Finding prostate cancer early, when it is easier to treat, is one of the most effective ways to reduce its impact. PSA testing has long been the main tool, but it has limits. Genetics is now adding another layer. This article answers common questions about the prostate cancer genetic risk score, known as a polygenic risk score, and how it can work alongside PSA.
Is the PSA test enough on its own?
The PSA blood test is an important tool for checking prostate health, but it is not perfect. Some aggressive prostate cancers do not raise PSA, so a result can look normal even when cancer is present. On the other hand, many men with a raised PSA never develop cancer, which can lead to unnecessary worry, scans and biopsies.
The NHS explains the benefits and limitations of PSA testing, and our overview of prostate cancer describes the main symptoms and tests.
Where does genetics come in?
Prostate cancer is one of the cancers most strongly linked to inherited risk. Your genes influence your risk even if you feel well and even if no one in your family has had the disease. Some men carry single gene changes with a large effect, such as BRCA2; our article on BRCA testing and prostate cancer covers these. Most inherited risk, however, comes from many small variations working together.
What is a polygenic risk score?
A polygenic risk score, or PRS, is a calculation based on many small variations in your DNA. Each variation has only a small effect, but together they give a picture of your personal risk of developing prostate cancer. The test is usually done once in a lifetime, often from a saliva sample collected at home, and the result can help guide how and when you should be checked.
Why does it matter?
Professor Dasgupta notes that men with a higher genetic risk can be up to three times more likely to die from prostate cancer if it is found late. If a man is known to be at higher risk, he can be monitored more closely, using MRI scans as well as PSA, to find any cancer early. Men at lower genetic risk may be able to avoid unnecessary tests and the anxiety that comes with them.
Is there evidence that it works?
Yes. The UK BARCODE1 study showed that polygenic risk testing identified higher-risk men who would have been missed by PSA testing alone. Research into how best to use genetic scores alongside PSA and MRI is continuing.
How can I access a test?
Polygenic risk tests for prostate cancer are available privately in the UK, for example through preventcancer.co.uk/prostate. These tests usually use a saliva sample and give you and your doctor guidance on how to approach monitoring (description accurate at time of writing). Discuss the result with a specialist, who can explain what it means alongside your PSA, family history and any symptoms.
Who might consider it?
A genetic risk score may be of interest if you:
- have a family history of prostate, breast or ovarian cancer
- are of Black African or Black Caribbean heritage, which is linked to higher risk
- want a clearer picture of your personal risk before deciding on PSA testing
- have had a borderline PSA result and want more information
What happens if my risk is high?
A higher score does not mean you have cancer. It means closer monitoring may be worthwhile, typically regular PSA tests and, where appropriate, MRI. Our article on smart screening for prostate cancer describes a structured approach to checking prostate health.
The bottom line
Professor Dasgupta's advice is simple: PSA is useful, but not enough on its own. Adding genetic risk to the picture can help find cancers earlier, focus monitoring on the men who need it most and spare others unnecessary tests. You can read more about his background.
If you would like to discuss your prostate cancer risk, please contact the clinic to arrange a consultation.