Our ultimate guide to the pros and cons of prostate cancer screening: We reveal why some doctors are opposed to mass testing, who SHOULD ask for a check and the truth about the risks

On paper, it seems like a perfectly rational suggestion. Recommend that all middle-aged men get tested every few years to determine their risk of prostate cancer, the most common cancer in men, with about 63,000 diagnoses and 13,000 deaths annually.

A national screening program, such as the regular mammograms offered to women to check for breast cancer, could catch cases earlier before the cancer has a chance to spread.

As a result, campaigners say countless lives could be saved every year.

This is something doctors and advocates are increasingly demanding; This includes Olympic cyclist Sir Chris Hoy, who was diagnosed with terminal prostate cancer without any symptoms in September 2023, aged just 48.

But according to reports circulating last week, the Government is preparing to implement its proposal for a national prostate cancer screening programme.

Moreover, many doctors agreed, arguing that prostate screening could harm patients by subjecting them to unnecessary tests and procedures. So what is the truth?

The Mail on Sunday spoke to some of the country’s leading prostate cancer experts to find out.

Q Prostate cancer screening seems like a very simple task. So why do some doctors against it?

A. The main method to be used in a screening program is called the PSA test.

This measures levels of a protein called prostate-specific antigen. A high PSA score indicates that the prostate, a small gland located below the bladder, is not working as it should. However, this is not always a sign of cancer. PSA can be elevated due to an enlarged prostate, infection, recent sexual activity, or even cycling.

However, men with suspicious results are often sent for scans to determine the cause.

Currently, any man over the age of 50 can request a PSA test from his doctor if he is concerned about prostate cancer. But experts fear that routinely administering the test to all men over a certain age would trigger a large number of false-positive results.

Until recently, this meant that many men were subjected to needlessly invasive biopsies. Today, most people are first referred for an MRI scan, which, like an X-ray, allows doctors to see inside the body with minimal risk. Despite this, concerns continue.

Professor Roger Kirby, retired prostate surgeon and president of the Royal Society of Medicine, says: ‘As PSA is not a particularly accurate marker for cancer, many men with worrying results are sent for expensive MRI scans, which for most are completely normal. ‘This is an unnecessary drain on resources.’

However, Professor Nicholas James, Professor of Prostate and Bladder Cancer Research at the Institute of Cancer Research, adds: ‘There have been numerous trials where half the male population were given a PSA test and half were not. ‘The one thing we have learned is that if you refer men with high PSA levels for further testing, you will find cancer.’

He says the current National Screening Committee proposal is based on outdated data. ‘The committee is looking at the same data set it used when rejecting a similar proposal five years ago. But new studies have shown different results.

‘A large trial conducted in Europe has found that you can reduce the risk of death from prostate cancer by having regular PSA tests.

‘And a recently published 15-year follow-up showed that

the benefit actually increases over time. Men who were not screened continued to die. ‘Those who did didn’t do it.’

Question If screening only means blood tests and MRIs, could this do more harm than good, as some claim?

A. About half of men with high PSA who present to the clinic receive normal MRI results and are sent home.

But others whose scans appear abnormal go on to have a biopsy, in which a needle is inserted into the prostate to remove small samples of tissue for testing.

Rectal exams are no longer routinely used to check for prostate cancer.

Although diagnostic tests rarely cause permanent damage (except for the occasional infection or the stress of waiting for results), prostate cancer treatment can.

Professor Kirby explains: ‘The problem with early detection is that as men get older many develop small prostate cancers that can be detected by screening but never cause problems.

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‘Prostate surgery to remove part or all of the prostate will inevitably alter sexual function. ‘Some patients will be left with lifelong problems after a cancer treatment that will probably never harm them.’

Professor James says the risk of overtreatment should not deter men from having a PSA test.

‘Having a high PSA doesn’t mean you have prostate cancer or even need treatment, but it does allow you to make more informed decisions about your health. ‘By the time prostate cancer symptoms appear, in most cases it is too late to do anything.’

Q Stories like Sir Chris Hoy’s are worrying but now I’m reading that a national screening scheme might be a bad idea. Should I bother to get tested?

A. Professor James says men should not be swayed by medical debates.

He emphasizes that the important thing to understand is that the National Screening Committee does not decide whether men should have a PSA test.

Its mission is to evaluate whether a nationwide screening program could save enough lives to justify the cost; This inevitably means diverting funds from elsewhere in the NHS.

‘The question for men considering having a PSA test is whether it is in their best interest, and I would recommend that it is,’ Professor James said.

‘On the other hand, whether offering PSA tests as part of a national screening program is the best use of NHS money is an entirely different question.’

Question: If there is no national screening program, who should order the test?

A. Some men are more likely to get prostate cancer than others. There are certain genetic mutations that increase women’s risk of breast and ovarian cancer, such as the BRCA1 and BRCA2 genes; These mutations, along with a family history of the disease, can make men more vulnerable.

Ethnicity also plays a role: Black men are more likely to get prostate cancer and do it earlier. Approximately one in four black men in the UK will be diagnosed at some point in their lives.

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Professor James says everyone in these groups should have a PSA test as soon as they are eligible.

PSA tests are available upon request to men over 50, while black men over 45 may be offered PSA tests. You don’t need symptoms to order testing, and your doctor can’t refuse after discussing the risks and benefits.

However, a recent Healthwatch study revealed that more than 60 percent of men aged 50 and over do not request a PSA test.

‘If you are between the ages of 50 and 65, you should have a PSA test, even if you are in good health,’ Professor James said.

‘It’s like knowing your blood pressure; A high reading doesn’t mean you’ll have a heart attack, but it does allow you to manage the risk.’

Q I am in good health and have no risk factors – should I still get tested?

A. Professor Kirby says regular PSA testing may be less necessary if you don’t meet any of the high-risk criteria.

‘Those with a family history of the disease or those of Afro-Caribbean descent should have a PSA test every year,’ he adds.

‘For men who do not have these risk factors, testing approximately every five years will probably be sufficient.

‘Treat this like you would monitor blood pressure or cholesterol; determine baseline PSA and keep an eye on it. If it rises, you can investigate further.’

Both experts agree that the only men who don’t need to bother at all are those with multiple serious health problems, such as heart disease.

‘The chance of dying from a heart attack is much higher than the chance of dying from prostate cancer,’ says Prof Kirby. ‘For those with limited life expectancy this is probably a waste of time.’

Question: If a national screening program were initiated, what would it look like?

A. While it seems unlikely that all men will be screened on the NHS, there are ways to increase the numbers tested.

Rolling out national screening for those at highest risk would cost the NHS just £18 per patient and require just five additional MRI scanners, according to a new report by the charity Prostate Cancer Research.

Its authors claim that the proposed program offering annual prostate testing to all men ages 45 to 69 who have a family history of the disease or are black could give these men a collective 1,254 extra years of life each year.

Professor James says this type of targeted screening is probably the most effective option.

‘Men who get tested for prostate cancer now tend to be white, middle class and college educated,’ he says.

‘Those who don’t tend to be working class or people of color; These groups are more likely to be affected in the first place.

‘A targeted approach will, to some extent, prevent us from spending so much money testing the wrong people – people who already know their way through the system.’

But Professor Kirby says the future of prostate cancer screening likely lies in an even more personalized process: genetic testing.

‘We can measure people’s individual susceptibility by looking at their genome and target PSA and MRI scanning accordingly,’ he says. ‘These tests are still in development and will not yet be ready for NHS roll-out; but this is truly the holy grail.’

I was lucky: strive to take the exam

Junior Hemans was 52 when he first asked his GP for a PSA test, seven years after he became eligible.

The Wolverhampton-based property developer had no symptoms but had seen scores of men in his community succumb to prostate cancer.

‘I heard that the rate of prostate cancer in black men is one in four,’ he said. ‘I just felt the need to look.’ The results came a few days later: His PSA was high for his age and he was referred to hospital.

After an MRI and a second PSA test, doctors decided to keep him under observation.

Five years later, he was diagnosed with early-stage prostate cancer. He underwent radiotherapy and is now 62 years old and cancer-free. ‘I tell men, the sooner you test, the more of you will be saved,’ he said.

‘If you present late, when the cancer is more advanced, you will need to cut out more of the prostate, causing more damage.

‘I was very lucky to catch mine early; But other men also need to have a PSA test as soon as possible.’