Screening for prostate cancer

There is no national screening programme for prostate cancer in the UK. This is because there isn’t a reliable test that can pick up prostate cancer that needs treatment at an early stage.

Researchers have looked at the PSA test for prostate cancer screening in those without symptoms. But overall studies show that this only leads to a small reduction in the number of men dying from prostate cancer. Studies also show that some men are diagnosed with a prostate cancer that would not have caused problems or needed treatment.

Research is going on to find a new test. Or to see if the current test is more effective if used in a different way.

What is cancer screening?

Screening means testing people for early stages of a cancer, or for early changes that could develop into cancer if left untreated. For screening to be useful the tests:

• need to be reliable at picking up cancers that need treatment
• overall must do more good than harm to people taking part
• must be something that people are willing to do

Screening tests are not perfect and have some harms as well as benefits.

In the UK, there is an independent body of experts. They are called the National Screening Committee (UKNSC). The UKNSC makes recommendations to governments on screening programmes. They base these on the best scientific evidence.

The UKNSC’s will only recommend a screening programme if overall, the benefits outweigh the harms. The screening programme should also be good value for money for the NHS.

Why there isn’t a screening programme for prostate cancer in the UK

The UK National Screening Committee doesn’t currently recommend screening for prostate cancer. This is because the PSA test is not reliable enough to detect prostate cancer that needs treatment. The PSA test can:

• miss some cancers - this is called a false negative
• suggest someone has cancer when they don’t - this is called a false positive
• lead to overdiagnosis 

What is the PSA test?

PSA stands for prostate specific antigen. It’s a protein made by both normal and cancerous prostate cells. It's normal for all men to have some PSA in their blood.

A high level of PSA can be a sign of prostate cancer. But your PSA level can also be raised because of other conditions that aren't cancer. This includes:

• a urine infection

• a benign enlarged prostate

The PSA test can also miss some prostate cancers. A major study showed that:

• around 15 out of 100 men with a normal PSA level (around 15%) have prostate cancer - this is a false negative
• around 75 out of 100 men (around 75%) with a raised PSA do not have prostate cancer - this is a false positive

Because of this, and the risk of over diagnosis, the PSA test on its own is not recommended as a screening test for prostate cancer. But men over 50 can usually ask their GP for a PSA blood test if they want. Your GP will explain the potential benefits and risks of having a PSA test.  

Understanding your PSA test results

PSA is usually measured in nanograms per millilitre of blood (ng/mL). There is no one PSA value that is considered normal. The value varies from man to man and increases as you get older. Most men have a PSA level of less than 3ng/ml. 

Your GP or specialist may suggest further tests if your PSA level is higher than would be expected for someone of your age. Talk to your doctor about your PSA level and what this means for you.

Research into prostate cancer screening

Research is ongoing to find other prostate cancer screening tests and ways to improve the current test. This includes:

• new blood and urine tests
• a combination of a blood test and other information such as age and family history
• MRI and other types of scans

More research is needed to find out whether these tests are reliable enough to detect prostate cancer.

What to do if you are worried about prostate cancer

Speak to your GP if you are worried about your risk of prostate cancer. Some people are more likely to be diagnosed with prostate cancer than others. For example if you:

• are a Black male or a Black person who has a prostate

• have a close relative, such as brother or father, who has prostate cancer

• have inherited certain genes which can increase the risk of prostate cancer

The risk of prostate cancer also increases as men get older.

There is not enough evidence to suggest that screening men with a high risk of prostate cancer would save lives. In fact, it might lead to men having treatment for prostate cancer even though that cancer wouldn’t have caused any problems or symptoms.

What to do if you have prostate cancer symptoms

Talk to your GP if you have urinary symptoms such as difficulty passing urine. The symptoms don't mean that you have prostate cancer, but it is important to get them checked.