It’s the UK’s most common cancer, but guidance given to GPs about prostate cancer screening has recently changed. Do men still have the right to ask for a PSA test? We answer your questions.
There are more than 63,000 new cases of prostate cancer every year. “It mainly affects men over 50, with risk increasing with age – and is the second-most common cause of cancer deaths in men after lung cancer,” says Chiara De Biase, director of health services at Prostate Cancer UK (PCUK).
“If your father or brother has had prostate cancer your risk is two-and-a-half times that of a man who has no relatives with the cancer, while black men carry double the risk of the general population, with one in four developing the disease. They are also twice as likely to die from it as men of other ethnicities.”
The prostate gland is usually the size and shape of a walnut but can start to grow in your forties. “Prostate cancer occurs when cells start to grow in an uncontrolled way,” says De Biase.
Discover your own risk using Prostate Cancer UK’s 30-second online risk checker or by calling 0800 448 0821.
Prostate cancer remains the last major cancer in the UK without a routine population screening programme but, last November, the UK National Screening Committee (NSC) recommended that those with a specific genetic risk (carriers of the BRCA gene variant which also causes breast cancer) should be screened. In June this year, the UK Government accepted this recommendation, and now plans to roll out screening for this group in England from 2027.
Routine screening isn’t offered because there is widespread mistrust of the test used, which measures the amount of a protein, the prostate specific antigen (PSA), in a man’s blood.
Stephen Langley, professor of urology at the Royal Surrey Cancer Centre & NHS Hospital and Prostate Project charity trustee explains, “Prostate cancer screening has been blocked for years by concerns about PSA inaccuracy (75% of men with a raised PSA do not have cancer), men having unnecessary, invasive biopsies based only on PSA readings and being overtreated for slow-growing cancers that would never have become life-threatening, and experiencing all the side effects that come with cancer treatment.”
But he’s critical of targeting screening on such a small proportion of the population. “It seems the NSC recognises the importance of targeted screening, but recommending we test an infinitesimally small fraction of men with the BRCA gene – a group that virtually doesn’t exist – while overlooking black men whose fathers have had prostate cancer, despite them being at similar high risk, is unbelievable.”
Despite the lack of a routine screening programme, up until this summer all men over 50 could request a PSA test via their GP if they wanted one, including men with no symptoms. Under the Prostate Cancer Risk Management Program (PCRMP), GPs would talk to the patient about the pros and cons of the test before it was decided whether to go ahead and book one.
Then, in mid-August, the Department of Health and Social Care (DHSC) announced that they had withdrawn this program.
The decision prompted annoyance from prominent prostate cancer campaigners and sufferers like TV presenter Jeremy Clarkson and former prime minister David Cameron, who called it “yet another step backwards”.
However, the true situation is not quite as straightforward as it sounds. GPs are now directed to the NICE Clinical Knowledge Summaries (CKS) of best practice instead. This states that PSA testing should be considered in men with suspected prostate cancer [and] offered to men with a BRCA2 gene variant as part of the proposed national screening programme.
“The CKS covers men who are symptomatic [have prostate cancer symptoms], but while it does acknowledge that most people with prostate cancer are asymptomatic [have no symptoms], it doesn’t give clear guidance on what GPs should actually do for those men. So there is a bit of a gap there,” says Andrew Seggie, at Prostate Cancer UK.
For example, the CKS doesn’t advise a GP what to do for a man who is symptom free but would like a PSA test because his father died of prostate cancer.
“We can see that there’s frustration amongst men and a feeling that, with this changing guidance, there could be more difficulty in accessing the PSA test,” says Seggie. “However the DHSC states that there has been no change to the policy whatsoever, and that men without symptoms who are worried about their risk of prostate cancer can still ask their GP about having a PSA test.”
The most up to date information for patients can be found here.
The upshot is men can still ask for a test. Whether they receive one is now left to individual GPs to decide, based on a man’s personal risk factors.
De Biase adds, “PCUK still strongly encourages all men over 50, and black men and those with a family history of prostate cancer over 45 to ask their GP about the test.”
Professor Langley adds, “A recent study published in The New England Journal of Medicine in November last year followed over 160,000 European men and clearly showed that men who were offered PSA screening were 13% less likely to die from prostate cancer than those who weren’t.”
It’s true that it can pick up slow-growing cancers that may never cause any bother, and also that it misses other, potentially serious, cancers. But it’s no longer the only weapon in the armoury. If your PSA levels lead your GP to suspect you may have prostate cancer (after ruling out a UTI), you should be sent for an MRI scan.
“Men with a raised PSA will be sent for an MRI before they even see a urologist or specialist, and MRIs only really show clinically significant prostate cancer,” says Prof Langley.
“Additionally, the UK is the world leader in active surveillance, so when we do find low-risk, low-grade cancer, we opt for careful monitoring so we can spot if anything changes or eventually needs curative treatment. That means many men with a slightly high PSA can simply be reassured following an MRI and discharged without any invasive procedures. It all makes screening a far more viable option.”
Probably not. Prostate cancer is usually entirely symptomless until it has spread. “If prostate cancer is detected before it spreads, then the disease is eminently curable in over 80% of men,” says Prof Langley.
“If you catch it late, after it has symptoms, then it’s no longer as easily curable – men often need lifelong treatment. Ultimately, for over 12,000 men in the UK every year, prostate cancer becomes lethal. Asking your GP for a PSA test is the only way to get on a pathway that will tell you if you might have early prostate cancer.”
Once cancer has spread, symptoms include difficulty urinating, increased frequency, weak flow, blood in your urine or semen, erectile dysfunction, lower back pain and weight loss without trying.
“There are a number of exciting methods for diagnosis being tested, including an ‘at-home spit test’,” says Dr Matthew Hobbs, director of Research at PCUK. A new study in The New England Journal of Medicine reported that the test, which calculates risk of developing prostate cancer from DNA in saliva (called a polygenic risk score) was more accurate at identifying future risk than the PSA test.
It’s not available on the NHS, though experts hope it will be soon. “It’s a real story of success, but we still need to make sure it works at scale, and for men of all ethnicities,” adds Dr Hobbs.
Last November, the first invitations went out via GPs for Transform, the biggest prostate cancer screening trial in 20 years, recruiting men aged 50-74 (from age 45 for black men). It aims to uncover the most effective method of detection and diagnosis.
Then in June, the Government announced an additional investment of up to £18m to ensure all eligible black men will be invited to sign up.
“Using the latest screening techniques, like fast MRI scans, PSA blood tests and genetic tests, we’re aiming to find the best way to screen men for prostate cancer,” says chief investigator Professor Hashim Ahmed at Imperial College Healthcare NHS Trust.
“Importantly, we’ve designed the study so that we can evaluate promising new tests as soon as they’re developed.
“Anyone who receives one is strongly encouraged to take part.”
Health insurance for people over 50 that provides a quicker route to diagnosis and planned medical treatment in a private facility.
Underwritten by Bupa Insurance Limited.
Find out about Saga’s walking holidays here…
Saga’s walking holidays are perfect for exploring Europe’s stunning destinations on foot. They’re suitable for all fitness levels and offer a well-balanced mix of guided walks and relaxation.
Are you retiring at the wrong age? The best age to retire for your body, brain, happiness and pocket.
Everything you need to know about the lung infection, and how you could be ill with “walking” pneumonia without realising it.
Strong calves for a strong mind: how they support our circulation and brain health, with easy moves to strengthen yours at home.
Our GP Dr Mark Porter explains what can cause itchy skin, which is a common problem as we get older.
Worried you’ve morphed into Victor Meldrew? Find out how to battle that bad mood, and what to do if you’re stuck with a grouchy loved one.
The benefits of heat and cold therapy, and how Nordic bathing won over our nervous writer.
Here’s how to spot the symptoms of heat disease and reduce your danger.
Everything you’re entitled to this year, when you can have it, and the gaps that remain.
Pilates for back pain – what to do if you are suffering, and five gentle exercises that could help.
Dizziness or vertigo: a sensation of spinning, can stop us doing everyday things for fear of falling. Try these tips to stop feeling dizzy
You don’t have to put up with bladder leaks. We try out the latest pelvic floor gadgets for men and women.
Cataracts are a normal part of ageing. Learn how to spot the signs – and when it’s time to consider surgery.
