{"id":4604,"date":"2025-04-08T07:35:11","date_gmt":"2025-04-08T07:35:11","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/4604\/"},"modified":"2025-04-08T07:35:11","modified_gmt":"2025-04-08T07:35:11","slug":"why-every-over-50-man-must-be-screened-for-prostate-cancer-now-experts-reveal-whod-be-tested-at-what-age-and-how-to-minimise-the-shattering-side-effects","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/4604\/","title":{"rendered":"Why every over-50 man MUST be screened for prostate cancer: Now experts reveal who’d be tested, at what age… and how to minimise the shattering side-effects"},"content":{"rendered":"

It\u2019s 37 years since breast cancer<\/a> screening was introduced in the UK to save women\u2019s lives. Yet men still don\u2019t have access to a national screening programme for prostate cancer \u2013 despite the fact that the disease, which affects the doughnut-shaped gland that sits around the urethra, has now become the most common cancer in England.<\/p>\n

The first step in checking the prostate is currently a prostate-specific antigen (PSA) test, a blood test for a protein produced by the prostate gland \u2013 levels usually rise in prostate cancer.<\/p>\n

Diagnosis is then confirmed after an MRI scan, followed by a biopsy. But this is only if a man has symptoms (such as an increased need to pee and poor flow).<\/p>\n

If you\u2019re over 50 and don\u2019t have symptoms, the only way you can get a PSA test is by asking for it. And even then, your GP can turn you down \u2013 a study last year by the charity Prostate Cancer Research found that more than half of those surveyed had problems getting a PSA test, with 39 per cent of them saying their GP was reluctant to offer it.<\/p>\n

The main problem is the long-standing argument that PSA is an unreliable screening tool, as PSA levels rise with age and can be affected by numerous factors, including infection and even a bike ride (intense cycling can increase PSA levels for up to 24 hours).<\/p>\n

All may lead to false positives, resulting in unnecessary, invasive investigations and even treatments. Indeed, research has suggested the risks outweighed the benefits \u2013 including the largest study to date looking at PSA testing, the Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP) \u2013 published in the journal JAMA last April.<\/p>\n

This found there was only a tiny improvement \u2013 less than 1 per cent \u2013 in the risk of dying from prostate cancer over the 15-year study timeframe in men who were screened with a PSA test compared with no screening at all. It\u2019s this kind of evidence that has stood in the way of a screening programme.<\/p>\n

Yet weighed against this are the results of other studies, such as the European Randomised Study of Screening for Prostate Cancer, published in 2019, which found that men screened with PSA testing had a 20 per cent lower risk of dying from prostate cancer than men who weren\u2019t screened.<\/p>\n

\"If <\/p>\n

If you\u2019re over 50 and don\u2019t have symptoms, the only way you can get a PSA test is by asking for it. And even then, your GP can turn you down<\/p>\n

\u2018This study was a very well-designed study which followed scientific principles and got accurate results, unlike the CAP trial,\u2019 says Nick James, a professor of prostate and bladder cancer research at the Institute of Cancer Research in London.<\/p>\n

The UK\u2019s National Screening Committee (NSC) is due to publish its next review on prostate cancer screening at the end of this year. It comes as many experts \u2013 backed by a new Daily Mail campaign \u2013 argue that it\u2019s time for a rethink.\u00a0<\/p>\n

\u2018The evidence in favour of introducing routine screening for prostate cancer has been pretty strong for a number of years and the weight of public opinion is also shifting behind it,\u2019 says Chris Eden, a professor of urology at the University of Surrey. \u2018I\u2019ve seen too many cases where men have discovered their disease too late and treatment options are very limited.\u2019<\/p>\n

\u2018I would support nationwide screening for men if it could be targeted and properly planned,\u2019 adds Mike Kirby, a physician and the President of the British Society for Sexual Medicine.<\/p>\n

The top expert who changed his mind\u00a0 <\/p>\n

Nick James does not have symptoms \u2013 but the professor of prostate and bladder cancer research at the Institute of Cancer Research in London, who is now 65, has been having regular PSA tests since his late-50s.<\/p>\n

\u2018I really recommend getting PSA tests done because it is a good indicator that something may be wrong,\u2019 he says.\u00a0<\/p>\n

But he didn\u2019t always think this way. \u2018I left it so long as I was worried about over-diagnoses and over-treatment leading to side-effects such as sexual dysfunction.\u2019\u00a0<\/p>\n

What changed his mind? \u2018Data in the last decade with MRI scans shows that they are highly accurate at detecting the size and grade of prostate tumours.\u2019\u00a0<\/p>\n

Now he\u2019d recommend that SOME men start getting screening PSA blood tests as early as their mid-40s for high-risk groups such as black men or those with a strong family history.<\/p>\n

\u2018There is no harm in knowing your risk so you can take action,\u2019 he adds.<\/p>\n

\"Nick <\/p>\n

Nick James,\u00a0professor of prostate and bladder cancer research at the Institute of Cancer Research in London, recommend some men start getting screened in their mid-40s<\/p>\n

\u2018As well as it being cost-saving to detect the disease as early as possible, earlier diagnosis means better outcomes in terms of quality of life, in particular reducing side-effects such as incontinence and erectile dysfunction.\u2019<\/p>\n

Professor Kirby argues for \u2018risk-adapted\u2019 screening \u2013 essentially treating each man as an individual based on his risk of getting prostate cancer according to his PSA \u2018baseline\u2019 \u2013 then inviting him back to have regular tests at longer or shorter intervals. He says this is more efficient than applying the same gap between screening to all men.<\/p>\n

Supporters of screening add that technological developments mean it\u2019s now possible to avoid many of the risks previously associated with prostate screening.<\/p>\n

For example, many men who are referred to NHS clinics for tests after having high PSA tests are now routinely offered MRI scans, (which can identify a tumour and indicate the likely grade \u2013 how aggressive it is) so avoiding unnecessary invasive biopsies.<\/p>\n

Professor James says: \u2018In my clinic at the Royal Marsden, for example, we do an MRI and if it\u2019s normal we often decide not to take a biopsy at all. In the past, most men had to have a biopsy.\u2019\u00a0<\/p>\n

New screening options are being assessed in the TRANSFORM trial, led by Imperial College London, involving hundreds of thousands of men aged 50 to 75, as well as black men aged from 45.<\/p>\n

These include short MRI scans (which do not need to be conducted in a hospital setting; more on this later).<\/p>\n

Although some experts are keen to see a national screening programme launched as soon as possible, Professor Hashim Ahmed, chair of urology at Imperial, who is leading the TRANSFORM trial, hopes the NSC will wait for the results before reaching a decision.<\/p>\n

He says: \u2018We need to be sure we\u2019re not going to create a huge amount of harm by screening for prostate cancer and while there is a need to reduce the mortality rates, we don\u2019t yet know if screening will make a huge difference.\u2019<\/p>\n

The data may take years, however. Professor Kirby is among those who believe that a national screening programme that targets high-risk men \u2013 those from black ethnic backgrounds, for example (one in four will get the disease, double the risk of white men) and those with a family history of the disease \u2013 should get the go-ahead as soon as possible.<\/p>\n

\u2018The TRANSFORM trial has only just started and may take a while to deliver results which I think is too long for men to wait.\u2019 But what would a screening programme look like? Here, leading experts explain all.<\/p>\n

WHAT\u2019S THE BEST WAY TO OFFER SCREENING?<\/p>\n

The experts largely agree that a national screening programme would ideally involve a short MRI and a PSA test at the age of 45 \u2013 as a \u2018baseline\u2019 PSA.<\/p>\n

Thereafter, the man would have follow-ups, every five years for men at low risk of the disease (ie their PSA was below 0.5ng\/ml at age 45), or every three years or annually for men at medium (PSA 1-3ng\/ml at age 45) to high risk (above 3ng\/ml), suggests Professor Kirby.<\/p>\n

PSA rises naturally with age, so for older men the baseline rises. According to guidance from the National Institute for Health and Care Excellence, up to age 49, the cut-off for further investigation is a reading of 2.5ng\/ml; 50-59, it\u2019s 3.5; 60-69, 4.5; 70-79, 6.50.<\/p>\n

\"Prostate <\/p>\n

Prostate cancer affects the doughnut-shaped gland that sits around the urethra<\/p>\n

Short MRI scans, also known as prostagrams or biparametric MRIs, take a third of the time as standard MRI scans \u2013 15 to 20 minutes compared with 30 to 40 minutes (they take two sequences of images, rather than three).\u00a0<\/p>\n

Studies show they are reliable \u2013 most recently, in February the journal European Urology reported that short MRI scans allowed radiologists to correctly identify tumours in 88.6 per cent of cases compared with 89.4 per cent for standard MRIs.<\/p>\n

\u2018We know that PSA tests can be unreliable, but the short MRI combined with PSA tests does appear to boost accuracy and reduce false positives, and could be used in a national screening programme,\u2019 says Professor Kirby.\u00a0<\/p>\n

A study in the journal BMJ Oncology in 2024 found that the MRI can pick up significant cancerous changes before PSA levels start to rise, offering an opportunity for early detection.<\/p>\n

WHEN WOULD SCREENING START AND STOP?<\/p>\n

Initially, the thinking is that a national screening programme would be focused on men who are at higher risk, because of their ethnicity or strong family history of prostate cancer, for example, from the age of 45 (black men are more likely to get prostate cancer at a younger age; for other men the risk increases from the age of 50, says Prostate Cancer UK).\u00a0<\/p>\n

This is what the Mail campaign is calling for.<\/p>\n

\u2018This would certainly be much less costly and would target the main effort on those men most at risk,\u2019 says Professor Kirby.<\/p>\n

\u2018Screening would probably stop at around the age of 70 because cancers detected after that are usually very slow growing\u2019, he adds. NHS breast cancer screening ends when a woman is 71, although a woman can request mammograms after that.)<\/p>\n

WHERE WOULD THE SCREENING BE DONE?<\/p>\n

In some pilot schemes in Europe (see panel, right) men are being sent DIY PSA tests to do at home.<\/p>\n

\u2018There\u2019s no doubt that a PSA test should ideally be done by a health professional such as a practice nurse or GP,\u2019 says Professor Kirby.\u00a0<\/p>\n

Short MRIs could be done in a hospital or pop-up clinic, as with mammograms.<\/p>\n

\"\u00bfThe <\/p>\n

\u2018The evidence in favour of introducing routine screening for prostate cancer has been pretty strong for a number of years,\u2019 says Chris Eden, a professor of urology at the University of Surrey<\/p>\n

WHAT ARE THE RISKS INVOLVED?<\/p>\n

\u2018The downside of screening is always said to be over diagnosis and over treatment due to unreliable tests,\u2019 says Professor Eden.<\/p>\n

In other words, men undergoing invasive treatments they don\u2019t need either because their cancer was never life-threatening \u2013 or they didn\u2019t have cancer at all.<\/p>\n

\u2018However, that argument is getting weaker \u2013 and ignores the risk of under diagnosis and under treatment, which is death,\u2019 says Professor Eden.<\/p>\n

Professor James agrees, adding: \u2018Screening can also lead to false negatives, leading to the possibility of the problem not being detected in its early stages.\u2019<\/p>\n

When it comes to PSA, Professor Eden says: \u2018Research has shown it\u2019s actually accurate when it comes to predicting a man\u2019s future risk of prostate cancer when it\u2019s done as a baseline test at 45.\u2019<\/p>\n

COULD THE NHS COPE WITH WORKLOAD?<\/p>\n

There are concerns about whether the NHS, and GPs, will be able to cope with the increased workload.\u00a0<\/p>\n

Professor James says: \u2018At the moment PSA testing falls to GPs. As with some other\u00a0screening programmes, a prostate cancer screening programme could take work off GPs.\u2019<\/p>\n

However, without proper measures in place, a screening programme could soon clog up a health system already at maximum capacity \u2013 \u2018any service expansion would need to be properly planned to avoid this, it could not be switched on overnight\u2019, says Professor James.<\/p>\n

And there is a shortage of MRIs and trained staff \u2013 increased demand for prostate MRI meant that in 2019, only 62 per cent of men in England and Wales who needed one received a prostate MRI.<\/p>\n

Artificial intelligence (AI) to interpret scans could help, says Professor James:<\/p>\n

\u2018We already use AI to assess mammograms. This would also help deal with the NHS shortage of radiologists who can assess scans \u2013 key if we are to expand early diagnosis programmes.\u2019<\/p>\n

As for the financial cost, a recent report by Prostate Cancer Research calculated that, while a national screening programme would have an economic cost to implement, early diagnosis of prostate cancer could potentially save more than \u00a3200million, driven by improved patient outcomes.<\/p>\n

\"Professor <\/p>\n

Professor Hashim Ahmed, chairman of urology at Imperial, who is leading the TRANSFORM trial, hopes the NSC will wait for the results before reaching a decision<\/p>\n

WILL I NEED A DIGITAL RECTAL CHECK?<\/p>\n

Many men are put off the idea of prostate checks because they fear they have to have a digital rectal examination (DRE).<\/p>\n

A survey of more than 2,000 men by Prostate Cancer UK in 2023 found that 60 per cent were concerned about having it, with 37 per cent of them reporting they would not speak to a GP about prostate worries because of the check.<\/p>\n

\u2018The fact that many men don\u2019t like the idea is a major drawback with the DRE,\u2019 says Professor Kirby.<\/p>\n

\u2018And it only allows for the clinician to feel the back wall of the prostate, so any abnormalities located in the middle or front part of the gland can\u2019t be felt.\u2019<\/p>\n

In 2022 the British Journal of General Practice reported that DRE wasn\u2019t reliable and probably does more harm than good \u2013 and that these days many doctors forgo them.<\/p>\n

\u2018It is likely that the DRE will be discontinued as an unnecessary and invasive test,\u2019 says Professor Kirby.<\/p>\n

Professor Eden adds that DREs are culturally unacceptable in some communities, and could impact take up of any screening programme.<\/p>\n

WHY DON\u2019T THEY USE THE NEW BLOOD TEST?<\/p>\n

There are a number of new tests, including the EpiSwitch PSE, which is done following a PSA test and measures five markers and combines these with the patient\u2019s PSA score. It claims to boost accuracy from 55 per cent to 94 per cent.<\/p>\n

But Professor Kirby says: \u2018It can take months to get results back for genetic tests from NHS laboratories and tests identifying multiple biomarkers can be very expensive. So they\u2019re unlikely to form part of a national screening programme.\u2019<\/p>\n

THE COUNTRIES WHERE MEN ARE ALREADY SCREENED <\/p>\n

Cancer screening saves lives. It\u2019s one of the most effective ways to detect early signs of the disease.<\/p>\n

But for prostate cancer, which has overtaken breast cancer as the most common cancer in England, there is no screening programme.<\/p>\n

The UK National Screening Committee, which advises the Government on new screening programmes, last reviewed the evidence for prostate cancer in November 2020. It is now looking at it again, with a decision due by the autumn.<\/p>\n

Campaigners say the case for such a programme is strong \u2013 and similar schemes are already being piloted across the world.<\/p>\n

Currently in the UK, screening for prostate cancer (if you don\u2019t have symptoms) is pretty ad hoc.\u00a0<\/p>\n

Under the NHS guidelines, any man aged 50 and over can \u2018make an appointment with their GP to discuss having the prostate specific antigen (PSA) test\u2019.<\/p>\n

\u2018But this relies on an individual\u2019s knowledge, every man knowing their own risk,\u2019 says Dr Matthew Hobbs, director of research at Prostate Cancer UK.\u00a0<\/p>\n

\u2018GPs are not permitted to raise the subject, nor can they invite men for a test.\u2019<\/p>\n

A \u00a342million research programme named the TRANSFORM trial is looking at the best way to screen men for prostate cancer.\u00a0<\/p>\n

But there won\u2019t be significant new evidence for around three years.<\/p>\n

Yet some countries already offer screening, with trials being rolled out across Europe.<\/p>\n

In the Czech Republic, all men aged 50-59 are being offered a PSA test via their GP, under a five-year pilot programme introduced last year.<\/p>\n

Depending on the test results, the GP either follows up with another PSA test in four years, a test in two years, or an MRI and a referral to see a urologist if necessary.<\/p>\n

In Croatia, men aged 50 and older are offered opportunistic screening during a health examination or routine medical visit. This is the same for men aged 50 to 75 in Lithuania when they visit their GP.<\/p>\n

Meanwhile, pilot schemes are being tested across Europe.\u00a0<\/p>\n

Typically, these aim to target those who are most at risk due to family history or ethnic background and then give them a PSA, followed by MRI scans if results are raised.<\/p>\n

In Ireland, for instance, around 8,000 men aged 50 to 69 living in Dublin and Waterford will be randomly selected to take part in a study over the next nine to 12 months, where they will receive a home-based PSA test kit. Men will go on to be scored by their PSA level and whether they have other risk factors such as a family history or black ethnicity.<\/p>\n

Anyone with low risk will be retested in the future. Those with raised PSA or risk factors will have a detailed MRI scan to check for tumours.<\/p>\n

Here is what is currently offered elsewhere in the world:<\/p>\n

While there is no national screening programme in France, PSA testing is widely used. One 2024 study published in the Journal European Urology Oncology found that 50 per cent of men aged 50 to 75 had received at least five PSA blood tests.<\/p>\n

Men aged 45 in Germany\u00a0are offered a digital rectal exam and an examination of the penis and testicles.\u00a0<\/p>\n

But now an ongoing trial, which started in 2014, is looking at different prostate cancer screening\u00a0protocols. In the latest phase, men aged 45 are being given PSA tests and depending on their scores are then offered either a second PSA test at 50 or an MRI and biopsy immediately.<\/p>\n

In Sweden, men aged 50 are invited for prostate cancer testing in a pilot scheme. Depending on their PSA scores, men are then invited for another PSA test after six years, two years or referred for an MRI scan and a biopsy. The programme has been running in the three most populated regions since 2020 and in others since 2022.<\/p>\n

Screening is recommended to all men aged 50 to 69 in Australia, and those with a family history should be offered PSA testing every two years from 40 to 45.<\/p>\n

Charlotte Dovey\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"It\u2019s 37 years since breast cancer screening was introduced in the UK to save women\u2019s lives. Yet men…\n","protected":false},"author":2,"featured_media":4605,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[92,393,105,211,16,15],"class_list":{"0":"post-4604","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-dailymail","9":"tag-england","10":"tag-health","11":"tag-nhs","12":"tag-uk","13":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114301195065781665","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/4604","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=4604"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/4604\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/4605"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=4604"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=4604"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=4604"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}