The Department of Health and Social Care has issued updated guidance that could affect men over the age of 50 seeking Prostate-specific Antigen (PSA) tests. Previously, men in this age group could request a PSA test from their GP regardless of symptoms, but the new advice grants GPs discretion in deciding whether such tests are appropriate.
The PSA blood test is designed to detect prostate cancer even in its earliest stages, often before symptoms appear. Prostate cancer is the most common cancer among men in the UK, though there is no nationwide screening programme currently in place. Earlier this year, the UK’s National Screening Committee recommended against broad screening, suggesting instead targeted testing for men at highest risk due to potential harm caused by widespread testing.
David James, director of patient projects and influencing at Prostate Cancer Research, expressed concern over the change, describing it as a “shocking betrayal and backward step” that could lead to more late-stage diagnoses.
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Prostate cancer typically develops slowly and rarely shows symptoms early on. When symptoms do occur, they commonly affect urination, including difficulty starting or stopping, weak flow, or increased frequency. Other symptoms can include erectile dysfunction, blood in urine or semen, lower back pain, or unexplained weight loss. The NHS advises men experiencing any of these signs to consult their GP promptly.
The NHS also points out that such symptoms do not necessarily indicate cancer and may result from a non-cancerous enlarged prostate, a common condition as men age. GPs may decide to offer a PSA test based on symptoms, which can highlight potential prostate issues though it is not a definitive cancer test. Elevated PSA levels often lead to further investigations to determine the cause.
Risk factors for prostate cancer include age over 50, having a Black African or African Caribbean background, a family history of prostate cancer, or close relatives with certain types of cancer diagnosed at a young age.
A Department of Health spokesperson explained that the previous guidance was withdrawn because it was ambiguous, clarifying that the intention has always been for GPs to make the final decision on PSA testing. They emphasised that men retain the right to request a PSA test, and the updated guidance merely directs GPs to the latest information to aid their clinical judgement.