There is no national screening programme for prostate cancer because we don’t have a reliable enough test to use. Research has shown that the current tests don't reduce the number of men dying from prostate cancer. Research is going on to find a new test.
What is screening?
Screening means testing people for early stages of a disease before they have any symptoms. For screening to be useful the tests:
- need to be reliable at picking up cancers
- 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 risks. The screening programme should also be good value for money for the NHS.
PSA blood test
PSA is a protein produced 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 cancer. But a high PSA can also be because of other conditions that aren't cancer, or due to infection.
A PSA test on its own doesn't normally diagnose prostate cancer. Men over 50 can ask their doctor for a prostate specific antigen (PSA) blood test. The PSA test can be unreliable. Your GP will discuss the risk and benefits with you.
Research into prostate cancer screening
Many prostate cancers grow very slowly and don’t cause men any problems in their lifetime. Overall, evidence from trials of prostate screening has shown that prostate cancer screening does not reduce the number of men dying from prostate cancer.
The Cancer Research UK CAP trial looked at whether a single PSA blood test would reduce the number of men dying of prostate cancer. This was a large UK study with over 400,000 men between the ages of 50 and 69 taking part. Around half the men were offered a PSA blood test the other half weren't.
The results in early 2018 showed that the number of men dying from prostate cancer was the same in both groups. This was after 10 years of follow up. The researchers say that this trial doesn’t support PSA testing as a screening test for prostate cancer. They say we need more research to find a better screening test.
This supports what the 2013 Cochrane review found. This looked at screening research from a number of trials and concluded that prostate cancer screening did not reduce the number of men dying from prostate cancer.
Research looking at doing more than one test doesn’t show that this would help either. Increasing the number of tests could increase the level of harms such as diagnosing those cancers that wouldn’t cause any harm (overdiagnosis). Many men have side effects from treatment and the risks of routine PSA screening outweigh the benefits.
There’s early research looking at whether using a type of MRI (mpMRI) scan to screen for prostate cancer is possible.
A multiparametric MRI is a special type of MRI scan. This type of MRI produces a more detailed picture of your prostate gland than a standard MRI scan does. An mpMRI can help your doctor to see:
- whether you have cancer cells in your prostate
- how likely it is that the cancer cells will grow
As this is in the early stages it will be some time before we know whether it could be used as a way of screening for prostate cancer.
Men at higher risk of prostate cancer
Some men are at higher risk of prostate cancer than others. These are:
- black men
- men who have a family history of prostate cancer
The risk of prostate cancer also increases as men get older.
The evidence so far doesn’t suggest that routinely screening these men would help prevent deaths from prostate cancer. 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 symptoms
Talk to your GP if you're worried about symptoms or have noticed any unusual or persistent changes.