Unlike breast or bowel cancer, there is no national screening programme for prostate cancer in the UK. Instead, men can choose to have a PSA blood test after talking it through with their GP. This is known as informed choice. It works best when men understand what the test can and cannot do.
How informed choice works
Any man over 50 can ask his GP for a PSA test, even without symptoms. The GP should explain the possible benefits and drawbacks first, so the decision is yours. Men at higher risk, such as Black men or those with a family history of prostate cancer, may want to have this conversation earlier. Our article on who is most at risk explains these factors.
The NHS page on the PSA test sets out the official guidance.
The possible benefits
A PSA test can:
- find cancer early: before it causes symptoms, when treatment is more likely to cure it
- give reassurance: a normal result, in the context of your risk, can be reassuring
- create a baseline: a first result makes later changes easier to interpret
- guide further checks: a raised level can lead to an MRI scan, which helps decide whether a biopsy is needed
For men with an aggressive cancer, early diagnosis can make a real difference to the outcome.
The possible drawbacks
The test also has limitations:
- False alarms: PSA can be raised by an enlarged prostate, infection or recent activity, not just cancer. This can cause worry and lead to further tests.
- Missed cancers: some men with prostate cancer have a normal PSA.
- Overdiagnosis: testing can find slow-growing cancers that would never have caused harm. Knowing about them can still cause anxiety.
- Overtreatment: in the past, some men had treatment for cancers that did not need it, with possible effects on continence and sexual function.
How modern practice reduces the drawbacks
Several changes have made testing more useful and less likely to cause harm.
MRI before biopsy: most men with a raised PSA now have an MRI scan first. A normal scan can mean a biopsy is not needed.
Targeted biopsies: when a biopsy is needed, it can be aimed at the suspicious area, which improves accuracy.
Active surveillance: men with low-risk cancer can often be monitored closely rather than treated straight away, avoiding side effects unless treatment becomes necessary.
Our guide to smart screening for prostate cancer explains how PSA, risk assessment and MRI can be combined.
Questions to ask yourself
When deciding, it can help to consider:
- How would I feel about a raised result that needs further tests?
- Do I have risk factors that make early detection more valuable?
- Would I want to know about a slow-growing cancer, even if it might not need treatment?
- Do I have urinary symptoms that need checking anyway?
There is no right or wrong answer. Prostate Cancer UK has a helpful decision tool that walks through these points.
Preparing for a PSA test
If you decide to go ahead, avoid ejaculation and vigorous exercise, including cycling, for 48 hours beforehand. Let your GP know if you have a urine infection, as the test is usually delayed until it clears. Our guide to the PSA test explains how results are read.
If your result is raised
A raised PSA is a reason for further assessment, not a diagnosis. Your GP may repeat the test or refer you to a urologist for an MRI scan. Our prostate cancer page explains the next stages.
Professor Prokar Dasgupta can talk through the pros and cons of testing with you and review any results at The London Clinic. Please contact the clinic to arrange a consultation.