer is now the third most prevalent cancer among men in Hong Kong, with its incidence rising in tandem with the ageing population. Dr Na Rong, Clinical Assistant Professor in the Department of Surgery, School of Clinical Medicine, HKUMed, explained that early symptoms of prostate cancer are often subtle, leading to delayed treatment. PSA screening, a blood test used to detect PSA levels in the blood, helps identify high-risk or metastatic prostate cancer at an early stage. However, the city's current health policy does not include a targeted screening programme for prostate cancer, and there is insufficient scientific evidence to support the implementation of universal screening.
The research team evaluated 56 distinct PSA screening strategies, including annual PSA screening for men aged 45 to 75. The team found that this strategy could significantly reduce the proportion of patients diagnosed with advanced-stage cancer at initial diagnosis from approximately 39% to 1%, while also slashing the annual prostate cancer mortality rate from 6.14% to 2.85%.
Cost-effectiveness of city-wide PSA screening
The team also evaluated the cost-effectiveness of implementing city-wide PSA screening to reduce pressure on the public healthcare system. The results indicated that assuming annual PSA screening for the 45 to 75 age group, the costs for screening and subsequent treatments would be far below the 'cost-effective' threshold defined by the World Health Organisation (WHO). Specifically, the estimated annual incremental cost per person would be approximately US$4,950 (HK$38,500). This is far below the value generated by the intervention, especially when compared to Hong Kong's GDP per capita of approximately US$55,000 (HK$420,000), confirming that periodic PSA screening is 'highly cost-effective'.
'From a health economics perspective, if a medical intervention is proven to be “cost-effective” in regions with lower GDP per capita, its feasibility and economic benefits are even more significant in a high-income economy like that of Hong Kong. With more abundant medical resources and higher purchasing power, Hong Kong is well-positioned to implement proactive early screening to reduce the societal burden of advanced cancer,' emphasised Dr Na.
Optimising resource allocation through 'precision screening'
To avoid overdiagnosis and strain on the public healthcare system, the research team suggests 'precision stratification' of population risk. The study introduced polygenic risk scores (PRS) for prostate cancer prediction to tailor screening strategies based on individual risk levels. While high-risk groups would undergo more frequent monitoring, the screening starting age could be delayed or testing frequency reduced for low-to-medium risk groups (comprising two-thirds of the population). This stratified approach would improve cost-effectiveness without compromising overall survival rates.
'We hope this health economics study, which combines clinical data from Hong Kong and the Chinese Mainland, will promote a review of prostate cancer screening guidelines in the city. In the long term, this will help achieve "early detection, early treatment”, improve the healthy life expectancy of men in Hong Kong, and alleviate societal and medical costs,' concluded Dr Na.
Research based on big data from Hong Kong and the Chinese Mainland
The research utilised 20 years of clinical follow-up data from Hong Kong, screening cohorts from Guangzhou, and diagnostic data from Shanghai. Leveraging this real-world evidence, HKUMed and the Mainland teams accurately modeled the natural history and prognosis of prostate cancer in the region. These results are highly applicable to the local population for predicting disease burden and intervention outcomes.
About the research team
The study was led by Dr Na Rong, Clinical Assistant Professor, Department of Surgery; Professor Li Xue, Assistant Professor, Department of Medicine, both under the School of Clinical Medicine at HKUMed; in collaboration with Professor Gu Di, First Affiliated Hospital of Guangzhou Medical University. The first authors are Dr Liu Jiacheng, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; Dr Jiao Yuanshi, Department of Medicine, School of Clinical Medicine, HKUMed, and Dr Huang Yueting, First Affiliated Hospital of Guangzhou Medical University.
The research team hopes this health economics study will promote a review of prostate cancer screening guidelines in the city, ultimately improving the healthy life expectancy of men in Hong Kong in the long term while alleviating societal and medical costs. Photo source: HKUMed
Kentucky Gov. Andy Beshear is directly asking Sen. Mitch McConnell, the state's most powerful figure in Congress, to disclose more about his condition after three weeks of silence from the 84-year-old since he was hospitalized in Washington.
The letter released Wednesday from Beshear, a Democrat who is considered a potential presidential candidate in 2028, to the former Senate Republican leader says, “Kentuckians have grown increasingly concerned about the current state of your health and well-being, and ability to hold office.”
McConnell, whose physical condition has visibly declined in recent years, was hospitalized June 14. He has not released a public statement, photos or videos since. Aides have disclosed nothing specific about his condition, other than to say last week that McConnell “continues to improve, and is working closely with his staff on Kentucky and Senate matters while the Senate is out of session.”
That lack of detail has fueled rampant speculation about his prognosis and whether he will return to the Senate when it reconvenes next week. The firestorm was enough that Republican Senate leaders, including Senate Majority Leader John Thune, R-S.D. and Wyoming Sen. John Barrasso, on Tuesday made public statements saying they had talked to McConnell and he was alert and discussing current events.
Speaking to reporters aboard Air Force One on Wednesday evening, as he returned home following the NATO summit in Turkey, Trump was asked about McConnell but said the pair had not spoken.
“I have no idea how he’s doing," Trump said.
McConnell is retiring at the end of his term in January, and the campaign to elect his successor already is underway. Kentucky’s Senate succession law, which Republican legislators have twice changed during Beshear’s tenure, does not give the governor a role in picking a temporary successor should McConnell’s seat become vacant before his term ends.
Under the latest change in 2024, Beshear would call a special election if the seat became vacant. The winner of that election could take office after the result is certified. The general election winner would be sworn in as part of the new Congress in January. But there are unresolved questions about the timing of a special election under the untested law and the possibility the seat could remain vacant until January.
Beshear ended the letter by wishing McConnell “a safe and speedy recovery.”
A look at what an absence from the Senate or a vacancy could mean.
There is not much, if anything, that Beshear, Kentucky lawmakers or the Senate could do if McConnell remains in office but is unable to perform his duties between now and when the current Congress expires in January.
Senate rules do not allow proxy voting. But there have been extended Senate absences before, and the chamber has continued its business with however many senators are in attendance. Republicans currently hold a 53-47 advantage. Without McConnell, that means a maximum of 52 Republican votes are available.
McConnell had been among the senators blocking war powers resolutions that seek to limit President Donald Trump's military options in Iran. Without him, the administration has less of a buffer. On the other hand, McConnell already had been among the Republicans refusing to support Trump's sweeping elections law overhaul.
The 17th Amendment to the U.S. Constitution calls for Senate vacancies to be filled by popular elections. But it allows state legislatures to empower governors to appoint an interim senator to serve through those campaigns. Most states have taken this option, according to the Congressional Research Service.
Kentucky law allowed interim appointments until 2021, when McConnell and other state GOP leaders persuaded the Republican-run Legislature to make a change. They did not want Beshear to shift the partisan balance in Washington if he got the opportunity. They called for a committee of the previous senator's state party to select three people from whom the governor could choose an interim senator. In this case, that would mean Beshear picking which Republican would fill a vacancy. Several states have this system.
Kentucky lawmakers changed the law again in 2024 to require a special election. The only role for the governor is to call that election.
Beshear vetoed the 2021 and 2024 changes but Republican lawmakers overrode him.
The 2024 law says Beshear “shall” issue a proclamation for a special vote but it does not say when he should make that proclamation or what the election date must be. Separate laws require certain minimum windows between a proclamation and the election date, but not necessarily a maximum window.
Some officials have argued that any vacancy after Aug. 3 would mean a special election concurrent with the general. They have even speculated that at some point, it would be impractical to have a special election at all given the regular election already taking place.
The Kentucky secretary of state’s office declined to speculate on a hypothetical time frame.
If a special election was needed, the simplest option would be to hold it at the same time as the regular general election.
For the full Senate term that begins in 2027, Republicans nominated U.S. Rep. Andy Barr and Democrats nominated former state lawmaker Charles Booker. Concurrent elections would be separate, requiring new nominations by the parties, though they could choose Barr and Booker. Regardless, in this scenario voters would be electing the immediate replacement and the full-term lawmaker on the same Election Day.
Multiple vacant House seats have been filled that way with little national attention.
Yes. The 2024 law has never been tested. If a vacancy occurred, there could be different interests between parties and even among Republicans about special election timing and whether to hold one at all. That could create any number of legal questions and disputes that have to be settled by the courts.
Beshear's office did not immediately respond to an inquiry about how he interprets the law.
This story has been corrected to reflect that it depends on what the governor might do to determine whether there might be a special election if there was a Senate vacancy after Aug. 3 and whether the seat might remain vacant until January.
FILE - Sen. Mitch McConnell, R-Ky., arrives for a hearing at the Capitol in Washington, Tuesday, May 19, 2026. (AP Photo/J. Scott Applewhite, File)
