When Sir Chris Hoy spoke publicly about his prostate cancer, which had already spread by the time it was found, he prompted many men to think about their own health. Writing in The Times, Professor Prokar Dasgupta of King's College London praised his bravery and drew out lessons from his experience. This article summarises the main points on Sir Chris Hoy and prostate cancer, and what they mean for men with a family history of the disease.
Why his openness matters
Prostate cancer is the most common cancer in men in the UK, yet many men are reluctant to talk about it. A well-known figure sharing his diagnosis can encourage others to seek advice sooner. Professor Dasgupta expressed the hope that Sir Chris's story would bring greater awareness of prostate cancer, particularly among men with strong family histories.
Family history and earlier testing
For men with a clear family history of prostate cancer, Professor Dasgupta's advice is to have PSA blood tests from the age of 40. This is earlier than many men assume. The UK, like most countries, does not currently have a national screening programme for prostate cancer, so the emphasis is on informed decision-making and on what he calls smart screening for men at higher risk.
Family history is not limited to prostate cancer. Breast cancer in close relatives can also be relevant, because prostate and breast cancers sometimes share faulty genes such as BRCA. Our article on BRCA testing and prostate cancer explains this link in more detail.
Why PSA alone is not enough
The PSA test is a useful starting point, but on its own it is often inaccurate. PSA can be raised by other conditions, such as a urine infection or benign enlargement of the prostate. Our page on benign prostatic enlargement describes that condition and its symptoms.
In most men with a raised PSA, once infection has been ruled out, the next step is an MRI scan of the prostate. If the scan shows an abnormal area, a biopsy may follow. Other scans are being studied to improve on the accuracy of MRI, and new blood tests may in time prove far more accurate than PSA alone. The NHS explains PSA testing and its limitations.
Overdiagnosis and early diagnosis
One reason there is no national screening programme is concern about overdiagnosis: finding slow-growing cancers that might never cause harm. Professor Dasgupta acknowledges this concern, but argues that it is better to diagnose the cancer while it is still within the prostate than after it has spread.
Importantly, a diagnosis does not always mean immediate treatment. Cancers that do not need treatment can be monitored safely for years through active surveillance, with regular PSA tests and scans. Our overview of prostate cancer explains the different treatment pathways.
Smart screening in practice
Smart screening brings several tests together, rather than relying on a single PSA result. It is aimed at men with risk factors, men with urinary symptoms and men who want to check their prostate health. Our article on smart screening for prostate cancer describes what the programme involves.
Who is at higher risk
Men at higher risk of prostate cancer include those with a father or brother who has had it, those with relatives who have had breast or ovarian cancer, and men of Black African or Black Caribbean heritage. Prostate Cancer UK offers an online risk checker and information on talking to your GP.
A message for men and families
The central lesson from Sir Chris Hoy's experience is that men with a strong family history should not wait for symptoms. Talking to a GP or specialist about PSA testing, and about whether further tests make sense, can lead to an earlier and more treatable diagnosis.
If you have a family history of prostate or breast cancer and would like to discuss testing, please contact the clinic to arrange a consultation with Professor Dasgupta.