Prostate cancer screening

Common symptoms of prostate cancer include increased urgency and/or frequency of urination, a feeling of incomplete bladder emptying, difficulty urinating and having a weak flow of urine. If you do suffer from these symptoms, it does not necessarily mean that you have prostate cancer as the symptoms can be caused by many other conditions.

If you have any concerns about prostate cancer or worrying symptoms, you should speak to your GP. The GP should take a detailed history from you about your symptoms, any other conditions and your family history of prostate cancer. The GP may perform a physical examination, including a digital rectal examination. A common blood test to be performed is a PSA test. PSA (prostate specific antigen) is a protein produced by the prostate gland and increased levels in the blood can be a sign of prostate cancer, however the test alone does not diagnose prostate cancer.

If your PSA level is higher than normal levels for your age, the GP may refer you to a specialist, particularly if you have any concerning symptoms or risk factors. You may need to have an ultrasound scan that compares your PSA level to the size of your prostate, which helps doctors to decide if you need any more tests.

If you are under the age of 50 (or 45 in the case of black men or men with a family history of prostate cancer), the GP can refuse to carry out a PSA test. The test is not suitable for everybody, but if your GP refuses to carry out the test they should discuss the reasons why with you and the pros and cons of having a test. If after this discussion you still want a PSA test, you can try speaking to the practice manager at the surgery or making a complaint.

If you are over the age of 50 (or 45 in the case of black men or men with a family history of prostate cancer), you have the right to request a PSA test even if you do not have any symptoms.

If you have been referred to a specialist, you will usually have an MRI scan to look at the prostate in more depth. You may need a biopsy to test the tissue for cancer, the results of which can take a few weeks.

Most prostate cancers are slow growing, and patients may not start to suffer from any symptoms until the cancer is already advanced. Unlike with other common cancers, like breast cancer and bowel cancer, there is no mass screening of prostate cancer in the UK. There have been suggestions that PSA tests could be used as part of a screening programme.

However, the PSA test is by no means a foolproof way of detecting cancer; the blood test alone is actually relatively unreliable. 1 in 7 men with a normal PSA level have prostate cancer, and 1 in 50 may have a fast growing, aggressive cancer. This means that a diagnosis can be missed if a GP is solely relying on the results of the PSA test, rather than considering the whole clinical picture.

MRI scans are very accurate, but they can be misreported leading to men being told the scan is clear when it in fact shows evidence of a tumour. Similarly, biopsies can be misreported as benign when, instead, they are cancerous. This can lead to a delay in diagnosis until the cancer is much more advanced, and therefore more difficult to treat.

There are also incidences of men being given unnecessary treatment, either for a cancer that they do not have or for a slow growing cancer that is not going to cause them harm. PSA tests can produce results like a false positive, where men have a raised PSA but actually do not have cancer.

Treatment for prostate cancer can lead to a loss of bladder control so, whilst the treatment outweighs the harm in patients who do have a cancer that needs treating, it can have devastating effects on healthy men.

Common themes in clinical negligence claims arising from a delayed or missed diagnosis of prostate cancer include delayed referrals on the part of the GP to the specialist team, a lack of follow up and mis-reporting.

Regular PSA testing could help GPs to spot trends in a patient’s levels, which could suggest that cancer is developing; this would be particularly helpful in men who are already at a high risk of prostate cancer.

There is currently an ongoing trial, TRANSFORM, which is considering whether a combination of different tests or checks could be combined to provide a safe and effective mass screening programme.

Even with a mass screening programme, GPs and other healthcare professionals will still need to act upon the screening results, arrange any necessary repeat tests and to undertake the necessary examinations. The prognosis for prostate cancer is very good when caught in the earliest stages, which is usually when men are asymptomatic.

If you have concerns over a delayed prostate cancer diagnosis, please get in touch with our team below.