Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community. There are several reasons for this.
PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result). Most men are now offered an MRI scan before a biopsy to help avoid unnecessary tests, but some men may have invasive, and sometimes painful, biopsies for no reason.
Furthermore, up to 15% of men with prostate cancer have normal PSA levels (a false-negative result), so many cases may be missed.
The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. Some men may face difficult decisions about treatment, although this is less likely now that most men are offered an MRI scan before further tests and treatment
Treating prostate cancer in its early stages can be beneficial in some cases, but the side effects of the various treatments are potentially so serious that men may choose to delay treatment until it's absolutely necessary.
Although screening has been shown to reduce a man's chance of dying from prostate cancer, it would mean many men receive treatment unnecessarily.
More research is needed to determine whether the possible benefits of a screening programme would outweigh the harms of:
- overdiagnosis – people being diagnosed with a cancer that would never cause symptoms or shorten life expectancy
- overtreatment – people being treated unnecessarily for tumours that would unlikely be harmful
Should you know your PSA level?
Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.
If you're a man aged 50 or over and decide to have your PSA levels tested after talking to your GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, your GP may suggest further tests.