It seems, on paper, a perfectly rational proposal. Offer all middle-aged men a test every few years to flag up their risk of prostate cancer – the most common cancer in men, with about 63,000 diagnoses and 13,000 deaths a year.
A national screening programme – like the regular mammograms offered to women to check for breast cancer – would catch cases earlier, before the cancer has a chance to spread.
As a result, campaigners say, countless lives could be saved each year.
It’s something doctors and advocates have increasingly called for – including Olympic cyclist Sir Chris Hoy, who was diagnosed with terminal prostate cancer in September 2023, aged just 48, without having any symptoms.
But according to reports circulating last week, the Government is set to kick into the long grass the proposal for a national prostate cancer screening programme.
And what’s more, numerous doctors have come out to say they agree – arguing that prostate screening could actually harm patients by putting them through needless tests and procedures. So what’s the truth?
To find out, The Mail on Sunday spoke to some of the country’s leading prostate cancer experts.
Sir Chris Hoy appears on Lorraine to talk about his battle with prostate cancer
Q Screening for prostate cancer seems to be a no-brainer. So why are some doctors against it?
A The main method that would be used in a screening programme is called the PSA test.
This measures levels of a protein called prostate-specific antigen. A high PSA score indicates the prostate – a small gland that sits below the bladder – isn’t working as it should. But this isn’t always a sign of cancer. PSA can rise due to an enlarged prostate, infection, recent sexual activity or even cycling.
Despite this, men with suspicious results are usually sent for scans to identify the cause.
Currently, any man over 50 can request a PSA test from his GP if he is concerned about prostate cancer. However, experts fear that offering the test routinely to all men over a certain age would trigger scores of false positives.
Until recently, that might have meant many men being unnecessarily subjected to invasive biopsies. Today, most are referred first for an MRI scan, which – like an X-ray – allows doctors to see inside the body with minimal risk. Even so, concerns remain.
Professor Roger Kirby, retired prostate surgeon and president of the Royal Society of Medicine, says: ‘Because PSA is not a particularly accurate marker for cancer, many men with a worrying result are sent for expensive MRI scans that, for most of them, will be entirely normal. This is an unnecessary drain on resources.’
However, Professor Nicholas James, Professor of Prostate and Bladder Cancer Research at the Institute of Cancer Research, adds: ‘There have been a number of trials where half a population of men were given a PSA test and half were not. The one thing we’ve learned is that if you refer men with a raised PSA level for further testing, you will find cancer.’
He says that the current National Screening Committee proposal is based on outdated data. ‘The committee is looking at the same dataset it used to reject a similar proposal five years ago. But new studies have shown different results.
‘A massive European trial revealed you could reduce the risk of death from prostate cancer by having regular PSA tests.
‘And the recently published 15-year follow-up showed that
the benefit actually increases over time. Men who didn’t get screened kept on dying. Those who did, didn’t.’
Q If screening just means a blood test and an MRI, how could it do more harm than good, like some are claiming?
A Roughly half of men with a raised PSA referred to a clinic receive normal MRI results and are sent home.
But the others, whose scans look abnormal, go on to have a biopsy – where a needle is inserted into the prostate to remove tiny tissue samples for testing.
Rectal exams are no longer routinely used to check for prostate cancer.
While diagnostic tests rarely cause lasting harm – beyond the occasional infection, or the stress of waiting for results – treatment for prostate cancer can.
Professor Kirby explains: ‘The problem with early detection is that, as men age, many develop small prostate cancers that can be picked up on screening but would never go on to cause problems.
Sir Chris’s Tour De 4 charity event raised more than £2million for the fight against cancer
‘Prostate surgery – to remove part or all of the prostate – will inevitably change sexual function. Some patients will be left with lifelong problems after treatment for a cancer that likely would never have harmed them.’
That risk of overtreatment shouldn’t deter men from seeking a PSA test, says Professor James.
‘Having a raised PSA doesn’t mean you have prostate cancer or even need treatment, but it allows you to make more educated decisions about your health. By the time you develop symptoms of prostate cancer, it’s too late to do anything in most cases.’
Q Stories like Sir Chris Hoy’s are worrying, but now I’m reading a national screening scheme may be a bad idea. Should I bother to get tested?
A Professor James says men shouldn’t be put off by the medical debate.
What’s important to understand, he emphasises, is that the National Screening Committee isn’t deciding whether men should have a PSA test at all.
Its job is to assess whether a nationwide screening programme would save enough lives to justify the cost – which would inevitably mean diverting funds from elsewhere in the NHS.
‘For men considering asking for a PSA test, the question is whether it’s in their best interests – and I would advise that it is,’ said Professor James.
‘Whether offering PSA tests as part of a national screening programme is the best use of NHS money, on the other hand, is a different question entirely.’
Q So if there’s no national screening programme, who should be asking for a test?
A Some men are more likely than others to develop prostate cancer. There are certain genetic mutations – such as the BRCA1 and BRCA2 genes that increase women’s risk of breast and ovarian cancer – that can make men more vulnerable, as can a family history of the disease.
Ethnicity also plays a role: black men are more likely to develop prostate cancer, and to do so earlier. In the UK, around one in four black men will be diagnosed at some point in their lifetime.
Sir Chris has called for systemic change in the ways men get tested for prostate cancer
Anyone in these groups should make sure to get a PSA test as soon as they become eligible, says Professor James.
PSA tests are available on request to men over 50, while black men can be offered one from 45. You don’t need symptoms to ask for a test, and after discussing the risks and benefits, your GP cannot refuse.
Yet more than 60 per cent of men aged 50 and over have not requested a PSA test, a recent Healthwatch survey found.
‘If you’re between 50 and 65 – even if you’re in otherwise good health – you should get a PSA test,’ said Professor James.
‘It’s like knowing your blood pressure – a raised reading doesn’t mean you’ll have a heart attack, but it allows you to manage that risk.’
Q I’m in good health and have no risk factors – should I still get a test?
A If you don’t fit any of the high-risk criteria, regular PSA testing may be less essential, says Professor Kirby.
‘Those with a family history of the disease, or who are of Afro-Caribbean descent, should ask for a PSA test every year,’ he adds.
‘For men without these risk factors, getting tested every five years or so will probably suffice.
‘Treat it like monitoring blood pressure or cholesterol – establish a baseline PSA and keep an eye on it. If it rises, then you can investigate further.’
The only men who need not bother at all, agree both experts, are those with multiple serious health conditions such as heart disease.
‘The chances of dying from a heart attack are much greater than from prostate cancer,’ says Prof Kirby. ‘For those with limited life expectancy, it’s probably a waste of time.’
Q If a national screening programme were introduced, what might it look like?
A While it seems unlikely that all men will be screened on the NHS, there are ways to increase the number being tested.
Introducing national screening for those at highest risk would cost the NHS just £18 per patient and require only five additional MRI scanners, according to a new report from the charity Prostate Cancer Research.
The proposed programme – offering annual prostate tests to all men aged 45-69 with a family history of the disease or who are black – could give those men an extra 1,254 years of life collectively every year, its authors claim.
This kind of targeted screening is likely the most effective option, says Professor James.
‘The men who do get prostate cancer tests now tend to be white, middle-class and university-educated,’ he says.
‘Those who don’t are often working-class or non-white – the very groups more likely to be affected in the first place.
‘A targeted approach would stop us spending a lot of money testing, to some degree, the wrong people – those who already know their way around the system.’
But the future of prostate cancer screening, says Professor Kirby, likely lies in an even more personalised process: genetic testing.
‘By looking at people’s genomes, we could measure their individual susceptibility and target PSA and MRI screening accordingly,’ he says. ‘These tests are still in development and won’t be ready for NHS rollout just yet – but that’s really the holy grail.’
I was lucky: push for your test
Junior Hemans was 52 when he first asked his GP for a PSA test – seven years after he became eligible.
The Wolverhampton-based property developer had no symptoms but had seen several men in his community succumb to prostate cancer.
‘I’d heard the rate of prostate cancer in black men was one in four,’ he said. ‘I just felt the need to look.’ The results came back a few days later: his PSA was high for his age, and he was referred to hospital.
After an MRI and a second PSA test, doctors decided to keep him under surveillance.
Five years later, he was diagnosed with early-stage prostate cancer. He underwent radiotherapy and now, aged 62, is cancer-free. ‘What I say to men is that the earlier you test, the more of you will be saved,’ he said.
‘If you present late, when the cancer is more advanced, you’ll need to cut out more of the prostate, which causes more damage.
‘I was very lucky to catch mine early – but other men need to make sure to push for a PSA test as soon as they can.’
