Another day in my GP Practice…

🩺”While I’m here, can I have that prostate test done?”

We’ve recently seen a rise in PSA (Prostate-Specific Antigen) test requests, likely due to increased media coverage and public awareness about prostate cancer. But should every man have a PSA test?

Unlike some cancers, there’s no national screening programme for prostate cancer in the UK. Instead, we follow the Prostate Cancer Risk Management Programme (PCRMP), which allows men aged 50+ to request a PSA test after making an informed decision about the benefits and risks.

The National Screening Committee last reviewed all available evidence in 2020 and concluded that “screening is not currently recommended for this condition” (UK NSC Screening for Prostate Cancer External Review 2020).

This decision was based on several key factors:

❌The PSA test is not accurate enough – it can miss some cancers.

⚠️Many individuals have a raised PSA without having prostate cancer.
⚠️A small proportion of men with a low / normal PSA will later be found to have cancer.

❌The impact of PSA testing on reducing prostate cancer deaths remains uncertain, and it has not been shown to improve overall survival.
❌A PSA-based screening programme could cause harm, as some men would be diagnosed with a cancer that would never have become clinically significant in their lifetime.

⚠️You could be diagnosed with a slow-growing cancer that would never have caused you problems. This can lead to unnecessary worry and treatment.

What Does the Evidence Say?

📊Roughly 1 in 7 asymptomatic men who undergo PSA screening will have a raised PSA result.
📊66% of men offered a biopsy due to a raised PSA will NOT have prostate cancer.
📊15% of men with a normal PSA will still have prostate cancer.
📊2% of men with a normal PSA will have advanced prostate cancer.

Key Considerations Before a PSA Test:

✅Do you have symptoms? (e.g., urinary issues, erectile dysfunction, visible blood in urine) – these may require a different approach.
✅Do you have a strong family history of prostate cancer? Close relatives diagnosed young increase your risk.
✅Are you in a high-risk group? Black men have a 1 in 4 lifetime risk compared to 1 in 8 for white men.
✅Are you under 50 but at higher risk? Clinical discretion can be used to discuss earlier testing.

Preparing for a PSA Test

For 48 hours before your PSA test, do NOT:

❌Do anything that leaves you out of breath (e.g., heavy exercise)
❌Ejaculate (come)

These activities can increase your PSA levels, making the test less accurate. However, you can eat and drink as usual before the test.

So, Should You Get a PSA Test?

It’s not a simple yes or no answer. The best approach is shared decision-making, where we discuss:

🔹Your individual risk factors.
🔹The benefits and downsides of PSA testing.
🔹What happens next if your PSA is raised.

📅Thinking about a PSA test? Book an appointment to discuss your risks and options.

Let’s make informed choices about our health! 💙