To test or not to test: the merits of PSA screening for prostate cancer

Posted: 15/11/2016

Prostate cancer awareness comes to the fore every 'Movember' with publicity campaigns focused on men's health issues. Prostate cancer is the most common cancer among men, with around 40,000 new diagnoses a year. Research shows there are different causes of the disease and that some men are more susceptible than others. Risk factors include age, ethnicity and genetics, which means the cancer is often patient-specific and what works to diagnose and treat one patient may not be right for another. Testing for prostate cancer is therefore complex.

There has been much debate about the merits of testing for 'prostate specific antigen' - the 'PSA test'. A raised level of this antigen indicates there might be a problem with the prostate, but it is not definitive and there can be a number of explanations for a high PSA test result without meaning a patient necessarily has prostate cancer. On the other hand, there are some forms of prostate cancers that do not affect PSA levels at all and would not be suspected from a PSA test alone.

A recent report by the Academy of Royal Colleges therefore concluded that introducing a screening programme for all men in the population at large would not lead to longer life. We should focus on those patients already known to be at higher risk. Even so, at the moment there is no better alternative to the PSA test to detect potential problems in the prostate.

Andrew Clayton of Penningtons Manches' clinical negligence team explains: "There is no doubt that the PSA test is a blunt tool in the diagnosis of prostate cancer. Many would not benefit from a universal screening programme. Some prostate cancers would not be caught by the screening, giving false reassurance. Others may have a high PSA test result that leads to unnecessary stress, investigations and treatment for prostate cancer when in fact the high level of PSA might be nothing to do with prostate cancer.

"The PSA test does, however, still have a place, among men with known risk factors including age, ethnicity and family history, and in those who may be demonstrating signs of possible cancer. In advising clients, we know that PSA testing can be a useful indicator, albeit not conclusive. A high initial test result or a slow, steady increase in PSA levels over time should cause suspicion and lead to referral for further investigations as appropriate. As with most cancers, early diagnosis is key to improving outcomes and the PSA test still plays an important role."

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