Prostate cancer screening

Screening for prostate cancer can reduce the death rate but there are major risks of over-diagnosis and over-treatment.

Results from a landmark European-wide trial have shown that screening for prostate cancer can reduce deaths from the disease by 20%.

Experts disagree on the usefulness of the PSA (prostate-specific antigen) test, the main test for prostate cancer. This is why there is no national screening programme for prostate cancer in the UK.

The test could save your life if it indicates the presence of cancer, but it is not a very accurate test and can lead to treatments which could cause unnecessary anxiety and side effects.

Published in 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) started in the 1990s to evaluate the benefits of PSA testing.

The study involved 182,000 men from seven countries, aged between 50 and 74, who were randomly allocated whether or not to be offered PSA screening.

“The ERSPC provided the first convincing evidence that screening can lead to a reduction in the risk of death from prostate cancer,” says cancer specialist Dr Chris Parker.

Over-diagnosis

There is currently no organised screening programme in the UK for prostate cancer.

But screening is not without risks. The research found that screening was associated with a “high risk of over-diagnosis” of prostate cancer.

The study has now been followed up for 13 years, and the latest data published in August 2014 shows that to save one life from prostate cancer, 27 men would have to be treated. 

The researchers still say that better understanding of the side effects of screening and reducing the side effects would be needed before a national screening programme could be introduced. 

This means many men would be diagnosed with prostate cancer that would otherwise not have been detected or required treatment.

“The majority of PSA-detected prostate cancers are harmless,” says Dr Parker.

Men considering going for a PSA test need to decide, based on their personal circumstances, whether the benefits outweigh the harms. 

An information sheet for men considering a PSA test is available for download (PDF, 116kb).

A positive diagnosis can lead to anxiety and is often followed by treatment, with its risks to sexual, bladder and bowel function.

Black men and those with a family history of the disease are at greater risk and might have more to gain from testing.

“It is in some ways a lifestyle choice,” says Dr Parker. “If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense.

“If, on the other hand, you are more accepting of your ‘allotted span’, and are keen to preserve normal sexual and urinary function, then you may decide not to have the test.”

Way forward

'The majority of PSA-detected prostate cancers are harmless.' Dr Chris Parker

Dr Parker says the way forward should be to develop better ways of screening to reduce the risks of over-diagnosis and unnecessary biopsies.

He says the PSA test should no longer be used in isolation, but rather in combination with other indicators, such as age, ethnicity and family history, to assess an individual’s risk of prostate cancer. 

With recent improvements in imaging, MRI scans may also help in future to decide who should have a prostate biopsy.

In addition, being diagnosed with prostate cancer should not automatically lead to treatment, says Dr Parker.

Regular check-ups to monitor the cancer and check that it isn't becoming aggressive, known as active surveillance, could spare many men from unnecessary treatment.

NHS screening

There is currently no organised screening programme in the UK for prostate cancer.

For more on the latest policy position, go to the UK National Screening Committee’s prostate cancer section.

An informed choice programme has been introduced to help men decide whether or not to have the PSA test.

The prostate cancer risk-management programme (PCRMP) gives men with no symptoms information on risks and benefits of the PSA test to help them decide whether or not to take it. Your GP will have an information pack to help you decide.

Page last reviewed: 19/07/2014

Next review due: 19/07/2016

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Comments

The 6 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User801755 said on 07 September 2013

If you feel strongly enough about it you could insist on a male doctor, that wouldn't be a problem at all.

I am a 50 yr old male and I have a screening health check every year, which includes having a finger up the bum to check whether the prostate feels abnormal. I can't say I look forward to it. However, it is a few seconds of discomfort for a year's worth of reassurance.

I always get asked if I want a male or female doctor. At first I asked for male doctors because I thought it would be less embarrassing. But now, given a choice, I ask for a female one. Why? Because they tend to be gentler and have smaller hands!

Worth thinking about?

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Vizz said on 04 December 2011

Why are all women screened by female health professionals (Breast Screening etc) and men have to suffer the indignity of any sex medical professionals ? Can men choose to see a male nurse or doctor for treatment ?

Why does the NHS spend so much on female health issues and leave men dying 4 or 5 years earlier than women on average ?

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Wilde13 said on 30 November 2011

Researchers at Surrey University 01 March2011. states a Urine test that contains a chemical EN2 will show a prostate to be cancerous. Source 'BBC NEWS HEALTH' www.bbc.co.uk/news/health-12610972? Still to show if aggressive or non aggressive. watch this space..........Wilde

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Rumo said on 23 September 2011

Actually the information is not that up to date.

In the ERSPC trial there was a large degree of contamination. This means rather than testing to see if PSA screening reduced deaths between a screened and a non screened control group, they were actually testing between a higher screened group and a control group containing patients who had been screened before. So the ERSPC trial was effectively testing the reduction in mortality that came about at a higher level of screening than at a lower level.

In a more recent trial, the Goteborg study, they saw a reduction in mortality of 40%.
That would mean 4000 less prostate cancer deaths in the UK per year.

Dr Parkers statement of 'If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense' is slightly misleading.

Firstly 'great age' is no longer what it used to be; people are remaining healthy and active with good qualities of life for a lot longer. The most dangerous cancers are likely to be fast acting and kill you younger, these can be caught by PSA. In 2008 2.1% of prostate cancer deaths occured in men in their 50s, 12.4% in their 60s and 32.0% in their 70s.

Secondly, it is not the PSA test that causes the side effects of treatment - it is, obviously, the actual treatment.

Drs are now more able to determine how dangerous each cancer is, and act according to both this and a patients wishes. NICE guidelines are now advocating more focus on the use of active surveillance. This is where you are monitored by repeating a PSA test three times year and having a biospy biannually. So the harmless tumours that he speaks of do not necessarily have to be treated,


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Rumo said on 23 September 2011

Actually the information is not that up to date.

In the ERSPC trial there was a large degree of contamination. This means rather than testing to see if PSA screening reduced deaths between a screened and a non screened control group, they were actually testing between a higher screened group and a control group containing patients who had been screened before. So the ERSPC trial was effectively testing the reduction in mortality that came about at a higher level of screening than at a lower level.

In a more recent trial, the Goteborg study, they saw a reduction in mortality of 40%.
That would mean 4000 less prostate cancer deaths in the UK per year.

Dr Parkers statement of 'If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense' is slightly misleading.

Firstly 'great age' is no longer what it used to be; people are remaining healthy and active with good qualities of life for a lot longer. The most dangerous cancers are likely to be fast acting and kill you younger, these can be caught by PSA. In 2008 2.1% of prostate cancer deaths occured in men in their 50s, 12.4% in their 60s and 32.0% in their 70s.

Secondly, it is not the PSA test that causes the side effects of treatment - it is, obviously, the actual treatment.

Drs are now more able to determine how dangerous each cancer is, and act according to both this and a patients wishes. NICE guidelines are now advocating more focus on the use of active surveillance. This is where you are monitored by repeating a PSA test three times year and having a biospy biannually. So the harmless tumours that he speaks of do not necessarily have to be treated,


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Pottash said on 11 September 2011

The harms, form my viewpoint, outweigh any potential benefits. I think I will skip it if offered. At least there are some up to date figures on PSA testing. "To save one life from prostate cancer, the study showed that 48 men would have to be treated."

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