Prostate cancer - Screening for prostate cancer

There is currently no screening programme for prostate cancer in the UK, because it has not been proven that the benefits would outweigh the risks.

PSA screening

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.

More research is needed to determine whether a screening programme would reduce the number of deaths. One European study has shown that deaths from prostate cancer could be reduced by 20% if there was a screening programme, but found many men were being treated unnecessarily. Between 33 and 48 men would need to be diagnosed and treated to save the life of one man over a 10-year period.

A recent large study in America found no reduction in the number of deaths.

As there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. This includes looking at how PSA levels change over time, and comparing the PSA level to prostate size. Researchers are also looking at whether new imaging tests, such as MRI scans, or other blood and urine tests, can be used to decide which men with an elevated PSA should have a biopsy.

Instead of a national screening programme, there is an informed choice programme on prostate cancer risk management. It aims to give men good information on the pros and cons of a PSA test.

If you are aged over 50 and decide to have your PSA levels tested, your GP will be able to arrange for it to be carried out for free on the NHS.

If results show you have a significantly raised level of PSA, your GP may suggest further tests.

However, the exact figure for a "normal" PSA level can change, depending on your age and GP surgery location.

Should I have a PSA test?

Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer. A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.

If you are going to have a PSA test, it is important that you first discuss with your GP whether it is right for you, so you understand what the results might mean.

The Prostate Cancer Risk Management Programme gives you information on the risks and benefits of the PSA test to help you decide whether or not to have it.

Want to know more?

• Should I have a PSA test?
• Cancer Research UK: PSA test for prostate cancer
• Prostate Cancer UK: PSA test