Screening for Prostate Cancer

Frimley Health NHS Foundation Trust

Historically, the assumption has been that screening would routinely mean checking the prostate-specific antigen (PSA) levels. This  is a controversial subject in the international medical community for several reasons.

PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result).  Furthermore, around 1 in 7 those with prostate cancer have normal PSA levels (a false-negative result), so many cases may be missed.

The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. So this test is discredited.

However, for high risk groups such as men on West African genetic heritage, PSA tests and if possible an MRI are an essential in my view

These days there is growing interest in using MRI as a screening test in much the same way than a Mammogram is used to screen for breast cancer in women.

The pioneering Prostogran program led by Professor Hashim Ahmed (Imperial) is an example. Further, Prostate Cancer UK is going to start a long term research program using MRI for screening.

The other are that is emerging is genetic and molecular testing. The most interesting being the Stockholm 3 test. This is suitable for men with increased risk of prostate cancer and can give a very accurate prediction of risk. However, although commonly used in the Nordic countries, it will be several years before it may be available on the NHS. In the meantime it is only available privately. You can find more information on dedicated pages in this section.

As to Risk, it is indicated if a man has the following signs in their families:

• Relatives with early onset prostate cancer (diagnosed before age 55)
• 3 first degree relatives (brother, son, father) diagnosed with prostate cancer
• Ashkenazi Jewish ancestry and breast, ovarian or prostate cancer
• Prostate cancer and two relatives with breast or ovarian cancer
• Prostate cancer and male breast cancer, or ovarian cancer or bilateral breast cancer
• Prostate cancer and early onset bowel or womb cancer (before age 50)
• Prostate cancer and 2 relatives with bowel or womb cancer