Screening For Prostate Cancer
The NHS recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. Both the NHS and the American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.
Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45. If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level.
Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community.
In some countries, all men aged over 50 are recommended to have an annual PSA test. However, this is not the case in the UK.
There are several reasons for this:
- PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result). This means that many men often have invasive and sometimes painful biopsies for no reason. Also, up to 20% of men with prostate cancer have normal PSA levels, so many cases may be missed.
- Treating prostate cancer in its early stages can be beneficial in some cases – but side effects of the various treatments are potentially so serious that men may choose to delay treatment until it is absolutely necessary.
- Although screening has been shown to reduce a man’s chance of dying from prostate cancer, it would mean many men getting treated unnecessarily.
If you would like to ask me about screening for prostate cancer then please ask me today. Free email advice from a real doctor.
Dr Helen Webberley MBChB MRCGP MFSRH
GP and Reproductive Health Specialist
Dr Webberley is an NHS GP in South Wales and also runs a private General Practice service online.
The PSA test is a blood test that can detect the early signs of an enlarged prostate. It is the most common initial test for men who are worried about prostate cancer.
The test, which can be done at a GP surgery, measures the level of PSA (prostate-specific antigen) in your blood.
PSA is a protein made only by the prostate gland. Some of it will leak into your blood, and the amount depends on your age and the health of your prostate.
Raised PSA levels
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). PSA levels can range from 1ng/ml to hundreds of ng/ml.
- If you’re aged 50-59, your PSA level is considered raised if it’s 3ng/ml or higher.
- If you’re aged 60-69, your PSA level is considered raised if it’s 4ng/ml or higher.
- If you’re aged 70 or over, your PSA level is considered raised if it’s 5ng/ml or higher.
There are well-known issues with the accuracy and potential harmful consequences of the PSA test, which is why there is currently no national screening programme for prostate cancer in the UK.
Instead, all men over the age of 50 can access quality information about the PSA test and discuss the option of having a free test with their GP, under a scheme called the Prostate Cancer Risk Management Programme (PCRMP).
Under PCRMP, your GP will be expected to discuss with you the benefits, limitations and risks of the PSA test, to help you decide whether or not to have it.
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