What to know about prostate cancer testing as NHS postcode lottery revealed
Prostate cancer testing on the NHS is experiencing something of a postcode lottery, a new study has suggested.
When it comes to testing men who have no signs of the disease research has found there is a "large variation" between GP surgeries across the nation.
The prostate-specific antigen (PSA) test is a blood test which is used to check for prostate conditions including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer. And men over the age of 50 can ask their GP for the test, even if they do not have symptoms.
But new research, analysing more than 9,800 records of men with prostate cancer from the 2018 English National Cancer Diagnosis Audit, has found there is a significant variation between GP surgeries in the proportion of men with no symptoms (asymptomatic) who are given the test.
Commenting on the findings lead author Dr Sam Merriel, from the University of Manchester and a practicing GP, said: "Inconsistencies in local, regional and national guidance mean it is really down to individual GPs to make decisions on which patients to test, how often to test, and what PSA thresholds warrant urgent referral for suspected cancer.
"These inconsistencies may be contributing to the variation in whether GPs are detecting prostate cancer in patients who do not have symptoms."
Following the results Prostate Cancer UK has called for guidelines to be changed so GPs can have "proactive" discussions with men at highest risk of disease about getting tested.
"This simple move would reduce the confusion for both men and GPs and save thousands of lives every year," Amy Rylance, assistant director of health improvement at Prostate Cancer UK said.
Prostate cancer is now the most commonly diagnosed cancer in England, overtaking diagnoses of breast cancer for two years in a row.
Prostate Cancer UK analysed NHS England data and found there were 55,033 prostate cancer diagnoses in 2023. In comparison, there were 47,526 breast cancer diagnoses in the same year.
Sir Chris Hoy announced his terminal cancer diagnosis last October, and urged men to make sure they ask for a check-up.
The Olympian, who was diagnosed with secondary bone cancer from prostate cancer in September 2023, said more men need to see their GP even if they are under the age of 50 - especially if they have a family history of prostate cancer.
Hoy is advocating for men to ask for the prostate-specific antigen (PSA) blood test, which can help diagnose prostate problems, including cancer.
A physical prostate exam is also commonly used to help diagnose the condition. This is known as a digital rectal examination (DRE).
What happens during a PSA test?
You can have a PSA test at your GP surgery. You may be recommended one if you’re worried about prostate problems, if you’re at increased risk of getting prostate cancer, or if you have symptoms such as problems urinating.
Prostate Cancer UK explains that, if you don’t have symptoms, your doctor or practice nurse should talk to you about the advantages and disadvantages of the test before you decide to have one.
If you decide to have one, your GP may suggest also undergoing a physical prostate exam and a urine test to rule out a urine infection. However, you can decide to have a PSA test alone.
The test involves taking a sample of your blood and sending it to a laboratory to be tested. The amount of PSA in your blood will be measured and it can take one to two weeks to get your test results.
PSA is a protein produced by normal cells in the prostate, but also by prostate cancer cells. It’s normal to have a small amount of PSA in your blood, and as you get older and your prostate gets bigger, the levels rise slightly.
However, a raised PSA level may suggest you have a problem with your prostate. It may not necessarily be cancer, but your doctor can help investigate it further.
Who can have a PSA test?
Men over the age of 50 can request a PSA test from their GP. GPs are currently told to use their clinical judgment for men aged under 50 without symptoms who they consider to be at increased risk of prostate cancer.
But Hoy is calling for the age limit for requesting a PSA test to be lowered. He said: "Maybe people seeing this or hearing my story - just by them asking their GP - will create enough of a surge of interest that people that make the decisions will go, ‘You know what, we need to address this’. And in the long term this will save potentially millions of lives."
Following Hoy’s comments, the health secretary Wes Streeting has ordered the NHS to review its guidance on testing for prostate cancer.
What happens during a physical prostate exam?
You may be recommended a prostate exam to check for any problems with your prostate. You can ask for a man or woman doctor if you prefer, and you can have someone else in the room, such as a family member.
During the examination, the doctor or nurse will ask you to take off your clothes on your lower half, including underwear, according to Cancer Research UK.
You will be asked to lie down on your left hand side, with your knees brought up towards your chest.
The doctor or nurse will put on gloves and put lubricating gel on their finger. They will then put their finger inside your rectum and feel your prostate.
They will feel for anything unusual, such as your prostate feeling larger than it should for your age, or for anything lumpy or hard.
Once the exam is over, you can get up and get dressed. Your doctor will then discuss the results of the examination with you.
Your GP may refer you for more tests or refer you to a specialist after the examination if something is unusual. You can leave as soon as you’re ready.
Read more about cancer:
The UK’s most common cancers, as prostate cases soar by 25% (Yahoo Life UK, 6-min read)
'Urgent research needed' after rise in cancer rates in younger people (Sky News, 2-min read)
Five lifestyle changes to cut your risk of cancer (Yahoo Life UK, 6-min read)
