Screening for prostate cancer, particularly in men who face a higher risk, is a topic that has gained increasing attention. Prostate Cancer Research, a leading charity, suggests that men at elevated risk—such as those with a family history or certain genetic predispositions—should begin testing at age 45. This approach, they argue, not only has health advantages but also makes financial sense when factoring in the long-term costs of late-stage treatment.
Unlike breast, bowel, or cervical cancer, the UK currently lacks a formal screening program for prostate cancer. Men over the age of 50 have the option to request a PSA (prostate-specific antigen) blood test from their GP, but the responsibility rests on them to initiate it. The absence of a standardized screening process has sparked a debate, as prostate cancer continues to claim more male lives annually than breast cancer does for women.
Recently, Olympic cyclist Sir Chris Hoy’s terminal diagnosis has reignited calls for improved screening, particularly for younger men who might be at greater risk due to family history. This has prompted the UK government to revisit the evidence, pushing the NHS to consider a shift in its guidelines.
Oliver Kemp, CEO of Prostate Cancer Research, voiced his concern over the current screening framework. According to Kemp, a lack of awareness remains a significant barrier, with many men unaware of their risk. He emphasizes that the current system isn’t effectively encouraging men to seek early detection.
The PSA test, while commonly utilized, has limitations. It measures the level of prostate-specific antigen, a protein produced by the prostate, but elevated levels aren’t exclusive to cancer. Other factors—such as an enlarged prostate, infection, inflammation, or even recent sexual activity—can also raise PSA levels. On the flip side, some men with normal PSA levels may still harbor aggressive cancer.
The challenge lies in the nature of prostate cancer itself, which can vary significantly from one case to another. Some forms are slow-growing, posing little threat over a man’s lifetime, while others are aggressive and demand immediate attention. GP Dr. Margaret McCartney highlights that one in three men over 50 may have a slow-developing form of prostate cancer that won’t impact their health. Conversely, a small percentage of cases involve fast-moving cancers that necessitate prompt treatment.
When PSA levels indicate potential concerns, follow-up procedures often include magnetic resonance imaging (MRI) scans and tissue biopsies to determine the presence and nature of cancer. Even so, some men undergo treatment for conditions that would never have posed a risk, leading to unnecessary interventions.
Clinical trials have yielded mixed outcomes on the effectiveness of widespread prostate cancer screening. In Europe, a large study suggested that screening saves lives, while in the UK, results pointed to a marginal benefit. A study in the US showed no significant advantage. According to Prof. Hashim Ahmed, a urology expert from Imperial College London, about 570 men need to be screened to prevent one death from prostate cancer—a number that underscores the complexity of making screening decisions.
Screening enables the early detection and treatment of aggressive cancers, but it comes with potential drawbacks. Large-scale testing can identify low-risk cases that require monitoring rather than immediate action. Despite the practice of “watchful waiting” for non-aggressive cancers, a diagnosis can still carry a psychological burden. Some men, anxious about the uncertain nature of their condition, opt for radical treatment—such as surgery—even when it might not be necessary. This can lead to long-term side effects like erectile dysfunction and incontinence.
For men diagnosed in their late 40s, dealing with these side effects for decades can be particularly challenging. Prof. Ahmed points out that finding low-risk prostate cancer in younger men can result in prolonged periods of stress and potential complications. Hence, he favors avoiding the detection of low-risk cases when possible.
To address the limitations of current screening methods, much research is being devoted to improving diagnostic accuracy. Prof. Ahmed is heading the Transform trial, slated to begin next year, which aims to evaluate the most promising technologies. However, results from such trials could be a decade away.
Despite the uncertainties, Prostate Cancer Research’s report supports screening for high-risk groups, particularly men aged 45 to 69 who are black or have a family history of prostate cancer. This targeted approach could lead to significant health and economic benefits. Finding and treating cancers early may outweigh the costs and risks associated with over-diagnosis by a factor of four, according to Oliver Kemp. Another charity, Prostate Cancer UK, echoes this sentiment, advocating for a revision of what it considers outdated NHS guidelines.
Prof. Frank Chinegwundoh, a consultant urological surgeon, acknowledges the difficulty of weighing the pros and cons of screening. While acknowledging the risks of over-diagnosis, he also stresses that earlier detection could have helped many men he’s treated—many of whom were relatively young when diagnosed. He specifically encourages black men, who are statistically at a higher risk, to consider PSA testing as early as age 40, particularly if they have a strong family history of prostate cancer.
However, recent concerns suggest that black men might be at greater risk of over-diagnosis due to naturally higher PSA levels. This adds another layer to the complex decision-making process surrounding prostate cancer testing.
As the debate continues, healthcare professionals like Prof. Ahmed argue that the NHS should equip men with better information to make informed choices. He emphasizes that the decision to undergo screening is deeply personal and varies from one individual to another. What one man finds acceptable in terms of risk might be intolerable to another.
The trade-off between early detection and the risks of over-treatment remains one of the most challenging aspects of prostate cancer care today.