Prostate Cancer Screening Services at Cardiff and Vale Hospitals

What is prostate cancer screening?

Prostate cancer screening means testing men who don't have any symptoms to check for early signs of prostate cancer, usually with a prostate specific antigen (PSA) blood test. There's no national screening programme for all men in the UK, though a new targeted programme for men at very high genetic risk is being introduced from 2027.

Why might I need it?

You might be offered, or choose to have prostate screening for a few different reasons.

From 2027, targeted screening will be offered in England to men aged 45 to 61 who have a known BRCA2 gene change and a family history of breast, ovarian, pancreatic or prostate cancer, because this group is more likely to develop a fast-growing prostate cancer.

Outside this programme, you can ask your GP for a PSA blood test if you're 50 or older, or 45 or older with a strong family history of prostate cancer, or if you're black or of Afro-Caribbean ethnicity, since these groups are at higher risk. Men of any age with urinary symptoms, such as difficulty starting to urinate or a weak stream, should see their GP for a full assessment, rather than just a PSA test.

What are the benefits of having it?

For most men, the evidence on benefit is mixed. Modelling by the UK's National Screening Committee found that for every 1,000 men screened in their 50s, testing would prevent around 2 deaths from prostate cancer over the next 15 years, but at the cost of significant overdiagnosis. This is why screening isn't offered to all men in the UK.

For men with a BRCA2 gene change and a relevant family history, the evidence is stronger, since this group is more likely to develop prostate cancer that grows quickly and needs treatment. Finding this earlier can mean starting treatment while it's still curable.

Are there different types of test?

The main screening test is the PSA blood test, which measures the level of a protein called PSA in your blood.

You may have heard that a digital rectal examination (DRE), where a doctor examines your prostate with a gloved finger, is part of prostate testing. This is no longer recommended as a standalone screening test on its own, though it may still form part of a wider assessment if you have symptoms.

If your PSA level is raised, you may be offered further tests such as an MRI scan and a biopsy to confirm whether cancer is present, since the PSA test on its own can't give a diagnosis.

How do I prepare for the test?

Before your test, it's worth thinking through the pros and cons of PSA testing with your GP, since the test isn't perfect and can lead to further tests you might not need.

On the day, avoid vigorous exercise, such as cycling, and avoid sex or masturbation for 2 days beforehand, as these can affect your result.

What happens during the test?

Having a PSA test is straightforward. A small sample of blood is taken from a vein, usually in your arm, and sent off to measure the level of PSA in it.

What happens after the test?

You should get your results within 1 to 2 weeks. Contact your GP surgery or the hospital where you had the test done if you haven't heard anything after a few weeks.

If your PSA level is raised, your doctor may look at it alongside your medical history and any previous results, since things like a urine infection or a benign enlarged prostate can also raise it.

You might be offered a repeat PSA test to check if the level is still high, and if it is, your GP may discuss referring you to a urologist for further tests, such as an MRI scan or biopsy.

If you're part of the targeted screening programme, you'll usually be invited for a PSA test every 2 years.

What are the risks?

The PSA test isn't perfect and carries some real downsides:

• around 15 in 100 men with a normal PSA result actually have prostate cancer that the test missed
• around 72 to 80 in 100 men with a raised PSA result turn out not to have cancer at all
• some men are diagnosed with a slow-growing cancer that would never have caused them harm, known as overdiagnosis.

Modelling by the UK's National Screening Committee estimated that for every 1,000 men screened in their fifties, 20 would be told they have a cancer that would never have needed treatment, and 12 of those would go on to have treatment that could cause side effects such as erectile problems or incontinence, without any real benefit.