Urology – Primary Care
Prostate Cancer
Update (November 2024): Increase in prostate cancer public awareness
You may have noticed an increase in the number of men presenting to your general practice wanting to discuss prostate cancer and the PSA blood test, which may be due to the recent diagnosis of Sir Chris Hoy which has been reported widely in the media.
The following provides some information from the Northern Cancer Alliance based on the current national advice and evidence regarding PSA testing for prostate cancer.
Routine PSA testing is not presently available in the NHS. Currently available evidence (Meta-analysis – Merrier et al, 2022) suggests PSA is highly sensitive but poorly specific for prostate cancer detection. It might instead lead to unnecessary invasive investigations for false positive PSA tests. Also, roughly 15% of people with prostate cancer have a normal PSA level (CRUK 2024)
Men of any age may present to discuss prostate testing. Our current advice at the Northern Cancer Alliance is that testing for prostate cancer should include DRE and PSA in these people:
Symptomatic patients
- Lower urinary tract symptoms: urinary urgency, hesitancy, terminal dribbling, nocturia, bone pain. Symptomatic people with a prostate, of any age can request a test.
Asymptomatic patients over the age of 50;
- Should be given the opportunity to have a PSA blood test after a clinical discussion OR after reading the PSA shared decision making (SDM) leaflet.
- Raised PSA results will require Clinical review to determine onward referral, in line with NICE guidelines.
Asymptomatic patients over the age of 45; should be tested (following discussion) if they have risk factors;
- Black men aged 45-70
- Men with a family history of prostate or breast cancer aged 45 -70
Patients over the age of 80;
There is a particular risk of over-diagnosing and overtreating prostate cancer in men over 80 where the prevalence of cancer is highest, but the proportion of cancers that are clinically significant is lowest. (Academy of Royal Medical Colleges, January 2024)
Men over the age of 80 with PSA > 20, could have Fast Track Suspected Cancer referral within NG12 guidance, but GPs may wish to use clinical judgement and SDM.
Dr Hassan Tahir
Clinical Lead for Primary Care
Please see link below to the PSA shared decision making (SDM) leaflet and other information.
Prostate Specific Antigen Testing: Summary Guidance for GPs
Shared Decision Making Leaflet
PSA testing Systematic Review & Meta-analysis
Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W. Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients. BMC Med. 2022 Feb 7;20(1):54. doi: 10.1186/s12916-021-02230-y. PMID: 35125113; PMCID: PMC8819971.
Cancer Research UK – PSA Testing
Academy of Royal Medical Colleges
Prostate case finding work remains part of the early diagnosis of cancer PCN DES.
The aim is to address the shortfall in both Prostate Cancer referrals and Prostate Cancer treatments when compared to Pre-COVID-19 periods.
Below is a link to further information to support practices with this aspect if the PCN DES: