Recent guidance issued by the Department of Health and Social Care may alter the way men over 50 access prostate-specific antigen (PSA) tests. Previously, men in this age group could request a PSA blood test from their GP without needing to show symptoms. However, the updated advice gives GPs discretion to decide if a test is appropriate, potentially reducing automatic PSA testing in symptom-free patients.
The PSA test is capable of detecting prostate cancer in its early stages, often before symptoms appear. Despite being the most common cancer among men in the UK, there is currently no nationwide screening programme for prostate cancer. Earlier this year, the National Screening Committee reported that widespread screening could cause more harm than benefit, recommending a targeted approach focussing on men at highest risk.
David James, director of patient projects and influencing at Prostate Cancer Research, criticised the changes, stating to the Telegraph that it is a “shocking betrayal and backward step” that may result in more men receiving late and incurable diagnoses each year.
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Prostate cancer usually develops slowly and symptoms tend to arise only in later stages. Common signs relate to urinary issues, including increased frequency, difficulty urinating, or a weak flow. Other symptoms include erectile dysfunction, blood in urine or semen, lower back pain, or unexplained weight loss. Men experiencing these are advised to consult their GP promptly.
NHS guidance points out that such symptoms do not necessarily indicate cancer, as they may be caused by benign prostate enlargement, which commonly occurs with ageing. Nonetheless, it emphasises the importance of medical evaluation if symptoms worsen or feel abnormal.
A GP may recommend a PSA test, which does not directly diagnose cancer but can indicate potential prostate problems. Elevated PSA levels may lead to further investigations to differentiate prostate cancer from other conditions such as infection.
Risk factors for prostate cancer include age over 50, Black African or Caribbean heritage, family history of prostate cancer, and close relatives with certain other cancers, particularly at a young age.
A spokesperson from the Department of Health and Social Care explained that the previous guidance was retired due to ambiguity and reassured that men retain the right to request PSA testing, with the final decision resting with their GP. The letter accompanying the new guidance was intended to direct healthcare professionals to the latest information.