Charity calls for change to prostate cancer testing guidelines

Men at a higher risk of prostate cancer should be given the option to have a test by their GP even if they have no symptoms, a charity has said, as it warned current NHS guidelines are “driving late diagnosis”.

It comes after two trials showed tests that measure prostate specific antigen (PSA) in the blood “reduce the number of men who die” from the disease.

PSA tests have previously been deemed unreliable as they can result in patients without cancer having further tests and treatments they do not need, such as invasive biopsies.

At the moment, doctors offer PSA tests to men with prostate cancer symptoms, but cannot proactively offer them to high-risk men with no symptoms, such as men over 50, black men and men with a family history of the disease.

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: “Current guidelines mean it’s up to men to ask about a PSA blood test.

“That practice is undoubtedly driving late diagnosis of prostate cancer, and massive inequality across the UK.

“Historically, the evidence that PSA testing saved lives was weak and there was strong evidence that testing caused harm.

“Now, the situation has changed; we have strong evidence from two separate trials that PSA testing does reduce the number of men who die from prostate cancer.”

To measure the impact of new scans and tests, researchers analysed data from more than 16,000 men referred with suspected prostate cancer in two NHS registries covering 16 hospitals.

At the moment, men with elevated PSA levels are sent for a pre-biopsy MRI. If the scan results are abnormal they are sent for a biopsy.

The study compared current methods with the former diagnostic pathway, which did not include the pre-biopsy MRI.

Based on a scenario of 10,000 men having a PSA test, researchers estimate the current pathway reduced potential harms by 79%.

Fewer men faced unnecessary biopsies, they said, with a fall in the number who developed sepsis following a biopsy.

Prostate Cancer UK is now calling for NHS guidelines to “catch up to the modern evidence”.

This disease is the most common cancer that affects men, with more than 52,000 diagnosed every year on average.

Symptoms include trouble urinating, or an increased need to urinate, as well as blood in the urine or semen.

Dr Hobbs added: “This latest research by Prostate Cancer UK demonstrates that modern techniques already being used as standard across the NHS have massively reduced the number of men who suffer harm.

“Guidelines must catch up to the modern evidence so that GPs are able to proactively raise the issue of prostate cancer with men at higher risk.

“Also, this new evidence of what is actually happening in the NHS should be part of the formal review of screening for prostate cancer being conducted by the National Screening Committee in case the balance is now tipped in favour of screening.”

Nick Burns-Cox, urologist and co-author of the paper, said: “This is a really important piece of research, because it measures the real experiences of patients treated in NHS hospitals, and makes a strong case for updating UK guidelines.

“It is also fantastic news for men and their families as it shows how dramatically harm has fallen in the ways we diagnose prostate cancer, even compared to just a few years ago.

“This means thousands of men avoiding unnecessary, invasive tests and spared the worry of an unnecessary diagnosis.”

Allan Roper, 73, was diagnosed with prostate cancer in 2015 but has been clear for six years. However, he now worries about his son.

Mr Roper, from Hook in Hampshire, said: “My dad had prostate cancer, so I knew I had a higher chance of getting it myself.

“My son, Adrian, is in his 40s now, and because I’ve had it, I know that he’s at risk of getting it too. I’m always reminding him to talk to his doctor about prostate cancer.

“For me, having the guidelines change so that GPs can start discussing prostate cancer testing with men like me and my son would be a huge step in the right direction.”

Labour’s Clive Efford was diagnosed with prostate cancer in November 2023 and said his doctors were “dismissive” when he asked for a test.

The MP for Eltham and Chislehurst said: “Despite knowing that my family history significantly increased my risk of prostate cancer, my doctors were incredibly dismissive when I asked for a PSA blood test.

“Prostate Cancer UK’s new report makes it clear that this reluctance from my doctors was unfounded and outdated; prostate cancer diagnosis is safer and more effective now than it has ever been.

“I was lucky that my cancer was caught early, and I am now in remission, but sadly this is not the case for everyone. This evidence means there is no excuse for guidelines not to change.

“The Government must do all it can to make sure UK guidelines reflect this evidence, and until we have the evidence for a screening programme, we must allow GPs to speak to men at higher risk of prostate cancer about their option to have a PSA test.”

An NHS spokesperson said: “The NHS is committed to using proven and effective cancer screening techniques which can benefit patients, and if there are updates to UK screening guidance, we will work closely with the Government to enact these.

“The ongoing joint Government and Prostate Cancer UK Transform trial is an important step in building the evidence around prostate cancer screening, and we await its outcome and the UK National Screening Committee’s recommendation.”

A Department for Health and Social Care spokesperson said: “We have inherited a broken NHS. Prostate cancer patients are waiting too long for treatment, and we are determined to change that.

“We are investing £16 million to find new ways to catch prostate cancer in men as early as possible, giving them the best chance of survival.”