Prostate Cancer Screening Explained: What Happens During the Process

Understanding Prostate Cancer Screening: The Complete Process

While mammograms and cervical smear tests are widely discussed in public health conversations, prostate cancer screening remains a topic shrouded in relative silence. This disparity in awareness persists despite prostate cancer being one of the most common cancers affecting men in the United Kingdom. As Prostate Cancer Awareness Month approaches in March, medical experts are seeking to demystify the screening process and encourage more men to understand their options.

The Current State of Prostate Screening in the UK

Mr Wissam Abou-Chedid, a consultant urological and robotic surgeon at Nuffield Health in Woking, Guildford, and Parkside in London, provides crucial insight into the current screening landscape. "As it stands in the UK, there's no national screening programme for prostate cancer," he explains. "However, any male patient above the age of 50 can approach their GP and request a PSA check. This opportunity extends to men above 45 who have a family history of prostate cancer."

The absence of a national screening programme means that proactive engagement from patients becomes particularly important. Unlike breast cancer screening which follows a structured national protocol, prostate cancer detection relies heavily on individual initiative and GP consultations.

—

Key Risk Factors That Influence Screening Decisions

When considering prostate cancer screening, understanding risk factors becomes paramount. "Race is an important risk factor," Abou-Chedid emphasizes. "Prostate cancer affects approximately one in four Afro-Caribbean men during their lifetime, compared to one in eight Caucasian men, and one in thirteen Asian men."

Beyond ethnicity, several other factors significantly influence prostate cancer risk:

• Family History and Genetics: "Patients with genetic mutations such as BRCA1 or BRCA2 genes face increased risk," notes Abou-Chedid. "Similarly, those with fathers, brothers, cousins, or uncles who have had prostate cancer are at elevated risk."
• Age: Prostate cancer predominantly affects men over 50, with the most common diagnosis age falling between 70 and 74 according to Prostate Cancer UK.

The Initial GP Consultation: What to Expect

When a patient expresses concern about prostate cancer to their GP, the consultation follows a structured approach. "Firstly, they will ask about your risk factors—examining your age, race, and family history," describes Abou-Chedid. "Then they will discuss the PSA test in detail, explaining both the advantages and limitations to help you make an informed decision."

The PSA test offers significant benefits for early detection but comes with potential drawbacks. "A pro of the PSA test is that it can lead to early detection of prostate cancer," says Abou-Chedid. "A con is that it can sometimes cause anxiety or lead to overdiagnosis—detecting prostate cancers that are insignificant and wouldn't have required treatment."

Understanding the PSA Test Procedure

The Prostate-Specific Antigen (PSA) test measures the level of PSA protein in the blood, typically conducted at local hospitals or GP surgeries by healthcare professionals. "PSA is a protein secreted by the prostate that can become elevated if prostate cancer is present," explains Abou-Chedid. "The results guide subsequent investigations and next steps."

Proper preparation is essential for accurate PSA testing. "PSA is not a specific tumour marker and can elevate due to various factors," cautions Abou-Chedid. "Ejaculation within 48 hours of testing can artificially increase PSA by up to 20%, so abstinence is recommended. Activities like prolonged horse riding or cycling before testing can also artificially elevate PSA levels, as can urinary tract infections."

Screening Without Symptoms: A Critical Consideration

One of the most important aspects of prostate cancer awareness is understanding that symptoms often appear late in the disease progression. "Prostate cancer from early to late stages is frequently completely asymptomatic," states Abou-Chedid. "You don't need symptoms to request a PSA test. Generally, when symptoms like bone pain emerge, it often indicates the cancer has already spread to bones."

The NHS lists several potential symptoms that may develop, including:

1. Difficulty starting urination or straining to urinate
2. Weak urine flow or "stop-start" urination patterns
3. Frequent or urgent need to urinate, including during night
4. Feeling of incomplete bladder emptying
5. Erectile dysfunction
6. Blood in urine or semen
7. Lower back pain and unexplained weight loss (typically advanced stages)

The Screening Pathway After Elevated PSA Results

When PSA levels return elevated, a structured follow-up process begins. "The first step is repeating the PSA test after a few weeks," outlines Abou-Chedid. "If the second test also shows elevated levels, your GP will refer you to your local NHS Trust where you'll be offered an MRI scan."

The MRI scan serves a crucial diagnostic function. "It helps identify any prostate areas suspicious for cancer," explains Abou-Chedid. "If suspicious areas are detected, patients are offered biopsies. Results typically return within seven to ten days, allowing discussion about whether the cancer is high-risk requiring treatment or low-risk suitable for active surveillance involving regular PSA checks and MRIs without immediate treatment."

The Evolving Role of Digital Rectal Examinations

Digital rectal examinations (DRE) have traditionally been part of prostate assessment, but their role is changing. "There is a subset of prostate cancer where patients have normal PSA but cancer is detected during DRE," acknowledges Abou-Chedid. "However, the British Association of Urological Surgeons (BAUS) now advises GPs against routine digital rectal exams."

This shift responds to patient concerns and aims to reduce screening barriers. "Many patients avoid discussing prostate cancer with GPs because they fear the DRE procedure," notes Abou-Chedid. "We're encouraging GPs to focus on PSA checks and refer patients to specialists who can then decide whether DRE is necessary based on individual circumstances."

This patient-centered approach seeks to balance thorough assessment with comfort and accessibility, potentially encouraging more men to engage with prostate health discussions without apprehension about specific examination procedures.